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 arV17130 
 
 A manual of medical iurisprudence for th 
 
 3 1924 031 237 484 
 olin,anx 
 
Cornell University 
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 The original of tliis book is in 
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 http://www.archive.org/details/cu31924031237484 
 
A MANUAL 
 
 OF 
 
 MEDICAL JURISPRUDENCE 
 
 FOK THE USE OF 
 
 STUDENTS AT LAW AND OF MEDICINE. 
 
 BY 
 
 MARSHALL D. EWELL, M.D., LL.D. 
 
 PROFESSOR OF COMMON LAW IN UNION COLLEGE OF LAW, CHICAGO 
 (law DEPAKIMEST OP THE NOETH-WESTEKN uAvERSITy). 
 
 BOSTON: 
 LITTLE, BEOWN, AND COMPANY. 
 
 1887. 
 
xyinsi 
 
 Copyright, 1SS7, 
 Bt Makshall D. Ewbll. 
 
 Uhiveesity Peess : 
 Jomr WiLsoir ahd Son, Cahbeidob. 
 
PEEFAOE. 
 
 The subject of Medical Jurisprudence is one which 
 does not receive from schools either of law or of medi- 
 cine anything like the attention which its importance 
 deserves. The author, when a student of the law some 
 twenty years since, and more recently when a student 
 of medicine, did not have the benefit of a single lec- 
 ture upon this subject ; and it is believed that many, if 
 not a majority, of the law and medical colleges of the 
 present day dismiss the subject either with no attention 
 whatever or with so little attention that students de- 
 rive no practical benefit from the instruction given. 
 For a medical man to study the subject (as is usually 
 the case if he studies it at all) clinically, so to speak, 
 as the defendant in an action for malpractice or as a 
 so-called expert witness, while certainly calculated to 
 make an impression upon his memory, cannot be said to 
 be wholly agreeable and profitable. On the other hand 
 it is not uncommon to see attorneys engaged in the 
 trial of cases involving important interests, betray cul- 
 pable ignorance of this subject. The attorney, to whom 
 
iv PREFACE. 
 
 is intrusted the trial of a case involving an important 
 question of Medical Jurisprudence, who has a good 
 knowledge of the leading facts and principles of medi- 
 cine and of their application to Medical Jurisprudence, 
 possesses an immense advantage over his adversary who 
 is not possessed of such knowledge ; and no amount of 
 preliminary " cramming " will supply the place of pre- 
 vious general knowledge of the whole subject. It is 
 the deliberate judgment of the author that no man can 
 be said to be prepared for every emergency which may 
 arise in the practice of either law or medicine without 
 a very considerable acquaintance with the science of 
 Medical Jurisprudence. 
 
 There are so many uniformly excellent treatises on 
 this subject that there seems to be no need for another ; 
 but these works are, as a rule, so large as to take more 
 time for their perusal than the student at law or of 
 medicine has to bestow upon them; moreover, most 
 of them are quite expensive. The experience of the 
 writer, both as a student and teacher, has led him 
 to believe that a work which within a moderate com- 
 pass states all the leading facts and principles of the 
 science, concisely and yet clearly, will prove useful to 
 students of both professions ; this work was accordingly 
 undertaken. It does not claim to be more than a care- 
 ful compilation from what seemed to be the best au- 
 thorities of the leading principles of the science. It 
 
PEEFACE. V 
 
 is believed, however, that within the moderate compass 
 of this volume will be found the substance of all the 
 principles stated in the more voluminous works. Two 
 exceptions should be made to this statement as respects 
 the subjects of Insanity and Toxicology. To treat 
 either of these subjects with anything like complete- 
 ness would require more space than is occupied by the 
 whole volume ; it was therefore thought better by the 
 author to treat with a reasonable degree of complete- 
 ness the other subjects usually discussed in works upon 
 Medical Jurisprudence, giving an outline only of these 
 two, than by attempting to cover the whole ground, in- 
 cluding Toxicology and Insanity, to make the whole 
 meagre and unsatisfactory. Accordingly, upon the sub- 
 ject of Insanity a brief outline only has been given, 
 which, however, it is hoped, will be found to accord 
 with the best authorities of the day. As respects Toxi- 
 cology, nothing more has been attempted than a con- 
 sideration of some general principles leading up to the 
 more particular study of the subject. The reasons for 
 this will be found more fully stated at the beginning 
 of the chapter upon that subject. 
 
 In order to save space it has been thought expedient 
 to omit the citation of authorities for the different 
 statements of the text, and, as a rule, they have there- 
 fore been omitted. It is proper, however, in this place 
 to say that free use has been made of the standard 
 
VI PREFACE. 
 
 European works upon this subject, and that the author 
 is especially indebted to the valuable works of Ogston, 
 Tidy, Taylor, and Woodman & Tidy ; special acknowl- 
 edgments are also due to Dr. Spitzka, of New York, 
 of whose manual upon Insanity free use has, with the 
 author's consent, been made. 
 
 Makshall D. Ewell. 
 
 Union College of Law, Chicago, 
 Aug. 2, 1887. 
 
OOS'TEIifTS. 
 
 Chaptee Page 
 I. Introductory; Evidence; Experts; Com- 
 pensation; Relation of Physician to 
 
 Patients, etc 1 
 
 II. Medico-Legal Inspections 17 
 
 III. Wounds, Burns, and Scalds 26 
 
 IV. The Signs, Modes, Causes, etc., op Death 49 
 
 V. Death by Asphyxia; Drowning; Hanging; 
 
 Strangulation; and Suffocation ... 72 
 
 VI. Death from Heat; Cold; Lightning; and 
 
 Starvation 89 
 
 VII. Pregnancy 96 
 
 VIII. Delivery 105 
 
 IX. Birth Ill 
 
 X. Abortion 115 
 
 XL Infanticide 120 
 
 XII. Defloration and Bape; Sodomy .... 142 
 
 Xni. Impotence and Sterility 162 
 
 XIV. Sex, Hermaphrodism, and Monstrosities 167 
 
 XV. Legitimacy and Paternity 181 
 
 XVI. Personal Identity 204 
 
Viu CONTENTS. 
 
 Chapter Page 
 
 XVII. Life Insurance 261 
 
 XVIII. Feigned, Factitious, and Latent Diseases 273 
 
 XIX. Malpractice 282 
 
 XX. General Toxicology 301 
 
 XXI. Insanity 328 
 
 XXII. Some Kdles of the Common Law respecting 
 the Disposition of Human Dead Bodies ; 
 
 Legislation upon Anatomy, etc. . . . 378 
 
 INDEX 397 
 
MEDICAL JUEISPRUDENCE. 
 
 GHAPTEE I. 
 
 introductory; evidence; experts; compensation; 
 relation of physician to patients, etc. 
 
 While the term " medical jurisprudence " is a mis- 
 nomer, — the collection of facts and conclusions usually 
 passing by that name being principally only matters 
 of evidence, and rarely rules of law, — still, the term is 
 so generally employed that it would be idle to attempt 
 to bring into use a new term, and we shall accordingly 
 continue the employment of that which has only the 
 sanction of usage to recommend it. 
 
 There are, however, some rules of law pertaining to 
 medical witnesses, and to a few other topics, which 
 may properly be treated in a work like the present. 
 No space, however, will be occupied in discussions, 
 often to be found in works upon medical jurisprudence, 
 of rules of law which have no especial reference to 
 medical practitioners more than to other citizens. 
 
 The jurisdiction and practice of the various courts, 
 and the rights and duties of witnesses vary to some 
 extent in the different States, and will be found defined 
 in local works of practice and the statutes of the differ- 
 
 l 
 
2 MEDICAL JUEISPRUDENCE. 
 
 ent States, as well as to some extent in general treatises 
 upon the common law, and it is beyond the scope of 
 this work to consider them. 
 
 It , may not be amiss, however, to state that the 
 subpoena of a court of justice cannot be disregarded 
 with impunity, but should be obeyed promptly. A 
 failure to obey may subject the witness to attachment 
 for contempt. 
 
 The medical witness should remember, also, that by 
 the common law a medical man has no privilege to 
 avoid giving in evidence^ any statement made to him 
 by a patient ; but when called upon to do so in a court 
 of justice he is bound to disclose every communication, 
 however private and confidential, which has been made 
 to him by a patient while attending him in a profes- 
 sional capacity. By statute, however, in some of the 
 United States, communications made by a patient to 
 a physician, when necessary to the treatment of a case, 
 are privileged, and the physician is either expressly 
 forbidden, or not obliged to reveal them. Such statutes 
 exist in Arkansas, California, Indiana, Iowa, Michigan, 
 Minnesota, Missouri, Montana, New York, Ohio, and 
 Wisconsin. The seal upon the physician's lips is not 
 taken away by the patient's death. Such communica- 
 tions, however, must be of a lawful character and not 
 against morality or public policy ; hence, a consultation 
 as to the means of procuring an abortion on another is 
 not privileged, nor would be any similar conference 
 held for the purpose of devising a crime or evading its 
 consequences. 
 
 1 See /ones vs. King, cited j>os<, in this chapter. 
 
COMPENSATION. 3 
 
 A report of a medical official of an insurance com- 
 pany, on the health of a party proposing to insure his 
 life, is not privileged from production ; nor is the report 
 of the surgeon of a railroad company as to the injuries 
 sustained by a passenger in an accident, unless such 
 report has been obtained with a view to impending 
 litigation. 
 
 Compensation. — By the Eoman law the services of 
 both an advocate and of a physician were strictly hon- 
 orary; by the common law of England, surgeons and 
 apothecaries could recover by law remuneration for 
 their services, but a physician was presumed to attend 
 his patient for an honorarium, and could not sue there- 
 for until the passing of the medical act in 1858. 
 
 By the law in this country aU branches of the pro- 
 fession may recover at law a reasonable compensation 
 for their services, the amount of which, unless settled 
 by law, is a question for the jury ; in settling which, 
 the eminence of the practitioner, the delicacy and diffi- 
 culty of the operation or of the case, as well as the 
 time and care expended, are to be considered. There 
 is no limitation by the common law as to the amount 
 of such fees provided the charges are reasonable. The 
 existence of an epidemic does not, however, authorize 
 the charge of an exorbitant fee. 
 
 A medical man can also recover for the services 
 rendered by his assistants or students, even though 
 the assistant is unregistered; it is not necessary that 
 there should be any agreed specified price, but he wiU 
 be allowed what is usual and reasonable. 
 
 It is not the part of a physician's business, ordinarily, 
 to supply the patient with drugs ; if he does so he has 
 
4 MEDICAL JUBISPRUDBNCE. 
 
 a right to compensation therefor. If the agreement is, 
 "no cure, no pay," he cannot, however, even recover for 
 medicines supplied, if the cure is not effected.^ His 
 right to recover for professional services does not de- 
 pend upon his effecting a cure, or upon his services being 
 successful, unless there is a special agreement to that 
 effect ; but it does depend on the skill, diligence, and 
 attention bestowed. The practitioner must be prepared 
 to show that his work was properly done, if that be 
 disputed, in order to prove that he is entitled to his 
 compensation. See ^os^. Malpractice. Where the surgi- 
 cal instruments employed in amputating an arm were a 
 large butcher-knife, and a carpenter's sash-saw, a charge 
 to the jury that if the operation was of service and the 
 patient did well and recovered, the surgeon was entitled 
 to compensation, — although it was not performed with 
 the highest degree of skill, or might have been performed 
 more skilfully by others, — was held proper. 
 
 If a surgeon has performed an operation which might 
 have been useful, but has merely failed in the event, he 
 is nevertheless entitled to compensation; but if it could 
 not have been useful in any event, he has no claim 
 upon his patient. A medical man who has made his 
 patient undergo a course of treatment which plainly 
 could be of no service cannot make it a subject of 
 charge ; but an apothecary who has simply administered 
 medicines under the direction of a physician may re- 
 
 1 See the late case of Jones vs. King, S. Ct. Ala., 1 South. Eep. 
 591 ; 24 Cent. L. J. 434. In this case it was held competent to prove 
 that the plaintiff's medicines were worthless, and, moreover, that not 
 being patented he had no property in the secret of his remedy such as 
 the law would privilege him from disclosing. 
 
COMPENSATION. 5 
 
 cover for the same, however improper they may have 
 been. 
 
 The number of visits required must depend upon the 
 circumstances in each particular case, and the physician 
 is regarded by the law as the best and proper judge of 
 the necessity of frequent visits ; and in the absence of 
 proof to the contrary it wiU be presumed that aU pro- 
 fessional visits made were deemed necessary and were 
 properly made. 
 
 There must not be too many consultations. The 
 physician called in for consultation or to perform an 
 operation may recover his fees from the patient, not- 
 withstanding that the attending practitioner summoned 
 him for his own benefit, and had arranged with the 
 patient that he himself would pay. 
 
 Where a medical man has attended as a friend he 
 cannot charge for his visits. 
 
 Where a tariff of fees has been prepared and agreed 
 to by the physicians of any locality, they are bound by 
 it legally as far as the public are concerned (that is to 
 say, they cannot charge more than the tariff rates), and 
 morally as far as they themselves are concerned. 
 
 A physician is always allowed discretionaiy powers 
 over his patients as to his mode of treatment, so as to 
 be able to alter the same according to the varying 
 necessities of the case. Unless such change of treat- 
 ment involves a risk of life, or consequences of which 
 he is unwilling to assume the responsibility, he is not 
 under obligations to give notice or obtain permission 
 before making it. 
 
 It is the duty of a physician who is attending a 
 patient having a contagious disease, when called upon 
 
6 MEDICAL JXIBISPEUDENCE. 
 
 to attend others, to take all such precautionary means 
 as experience has proved to be necessary to prevent its 
 communication to them. Where a physician who was 
 told by a patient not to attend any person infected 
 with small-pox, or his services would be dispensed 
 with, failed to say that he was attending such a patient 
 and promised not to do so, but continued so to attend, 
 and by want of proper care communicated small-pox to 
 plaintiff and his family, — these facts were held proper 
 evidence to go to the jury in reduction of damages in 
 an action for his account, and the physician was held 
 responsible for the suffering, loss of time, and damages 
 to which the patient was subjected. If a physician by 
 communicating an infectious disease has rendered a pro- 
 longed attendance necessary, thereby increasing his bill, 
 he cannot recover for such additional services necessi- 
 tated by his own want of care. 
 
 As to who should pay the physician, but little can be 
 stated in this connection; a few rules and principles 
 however, are the following : If A says to B, a medical 
 man, " Attend upon C, and if he does not pay you, I 
 will," this being a promise to answer for the debt of C, 
 for which he is also liable, the promisor cannot accord- 
 ing to some authorities be held unless the promise is in 
 writing, signed by A or by some one thereunto by him 
 lawfully authorized. But if he says to B, " Attend C, 
 and charge your bill to me ; " or, " I will pay you for 
 your attendance upon C," — no written agreement is 
 necessary. 
 
 A person who calls upon a physician and directs him 
 to attend upon a patient may render himself liable for 
 the fees of the physician ; the question in such a case 
 
COMPENSATION. 7 
 
 is whether the party so calling the physician is or is 
 not a mere agent; if he is a mere agent, he is not liable, 
 but otherwise he is ordinarily liable. 
 
 A wife has implied authority to bind her husband 
 for reasonable expenses incurred in obtaining medicines 
 and medical attendance ; but this implied authority is 
 terminated if she leaves home of her own accord with- 
 out suf&cient reason, and the fact has become notorious, 
 or the husband has given sufficient notice that he will 
 no longer be responsible for debts of her contracting. 
 If, however, a husband turns an innocent wife out of 
 doors without the means to obtain necessaries, he sends 
 his credit with her, and in such case medical attendance 
 is undoubtedly a necessary. If a physician attends a 
 wife whom he knows to be living separate and apart 
 from her husband, it is his duty to inquire whether she 
 has good cause for so doing ; if she has not, he cannot 
 collect his bill from the husband. 
 
 Although the law favors no particular school of med- 
 icine, it does not encourage mere quackery. Where, 
 therefore, a so-called doctor was in the habit of putting 
 a woman into a mesmeric sleep, who thereupon became 
 clairvoyant and prescribed medicines, which the doctor 
 furnished and for which he sued, the judge, in deciding 
 the case said : — 
 
 " The law does not recognize the dreams, visions, or reve- 
 lations of a woman in mesmeric sleep as necessaries for a 
 wife, for which the husband without his consent can be 
 made to pay." 
 
 By the common law the duty of a father to furnish 
 necessaries, including medical attendance, for his minor 
 
8 MEDICAL JUEISPEUDENCE. 
 
 child, is a moral obligation and not a legal one. The 
 father's liability, if it exists, is put on the ground of 
 agency, and the authority of an infant to bind the father 
 by contracts for necessaries, including medical aid, wiU 
 be inferred from very slight evidence. Medicines and 
 medical aid are necessaries, for which an infant may, 
 when not otherwise supplied, legally contract, and for 
 which he may render himself liable. 
 
 A master is not bound to provide medical assistance 
 for his servant ; the obligation, if it exists at all, must 
 arise from contract, and such contract will not be im- 
 plied from the fact that the servant lives under the 
 master's roof, nor because the illness of the servant 
 has arisen from an accident met with in the master's 
 service. 
 
 A master is bound to provide an apprentice with 
 proper medicines and medical attendance. 
 
 Where a physician or surgeon has been called in to 
 attend a passenger or employee injured by a collision or 
 other railway accident, the company cannot be held re- 
 sponsible unless it can be shown that the agent or ser- 
 vant who summoned the medical man had authority so 
 to do. It has been held that neither a guard nor the 
 superintendent of a station nor the engineer of the 
 train in which the accident happened has any implied 
 authority to bind the company for such medical ser- 
 vices. In England it has been held that the general 
 manager of the railway company has, as incidental to 
 his employment, authority to bind his company for 
 medical services bestowed upon one injured on his rail- 
 way. In Illinois a similar decision has been rendered 
 as to a general superintendent, but a contrary decision 
 
COMPENSATION. 9 
 
 has been rendered by the Superior Court of the city of 
 New York 
 
 The Compensation of Medical and other Ezperts is a. 
 subject which has been somewhat discussed by the 
 courts, and upon which the law is not entirely settled. 
 
 Statutory provisions will be found in some of the 
 States regulating this question. Thus in Iowa it is 
 enacted that — 
 
 " Witnesses called to testify only to an opinion founded 
 on special study or experience in any branch of science, or 
 to make scientific or professional examinations, and state the 
 results thereof, shall receive additional compensation, to be 
 fixed by the court, with reference to the value of the time 
 employed and the degree of learning or skill required." 
 
 Similar provisions, more or less extensive, are to be 
 found upon the statute-books of North Carolina, Ehode 
 Island, and Minnesota. 
 
 In Indiana, by statute, experts are compellable to 
 testify to an opinion without extra compensation. 
 
 While it is the general practice of parties employing 
 experts to give them extra compensation, it is regarded 
 as having been paid for the party's own benefit, and 
 hence can not, in the absence of statute, be regarded as 
 a necessary disbursement, and hence taxed as costs. 
 In every State there can, we think, be no doubt that an 
 expert cannot be compelled to make a preliminary 
 examination, such as the analysis of a stomach or the 
 examination of an alleged lunatic, so as to enable the 
 expert to testify in court as to his professional opinion, 
 without special compensation. It would seem also that 
 an expert cannot be required to attend during an entire 
 
10 MEDICAL JURISPRUDENCE. 
 
 trial, for the purpose of listening to the testimony, with 
 the view of enabling him to express an opinion there- 
 upon, without special compensation. 
 
 In the absence of statute and of such preliminary- 
 labor, can an ordinary expert witness legally require the 
 payment of special compensation as a condition prece- 
 dent to his testifying? When testifying as ordinaiy 
 witnesses to facts which have fallen under their notice, 
 they stand upon the same basis as ordinary witnesses. 
 When testifying as to matters requiring professional 
 skill, the question is not so clear. In England, at least 
 in civil cases, additional compensation seems to be ne- 
 cessary. But in England, a professional man, even when 
 called as to facts and not opinions, is entitled to extra 
 compensation on the higher scale allowed under the 
 statute of Elizabeth (5 Eliz. c. 9), which provides that 
 the witness must " have tendered to him, according to 
 his countenance or calling, his reasonable charges." 
 
 Writers upon medical jurisprudence have generally 
 been of the opinion that witnesses are entitled to extra 
 compensation as a matter of right; but these authors 
 have been, almost without exception, medical men, and 
 their opinion, except so far as supported by adjudicated 
 cases, is not conclusive in deciding a question like the 
 present. Passing by, therefore, these writers, a study 
 of the authorities seems to establish the following 
 propositions : — 
 
 In the first place, as already stated, unquestionably 
 medical men are not, in this country, when testifying as 
 ordinary witnesses to facts within their own personal 
 knowledge, entitled to extra compensation, even though 
 their professional skill may have enabled them to ob- 
 
COMPENSATION. 11 
 
 serve such facts more intelligently ; and this is so even 
 in those States allowing extra compensation to expert 
 witnesses when called as experts. 
 
 The general practice is thus stated by Mr. Greenleaf 
 in his work on Evidence : — 
 
 " In order to secure the attendance of a witness in civil 
 cases, it is requisite by statute, 5 Eliz. c. 9, that he have 
 tendered to him according to his countenance or calhng, his 
 reasonable charges." 
 
 Under this statute it is held necessary in England 
 that his reasonable expenses for going to and returning 
 from the trial, and for his reasonable stay at the place, 
 be tendered to him at the time of serving the subpoena ; 
 and if he appears he is not bound to give evidence until 
 such charges are actually paid or tendered, unless he 
 resides and is summoned to testify within the weekly 
 bills of mortality, in which case it is usual to leave a 
 shilling with him upon the delivery of the subpoena 
 ticket. These expenses of a witness are allowed pursuant 
 to a scale graduated according to his situation in life. 
 But in this country these reasonable expenses are settled 
 by statutes, at a fixed sum for each day's actual attend- 
 ance, and for each mile's travel from the residence of the 
 witness to the place of trial and back, without regard to 
 the employment of the witness or his rank in life. The 
 sums are not alike in all the States, but the principle is 
 believed to be everywhere the same. 
 
 " In some States it is sufiBcient to tender to the witness 
 his fees for travel from his home to the place of trial, and 
 one day's attendance in order to compel him to appear upon 
 the summons ; but in others the tender must include his 
 
12 MEDICAL JUEISPEUDENCE. 
 
 fees for travel in returning. Neither is the practice uniform 
 in this country as to the question whether the witness, hav- 
 ing appeared, is bound to attend from day to day until the 
 trial is closed, without the payment of his daily fees ; but 
 the better opinion seems to be that without payment of his 
 fees, he is not bound to submit to an examination. 
 
 " In criminal cases no tender of fees is, in general, ne- 
 cessary on the part of the government in order to compel its 
 witnesses to attend, — it being the duty of every citizen to 
 obey a call of this description, and it being also a case in 
 which he is himself in some sense a party. But his fees will, 
 in general, be finally paid from the public treasury. In all 
 such oases the accused is entitled to have compulsory pro- 
 cess for obtaining witnesses in his favor." 
 
 Ex parte Dement, 53 Ala. 389, decided in 1875, is a 
 well-considered case upon the question under consider- 
 ation. In this case it was held that a physician, like 
 any other person, may be called to testify as an expert 
 in a judicial investigation, whether it be civil or crim- 
 inal in its nature, without being paid for his testimony 
 as for a professional opinion ; and that upon refusal to 
 testify he may be punished as for a contempt. This 
 case will repay a careful perusal, as in it the authorities 
 are well collected and discussed. 
 
 The principle of the case of Ex jparte Dement was ap- 
 proved and followed in the late case of The State vs. 
 Teipner (S. Ct. Minn.), 32 N. W. Eep. 678, decided 
 May 6, 1887. 
 
 In Summers vs. The State, 5 Tex. App. 365 (1879), it 
 was likewise held that, although a physician cannot be 
 compelled to make an autopsy, yet, having made it he 
 may be compelled to testify as to its results. 
 
COMPENSATION. 13 
 
 In Illinois the rule seems to be settled by the case of 
 Wright vs. The People, 112 111. 540 (1884). In this case 
 the physician having voluntarily stated his profession, 
 etc., and the symptoms of the plaintiff in a civil action 
 for assault and battery, refused to answer the following 
 question calling for a professional opinion, unless his 
 fee of $10 should be paid or secured to him : — 
 
 " Question : If one person should strike another a heavy 
 blow on the head, at or near the temple, with that billy, 
 would it or would it not be likely to produce upon the per- 
 son receiving such blow a condition alike or similar to that 
 in which you find Jno. Finneran.'' 
 
 Upon the witness's refusing to answer, the court 
 below fined him as for a contempt, and the Supreme 
 Court af&rmed the judgment. The court, however, in 
 their opinion do not go beyond the case stated, and 
 perhaps may rule differently upon a different case. 
 
 Opposed to these cases are Buchman vs. The State, 
 59 Ind. 1 ; Bills vs. The State, id. 15 (following Blythe 
 vs. State, 4 Ind. 525). In these cases the court, upon 
 general principles, came to a conclusion opposite to that 
 of ex parte Dementj but also place their decision upon 
 Sec. 21 of the Bill of Eights of Indiana, which provides 
 that " No man's particular services shall be demanded 
 without compensation." The authority of Buchman vs. 
 State, and Dills vs. State, is weakened by the fact that 
 two, Biddle, C. J., and Niblock, J., of the five judges 
 dissented. 
 
 In re Eoelker, 1 Sprague, 276 (1855), (a nisi prius 
 case) holds that the court will not compel the attendance 
 of an interpreter or expert who has neglected to obey 
 
14 MEDICAL JtrEISPBXJDENCE. 
 
 a subpoena, unless in a case of necessity, and does not 
 seem to be a direct authority upon this question. 
 
 In U. S. vs. H(m& (U. S. DLst. Ct., Western Dist. Ark, 
 12 Cent. Law Jour. 193) the court refused to punish as 
 for a contempt a Dr. Bennett, who refused to testify 
 unless first paid a reasonable compensation. 
 
 The Hon. Emory Washburn, in discussing this sub- 
 ject in an address before the American Academy of 
 Arts and Sciences (1 Am. Law Eev., 1866, p. 63), used 
 the following language: — 
 
 "If the case be one of a public nature, involving the 
 question of a crime of magnitude, where the public safety 
 requires the investigation, the right to compel the attendance 
 of such witnesses becomes an incident to the exercise of 
 government itself, in the same way that a juror is obliged 
 to sacrifice convenience or profit to render a public service, 
 or the soldier is called upon to take up arms in defence or 
 execution of the law. It rests upon the maxim salus popidi 
 suprema lex." 
 
 He then quotes approvingly the following from 1 
 GreenL Ev. § 310, note: — 
 
 "There is also a distinction between a witness to facts 
 and a witness selected by a party to give his opinion on a 
 subject with which he is peculiarly conversant from his em- 
 ployment in life. The former is bound as a matter of public 
 duty to testify to facts within his knowledge. The latter is 
 under no such obligation; and the party who selects him 
 must pay him for his time before he will be compelled to 
 testify." Webb vs. Foffe, 1 C. & K 23. 
 
 It will be observed upon careful examination that 
 nearly all the authorities holding that a physician, can- 
 
RELATION OF PHYSICIAN TO PATIENTS. 15 
 
 not be compelled to testify as an expert without extra 
 compensation proceed upon the authority of the case of 
 Webb vs. Page, supra, or are influenced by statutory or 
 constitutional provisions. 
 
 According to the weight of authority it seems that in 
 those States where there is no statute or decision set- 
 tling the question in favor of the physician, his only 
 prudent course is to testify if ordered by the court to do 
 so, without demanding extra compensation, as otherwise 
 he runs the risk of punishment for contempt. 
 
 As to special contracts for compensation, they are 
 subject to the limitation that the contract cannot be 
 made conditional upon the success of the suit in which 
 the expert is to testify. A contract thus conditioned is 
 against public policy and void. 
 
 It is also unlawful for a physician to make a contract 
 under which he examines into the condition of a person 
 injured by a railway or other accident and reports the 
 same to the party liable, under a stipulation that his 
 compensation shall be proportioned to the amount re- 
 covered from the defendant. Such a contract is void as 
 being against public policy. 
 
 As respects the Relation existing between Physicians 
 or Surgeons and their Patients, the rule is well settled 
 that where one occupies a position which naturally gives 
 him the confidence of another or which in any way 
 gives him an influence or an undue advantage over the 
 other, transactions between them require something 
 more to give them validity than is necessary in other 
 cases. In such case where a physician or surgeon has 
 obtained from his patient any sort of valuable security 
 or property, he takes upon himself, if the validity of the 
 
16 MEDICAL JUEISPEUDENCE. 
 
 transfer is attacked, the burden of showing that no un- 
 due influence was exercised by him over the patient, 
 and of establishing the perfect fairness and equity of the 
 transaction ; if he cannot establish these facts the trains- 
 action wUl not be allowed to stand. 
 
 In the case of DeMay va.Boherts, 46 Mich. 161, a 
 physician took an unprofessional friend with him to 
 attend a case of confinement when there was no emer- 
 gency requiring the latter's presence. The physician 
 told the patient's husband that he had brought a friend 
 along with him to help him carry his things, and he 
 was accordingly admitted. The patient, on afterwards 
 discovering the fact, sued both, and it was held that the 
 plaintiff and her husband had a right to presume that 
 the outsider was a medical associate ; that in obtaining 
 admission without disclosing his true character, the 
 defendants were guilty of deceit; that plaintiff had a 
 right to testify that she supposed he was a physician or 
 medical assistant, and also to give evidence of whatever 
 may have been said at the time tending to support such 
 supposition. It was also held in the same case ad- 
 missible to ask a competent witness as to the custom 
 among physicians in regard to calling assistance in 
 these cases. 
 
CHAPTER II. 
 
 MEDICO-LEGAL INSPECTIONS. 
 
 The Importance of a Proper Order and Method as 
 
 well as thoroughness in making a medico-legal inspec- 
 tion of a dead body and its surroxmdings cannot well be 
 over-estimated; as, if done in an unsystematic or in- 
 complete manner, it will not unfrequently defeat rather 
 than aid in the administration of justice. To use a 
 technical expression, the degree of certainty as to the 
 cause of death should, when possible, be " certainty to 
 a certain intent in every particular ; " that is to say,. the 
 examination should be so complete and thorough as not 
 only to assign an adequate cause of death, but to nega- 
 tive any other cause. While this degree of certainty 
 is perhaps not attainable in many instances, it is in 
 some ; and it should be the constant endeavor of the 
 medico-legal practitioner to approach as nearly as possi- 
 ble to it ; and coroners and other officers engaged in the 
 preliminary examinations necessary for the detection 
 and punishment of crime should tolerate nothing less. 
 
 Medico-iiegal Inspections which are expected to come 
 before the courts should be made by at least two prop- 
 erly qualified medical men, and within from twenty-four 
 to forty-eight hours after death, whenever practicable; 
 When necessary, however, to advance the interests of 
 
18 MEDICAL JURISPRUDENCE. 
 
 justice, they may be made at any time after death ; even 
 putrefaction will not afford any valid reason for not 
 undertaking the same. They should, if possible, be 
 made by natural light, as when made by artificial light 
 certain characteristic colors indicative of poisoning 
 would probably escape notice. The body, if frozen, 
 should be allowed to thaw before commencing the ex- 
 amination, by leaving it for some time in a warm room. 
 
 The surroundings of the body should first be carefully 
 noted, and if possible a plan made locating the position 
 of the body when first seen, with reference to other 
 surrounding objects, such as furniture, instruments of 
 violence, cups, bottles, etc. Any blood-stains on the 
 person, clothing, or elsewhere, should be carefully 
 noted ; and articles likely to be important as means of 
 evidence should be marked and carefully preserved so 
 as to be capable of future identification. 
 
 The body should be first examined before the clothes 
 are removed ; the state of the clothes, whether marked 
 with blood-stains, etc., cut, or torn, — and if cut, the ex- 
 act position of the cuts and their relation to the wounds 
 on the body, if any, — should be carefully noted, and 
 the clothes themselves preserved for use as evidence. 
 
 Next, the attitude and position of the limbs, the con- 
 dition of the hands and nails as affording evidence of 
 a struggle before death, should be noted ; also the color 
 and other characteristics of the hair on the head and 
 face; the condition of the teeth, mouth, and tongue; 
 color of the eyes and pupils; and the expression and 
 color of the face. Particular notice should be taken 
 whether or not the body is in a condition of post-mortem 
 rigidity. 
 
MEDICO-LEGAL INSPECTIONS. 19 
 
 Having completed the external examination, the 
 clothes should be removed; the body should then be 
 examined as to its temperature, the presence of rigidity, 
 its state of putrefaction or otherwise, the sex, height, and 
 weight, probable age, development, whether lean or fat, 
 and the general condition of the body as to the state of 
 its nourishment. The body should also be examined 
 with reference to the color of the skin, scars, and marks 
 thereon, abnormities of structure, and stains, such as 
 feces, semen, etc. Careful examination should be made 
 for injuries, such as contusions, wounds, etc. ; if any 
 wounds are found, their nature, depth, direction, and 
 extent should be carefuUy determined. The condition 
 of the edges of the wounds should be particularly ex- 
 amined, and their depth carefully determined, not by 
 probing, but by careful dissection. The neck should be 
 examined to see if there are any marks of external 
 violence indicative of strangulation, etc. ; if a cord is 
 found its position upon the neck or otherwise should 
 be carefully noted. 
 
 In examining the body for injuries, particular ex- 
 amination should be made of all the inlets and outlets 
 of the body. It should be remembered that a fatal 
 wound may be inflicted through the orbit, fontanelles 
 in the case of infants, the mouth, vagina, or anus. 
 
 If the subject to be examined is an infant, its length 
 and weight,' the length and state of the hair, length 
 and condition of the nails, presence or absence of the 
 membrana pupillaris, condition of the genital organs, 
 the centres of ossification, the umbilical cord, the fon- 
 tanelles, and cartilages of the nose and ears, should aU 
 be carefully noted. 
 
20 MEDICAL JTTEISPEUDENCE. 
 
 In making a post-mortem examination a knowledge 
 of pathological anatomy is of the greatest importance. 
 As has been well observed by Virchow, — 
 
 "Medico-legal technics, with all due deference to the 
 independence of forensic medicine, will always go hand in 
 hand with pathological anatomy, for the latter is more uni- 
 versal : it has to deal with cases of aU kinds, and for that 
 reason is a great protection against that one-sidedness with 
 which medico-legal practice is so much encumbered." 
 
 A well considered order of examination is here of the 
 greatest importance ; and an examination of the various 
 authors upon this subject reveals a considerable variety 
 of methods. Many authors advise the examination of 
 the head first. Casper recommends opening first that 
 cavity in which there is the greatest probability of finding 
 the cause of deatk While exceptional cases may neces- 
 sitate a change of this order, the following scheme fol- 
 lowed by Professor Virchow has much to recommend it. 
 His practice has for years been that "under all cir- 
 cumstances the abdomen is to be first opened, but not 
 dissected." It is only necessary in this stage to deter- 
 mine the position of the diaphragm and other organs ; 
 and to note any abnormal contents of the abdomen 
 which may possibly be present, and the color of the 
 parts exposed. The position of the abdominal viscera 
 and their relations should be determined by manual 
 examination; their color should be noted, remembering 
 that the color of many parts is entirely due to the blood 
 and that in a dead body the arterial blood cannot be 
 well distinguished from venous blood. The presence or 
 absence of pathological coloring-matters, such as pus 
 
MEDICO-LEGAL INSPECTIONS. 21 
 
 or bile, and of extravasations should be noted. If any- 
 foreign matters are found, careful note of the same 
 should be made. The presence of adhesions and other 
 pathological conditions which may be determined without 
 dissection, should also be noted. The position of the 
 diaphragm in the dead bodies of infants should be noted 
 immediately after the opening of the abdomen. 
 
 After the completion of this preliminary examination 
 of the abdomen, the thorax is immediately to be opened 
 and dissected unless there is some cogent reason for 
 departing from the rule. The suspicion of poisoning is 
 always admitted to be a reason of this nature, and in 
 this case the whole of the examination centres in the 
 stomach, and every precaution must be taken to place 
 it and its contents without loss or change at the dis- 
 posal of the law. See post. Toxicology. 
 
 In examining the thorax the condition of the pleural 
 cavities should be noted, as respects the position, color, 
 and condition of their contents, and presence of foreign 
 bodies ; and this without cutting any of the important 
 structures, such as arteries, veins, etc. 
 
 The pericardium and heart should next be examined. 
 As observed by Professor Virchow, — 
 
 "He who would open the pericardium and dissect the 
 heart before determinining whether haemato-thorax, hydro- 
 thorax or pleuritis be present, is a man who ought not to 
 undertake a preliminary examination at all." 
 
 The lungs ought not to be removed from the thorax 
 before the heart has been examined, for this cannot be 
 done without separating the pulmonary arteries and 
 veins. Before removing any of the viscera from the 
 
22 MEDICAL JURISPEUDENCE. 
 
 thorax for more detailed examination, ligatures should 
 be placed upon aU the important vessels connecting the 
 same with the cranial and abdominal cavities, and the 
 sections of the vessels made between two ligatures. 
 
 In the examination of the contents of the thorax, 
 note any adhesions of the lungs, — whether they fill the 
 chest as in emphysema, or are coUapsed, — the presence 
 or absence of tubercular or other disease, etc. In the 
 examination of the pericardium, note the presence, 
 nature as purulent, sero-purulent, or serous, of the con- 
 tents of the sac. Note also the presence of tumors, if 
 any, in the .thorax. 
 
 In examining the heart and vessels note the size of 
 the heart, fulness of the coronary vessels and of the 
 different cavities of the heart, weight of the heart, its 
 condition as to fatty degeneration, etc., hypertrophy, 
 condition of the valves, etc. ; the condition of the vessels 
 whether atheromatous or having aneurisms. As to the 
 lungs, note the color, nature of the surface, capacity for 
 air, character of the lung tissue, and of the fluid they 
 exude on pressure ; condition of the bronchial tubes and 
 pulmonary artery ; the presence of foreign matter in the 
 air passages, and any pathological conditions not above 
 enumerated. The method of examining the lungs of 
 new-born children will be considered in the chapter on 
 Infanticide. 
 
 Prolonging the incisions to the chin, the larynx, 
 trachea, pharynx, oesophagus, and the great vessels of 
 the throat should next be examined. 
 
 Eeturning now to the further inspection of the ab- 
 dominal organs, they should, according to Professor 
 Virchow, be examined in the foUowina; order: — 
 
medico-legal; inspections. 23 
 
 1. The Omentum. 2. The Spleen. 3. The Left Kidney, 
 Supra-Eenal Capsule, and Ureter. 4. The Eight Kidney, 
 Supra-Renal Capsule, and Ureter. 5. The Bladder, Prostate 
 Gland, Vesiculse Seminales, and Urethra. 6. (a) The Testi- 
 cles, Spermatic Cord, and Penis; (b) The Vagina, Uterus, 
 Fallopian Tubes, Ovaries, and Parametria. 7. The Rectum. 
 8. The Duodenum, Portio Intestinalis of the Ductus Com- 
 munis Choledochus, 9. The Stomach. 10. The Hepato 
 Duodenal Ligament, Gall-Ducts, Vena Portse, Gall-Bladder, 
 and Liver. 11. The Pancreas, Ccsliac (Semi-Lunar) Ganglia. 
 12. The Mesentery with its glands, vessels, etc. 13. The 
 Small and Large Intestine. 14. The Retro-Peritoneal Lym- 
 phatic Glands, Eeceptaculum Chyli, Aorta, Vena Cava 
 Inferior. 
 
 After having completed the examination of the tho- 
 racic and abdominal viscera, the brain and the spinal 
 cord should next be examined. In examining the brain, it 
 may be necessary in some cases to shave the whole or a 
 portion of the head. Having done so when necessary, an 
 incision should be made across the head from ear to ear, 
 and the scalp reflected ; any injuries to the scalp should 
 be noticed, and the external surface of the skull should 
 be carefully examined for fractures or other injuries. 
 The skull should then be carefully sawn around, about 
 one-half inch above the meatus auditorius externus, 
 and the calvaria carefully removed. The condition of 
 the dura-mater, arachnoid, pia-mater, the great longi- 
 tudinal sinus, and the surface of the cerebral hemis- 
 pheres so far as exposed, should be carefully examined 
 and described. If the dura-mater is adherent to the 
 skull-cap it may be divided before detaching the latter, 
 and the skull-cap removed with the dura-mater adher- 
 
24 MEDICAL JURISPRUDENCE. 
 
 ing to it, as otherwise in endeavoring to separate the 
 skull-cap from the adherent dura-mater there is danger 
 of tearing the latter and crushing the brain itself. In 
 new-born infants and children these parts are, as a rule, 
 adherent, rendering necessary the procedure above de- 
 scribed. The brain should next be carefully removed, 
 and sliced from above downwards, and examined with 
 particular reference to congestions, extravasation, effu- 
 sions, serum, blood, lymph, pus, aneurism, embolism, 
 tumors, etc. These slices should be thin, as within the 
 interior of a section five millimetres thick there is 
 ample room for foci of morbid material sufficient to pro- 
 duce paralysis or convulsions. The less is found, the 
 greater should be the number of sections. The condition 
 of the internal portion of the skull, as to fractures, etc., 
 should also be carefully examined, as well as any me- 
 chanical injury to the brain corresponding thereto. 
 
 When for any reason the brain is first examined, the 
 head should be raised upon a block as high as can be 
 done without stretching the parts about the nucha, 
 and the head then opened in the usual way, and the 
 brain examined in situ. The head should be allowed 
 to remain in the same position till the condition of the 
 abdominal and thoracic organs is ascertained ; or if low- 
 ered, an assistant should compress the vessels at the base 
 of the skidl to prevent any draining of blood from the 
 carotid or vertebral arteries or jugular veins. For this 
 reason it wUl usually be expedient to examine the ab- 
 dominal and thoracic organs before the head, which 
 with the spinal cord may be last examined. 
 
 To examine the spinal cord and its membranes, the 
 vertebral laminae should be carefully sawn through, 
 
MEDICO-LEGAL INSPECTIONS. 25 
 
 and the cord removed with its dura-mater uninjured ; 
 the external and internal condition of the membranes 
 should be noted, and sections made throughout the en- 
 tire length of the cord, and all injuries and pathological 
 conditions noted. For further details as to the more 
 particular examination of the separate organs, see Vir- 
 chow's " Post Mortem Examinations " and the larger 
 treatises upon medical jurisprudence. 
 
 In making aU of the above described examination, 
 carefully written notes should be made as the work 
 progi'esses; particular cases may render necessary a 
 deviation from the above-described order of examina- 
 tion, but it should be adhered to in every case where 
 there is no sufficient reason to the contrary. 
 
CHAPTER III. 
 
 WOUNDS, BUENS, AND SCALDS. 
 
 The definition of a wound, both in surgery and at law, 
 is involved in considerable confusion. In surgery it is 
 usually considered to mean a solution of continuity in 
 any part of the body, suddenly made by anything that 
 cuts or tears, with a division of the skin ; by which some 
 understand is meant not only the external cutis, but also 
 the inward membranes of the gullet, intestines, bladder, 
 urethra, and womb. The legal definition of the term 
 "wound" is usually considered to be a breach of the 
 skin, or of the skin and flesh, produced by external vio- 
 lence. But the meaning of the term is often modified 
 by the context and the subject to which it is applied ; 
 and it will be convenient in this connection to include 
 within the term any personal injury suddenly arising 
 from any kind of violence applied externally, whether 
 such injury is external or internal. It will also be con- 
 venient in this connection to consider the subject of 
 " Burns and Scalds." 
 
 Wounds are classified as Punctured Wounds, In- 
 cised Wounds, Contused Wounds, Lacerated Wounds, 
 and Poisoned Wounds. 
 
 A punctured wound is one such as is usually caused 
 by a pointed instrument, such as a knife, sword, or 
 
WOUNDS, BURNS, AND SCALDS. 27 
 
 bayonet; and its depth will therefore be much greater 
 than its superficial extent. 
 
 An incised wound, commonly known as a cut, may 
 be defined as a solution of continuity without loss of 
 substance, — such as is usually produced by some cutting 
 instrument with a more or less sharp or thin edge. 
 
 A contused wound is one in which there is more 
 or less bruising, and hence discoloration of the skin or 
 tissues from the effusion of blood from small ruptured 
 vessels into the surrounding tissue. 
 
 A lacerated wound is one which may be produced by 
 a blunt or dull instrument, stones, bullets, missiles from 
 firearms, etc. Many wounds are of a mixed character, 
 such as those made by firearms or by the use of a knife, 
 in which at times one part of the wound may be incised 
 and another part lacerated. 
 
 Poisoned wounds may possess either of the above 
 characteristics, with the addition of some poisonous 
 matter introduced therein at the time the injury is in- 
 flicted ; they are usually made by cutting or pointed in- 
 struments, or by the stings or bites of insects, reptiles, 
 etc. 
 
 Punctured wounds. In punctured or penetrating 
 wounds as above defined, the margins will generally not 
 be found in close contact, but somewhat apart, and the 
 regularity of their edges will vary with the sharpness of 
 the instrument producing them ; when following thrusts 
 with instruments properly so called, they may usually 
 be distinguished from those caused by glass, crock- 
 ery, nails, etc., by the sharpness of their edges, their 
 freedom from contusions, and their amount of retrac- 
 tion or the reverse; however occasioned, they usually 
 
28 MEDICAL JURISPRUDENCE. 
 
 bleed but sparely, — unless when some large vessels are 
 divided or where cavities are. penetrated, — and almost 
 never heal by first intention. They may be produced 
 by any weapon or other substance having a sharp point, 
 such as a thin cane, tobacco-pipe, arrows, sharp stones, 
 etc. The solutions of continuity do not always take the 
 shape of the instrument by which they were produced, 
 but vary not only with the nature of the instrument, 
 but with the situation or direction of the wound, charac- 
 ter of the tissue, its degree of tension, etc. The wound 
 is seldom as large as the instrument which caused it. 
 The openings made in the clothes before entering the 
 body are in this class of wounds generally smaller than 
 the instrument producing them. Punctured wounds, 
 even when made with a sharp instrument, are not al- 
 ways in the form of a straight cut, but not infrequently 
 send off a spur somewhere in their course like the two 
 lines of the Greek letter 7. 
 
 Incised wounds. Although these wounds are usually 
 made by instruments with cutting edges more or less 
 sharp, they are not infrequently made by articles hav- 
 ing an angle nearly equal to or even exceeding 90 de- 
 grees ; even the fist, or a blunt body striking a sharp 
 bony ridge, will often produce sharply cut, gaping 
 wounds. The superficial extent of these wounds is usu- 
 ally greater than their depth, and they usually bleed 
 more freely than all others. Their margins are gener- 
 ally sharp, straight, and well defined. It is to be 
 remarked, however, that even where a sharp cutting 
 instrument is used, if considerable force has been em- 
 ployed it will sometimes be found not only to have 
 cut, but also to have bruised and lacerated the parts 
 
WOUNDS, BUENS, AND SCALDS. 29 
 
 divided. Incised wounds gape more than other wounds, 
 but the state of the muscles as to contraction or relaxa- 
 tion has considerable influence upon the size of the 
 wound. An incised flesh-wouiid in the direction of 
 the fibres of the muscle will give rise to little or no gap- 
 ing of the wound, while a transverse cut will appear 
 deeper and will gape more. It is not always possible to 
 determine whether an incised wound was produced by a 
 more or less blunt body or a cutting instrument, espe- 
 cially where from twenty-four to forty-eight hours have 
 elapsed, and the wound has not healed by first intention. 
 In attempting to determine the kind of instrument 
 employed, the condition of the edges should be particu- 
 larly noticed ; which, however, can only well be done 
 while the wound is recent. Where the wound is pro- 
 duced by a sharp instrument drawn across the part, the 
 edges will be found to be straight ; but if the instrument 
 is blunt, or pressure has been used upon it against the 
 part, the edge wiU be found more or less serrated or ir- 
 regular. In incised wounds where the different parts 
 are nearly of uniform consistency, the deepest part of 
 the wound is commonly nearer the commencement than 
 the end. At the commencement of incised wounds, 
 not infrequently one or two slight superficial incisions 
 have been made before the person was able to inflict 
 the principal wound. The principal wound frequently 
 ends in a bifurcation or in several points. These dis- 
 tinctive characteristics are usually more noticeable in 
 wounds^ of the throat; though even here they are not 
 invariable in their occurrence and are most apt to 
 be wanting in cases of suicidal cut-throat with blunt 
 instruments. 
 
30 MEDICAL JURISPKUDENCE. 
 
 In the case of homicidal or suicidal wounds in the 
 living, the principal incision is rarely the only one, and 
 the line of the incision will diverge more or less from 
 the straight course which usually characterizes an in- 
 cision in a dead body. 
 
 Where incised wounds are made through the cloth- 
 ing, the cuts through the same are usually larger than 
 the wounds. 
 
 As to the appearance assumed by incised wounds not 
 healing by first intention, it may be laid down as a 
 general rule that during the first twelve hours after 
 their infliction such wounds wiU be bloody. About this 
 time inflammation will have commenced, with secretion 
 of serosity, which will continue during the second day. 
 The third day sero-purulent matter will begin to exude, 
 and by the fourth or fifth day or even later, suppura- 
 tion will'be fully established, which in a simple wound 
 without loss of substance may last from five to eight 
 days; and from the fifteenth to the eighteenth day the 
 wound will cicatrize. This is the rule laid down by 
 Dr. Ogston; but when the wound is treated accord- 
 ing to the modern system of aseptic surgery this rule 
 will require more or less modification. The time re- 
 quired for healing will be considerably lessened, and 
 there may be (when the case is properly treated) no 
 suppuration. 
 
 The cure of an incised wound will, however, under 
 ordinary treatment, be influenced very much by circum- 
 stances. Thus, it may heal by first intention in some 
 healthy persons, without any suppuration ; and where 
 the subject is unhealthy a much longer time may 
 be taken in effecting a cure. The result may also be 
 
WOTINDS, BURNS, AND SCALDS. 31 
 
 influenced by the age of the party, depth and locality 
 of the wound, and other circumstances. 
 
 An important question frequently arises in this cout 
 nection, whether an incised wound has or has not been 
 inflicted during life. The experiments of Orfila and of 
 Taylor show that the appearances of woiinds inflicted 
 immediately after death so closely resemble those of 
 wounds inflicted immediately before death as not to be 
 distinguishable from each other ; but when the infliction 
 of the respective wounds dates either a few hours before 
 or after death, there are some marked appearances by 
 which the time of their infliction may usually be deter- 
 mined. Incised wounds made by sharp instruments on 
 living persons usually bleed more or less freely, and 
 the blood will be found to have clotted on various parts 
 of the body; clothes, floor, or surrounding objects. If 
 the wound has not been interfered with, clots will be 
 found adhering to the edges or to the wounded vessels. 
 The edges of the wound will be found everted, and the 
 muscular and cellular tissues of the wound effused with 
 blood. If the wound has been inflicted a few hours 
 before death, its edges will be found more or less 
 swollen, and if of small extent, its lips will be loosely 
 agglutinated. 
 
 If the wound has been inflicted some days it will 
 exhibit either signs of repair or of destruction of the 
 tissues. These may have healed by first intention or 
 sometimes under cover of a scab, or by means of granu- 
 lation which involves suppuration, and which is the 
 common method of healing, in wounds exposed to the 
 air, where there is much injury to the parts. The ap- 
 pearance of these signs of repair is. of course proof 
 
32 MEDICAL JURISPRUDENCE. 
 
 positive that the injury was inflicted before death. 
 The earliest period at which pus will be found is 
 from eighteen to twenty-four hours. 
 
 If the wound was inflicted after death its edges will- 
 usually be found in close apposition ; there will be com- 
 paratively little effusion of blood, and there will be very 
 little or no coagula around the wound, and of course no 
 evidence of repair or other vital reactions. 
 
 Contusions and contused w^ounds, which for conveni- 
 ence will be considered together, may give rise to effects 
 of three sorts,. namely, concussion, contusion, and disor- 
 ganization. 
 
 As respects concussion, this effect will depend upon 
 the degree of the impulse, and the nature and form of 
 the part struck. The results of concussion will differ 
 according to the part of the nervous system which is 
 the seat of the injury; thus, concussion of the brain 
 may cause momentary insensibility or death. Concus- 
 sion of the spine may produce more or less injury to 
 the parts receiving their nervous supply from the in- 
 jured portion of the spinal cord. A stroke over the 
 epigastrium or prsecordia may by arresting the. heart's 
 action prove immediately fatal; where the concussion 
 proves immediately fatal, death occurs by syncope, and 
 not unfrequently, except in the case of the concussion 
 of the brain, leaves no traces of the mode of its produc- 
 tion in the interior of the body. In cases of concussion 
 of the brain, however, there wiU usually be some local 
 •injury to the scalp; whether such fatal injuries will 
 always produce a visible injury to the brain is a matter 
 upon which surgical authorities are in conflict. In a 
 case of concussion of the. spine immediately fatal, there 
 
WOUNDS, BUKNS, AND SCALDS. 33 
 
 •will usually be found traces of the injury, such as rup- 
 tures of ligaments, fractures or dislocations of the verte- 
 brse, extravasation of blood outside or inside the cord, 
 etc. Where, however, the concussion of the spine was 
 not fatal, especially in cases of railway accidents, there 
 is a great conflict of opinion as to whether the existence 
 of real injury can be with certainty diagnosticated from 
 malingering. 
 
 The term " contusion " is usually restricted to injuries 
 unaccompanied by external wounds. A contusion 
 strictly so-called involves the application to the body 
 of sudden pressure accompanied with concussion, or of 
 pressure continued for some time. It may be effected 
 without rupturing the capillaries of the part struck, or 
 it may involve the rupture of the small vessels. In the 
 first place the contusion may not manifest itself by any 
 striking phenomena; the part struck is painful; the 
 meshes of the tissue of the skin have been compressed, 
 and after some minutes the part swells slightly and 
 reddens, the redness and swelling disappearing in from 
 twenty-four to thirty-six hours, leaving no trace of the 
 injury ; but if at the time of the receipt of such contu- 
 sion death supervenes from some other cause, the part 
 struck undergoes by evaporation a loss of its fluids, and 
 the skin becomes dried, brown, and hard, presenting 
 much the appearance of parchment ; which last effect, 
 however, may be as readQy produced on the dead as on 
 the living, and will be further considered hereafter. 
 
 Where the stroke has involved the rupture of the 
 capillaries the contusion will be accompanied by ecchy- 
 mosis or infiltration of blood into the areolar tissue of 
 the part. When such ecchymosis is superficial, as is 
 
34 MEDICAL JUBISPEUDENCE. 
 
 usually the case, the skin soon becomes of a blackish or 
 deep violet color ; later this color succeeds to a bluish 
 color ; this in turn becomes green ; the green becomes 
 yellow; and the yellow is finally succeeded by the natu- 
 ral color of the skin, — these phenomena occupying a 
 space of several days. As a general rule, the blue color 
 appears about the second day ; the green from the fifth 
 to the sixth ; the yellow from the seventh to the eighth; 
 and the color entirely disappears from the tenth to the 
 twelfth day, or even later. Ecchymosis may not in- 
 volve the skin at all, but may be confined to the subcu- 
 taneous areolar tissue, in which case the discoloration of 
 the skin will not appear till from thirty-four to thirty- 
 six hours, or even later. Ogston describes a case in 
 which ecchymosis did not appear till the expiration^ of 
 four days after the infliction of the blows. In some 
 cases where the ecchymosis exists deep among the 
 muscles of the limb, it will not be noticed at. all till at 
 the end of forty, fifty, or sixty days, when irregular yel- 
 lowish-green or bluish spots appear over the injured 
 part. It should be remembered that the ecchymosis 
 does not constantly appear at the situation the seat of the 
 contusion would indicate; and that it may sometimes 
 proceed from other causes than violence, such as scurvy, 
 purpura hfemorrhagica, strong muscular effort, etc. 
 
 It is often important to determine whether contu- 
 sions have been inflicted before or after death. When 
 inflicted two or three hours before death the change of 
 color produced cannot be confounded with any ordinary 
 post-mortem appearance ; and besides, the swelling and 
 extravasation of blood into the cellular tissue will ordi- 
 narily afford conclusive evidence of the ante-mortem 
 
"WOUNDS, BURNS, AND SCALDS. 35 
 
 nature of tke injury ; but where the strokes are inflicted 
 shortly after death there is more difficulty, as it has been 
 proved by experiment that some strokes inflicted shortly 
 after death produce marks which, so far as color is con- 
 cerned, do not differ from the effects of blows during, the 
 last moments of life. Swelling of the parts and coagula- 
 tion of the blood effused into the subjacent cellular tissue, 
 with the incorporation of blood with the whole thick- 
 ness of the true skin, rendering it black instead of white 
 and increasing its firmness and resistance, may be con- 
 sidered as strong if not conclusive evidence that the 
 blows were inflicted during life. 
 
 The co-existence of a wound with the contusion does 
 not much affect the character of the latter injury ; in 
 this case, however, there may be hemorrhage in the sur- 
 rounding tissues ; much blood rarely escapes outwardly. 
 Wounds of this class, unless over the cranium, are char- 
 acterized by uneven and irregular edges, and less acute 
 angles, and are in general too characteristic to require 
 description. The disorganization of the parts struck, 
 which may be one of the consequences when struck 
 with a blunt body, and which is termed "attrition," 
 differs both from contusion and laceration in that here 
 the structure is more or less completely destroyed and 
 broken down ; attrition is necessarily followed by ecchy- 
 mosis, — the broken-down tissue forming a cavity for 
 the effused blood, which' presents the characteristics of 
 a tumor with fluctuation. 
 
 The most serious injuries resulting from contusions are 
 lacerations of internal organs, and ruptures of blood-ves- 
 sels and other deep-seated parts ; such injuries, however, 
 rarely follow common assaults with the fist or even with 
 
36 MEDICAL JXTKISPRUDENCE. 
 
 sticks or stones, unless the blows are inflicted about the 
 head. The serious injuries referred to more commonly 
 arise from falls from a height, the fall of heavy bodies 
 upon the person, or from railway accidents. Euptures 
 of viscera are more common in the case of those organs 
 which are naturally voluminous and easily displaced, 
 such as the liver, kidneys, and spleen; and are more 
 rare in the case of the heart, lungs, brain, bladder, and 
 alimentary canal. Internal arteries and veins, when 
 healthy, except those within the cranium and spinal 
 canal, are not commonly injured by outward shocks. 
 It must be remembered that ruptures of the heart are 
 occasionally produced in certain diseased states of the 
 organ, such as attenuation and aneurism of its walls, 
 and it must also be remembered that spontaneous rup- 
 tures of the heart sometimes occur which cannot be cer- 
 tainly referred either to injury or disease. Euptures of 
 the cerebral mass from violence are believed to be ex- 
 tremely rare; in drunken quarrels and fights sponta- 
 neous ruptures of the cerebral vessels are not uncommon, 
 and ruptures of the larger blood-vessels within other 
 cavities of the body are not unusual consequences of 
 heavy falls. The larger veins ifiay also be ruptured 
 from violence, and may burst suddenly when weakened 
 by previous disease. For details of these interesting 
 cases the student is referred to larger standard works 
 on medical jurisprudence, the limits assigned to this 
 work preventing their full discussion here. 
 
 Lacerated 'Wounds. Lacerated wounds, which are 
 produced by tearing instead of cutting, are attended 
 with complete separation of the edges, and there is 
 always more or less thickening of their margins from 
 
WOUNDS, BURNS, AND SCALDS. 37 
 
 tlie bruising of their edges. la this respect they some- 
 what resemble contused wounds, from which, however, 
 they may usually be distinguished by the shreddiness 
 and irregularity of their margins. Such wounds are 
 remarkable for the want of correspondence between the 
 quantity of blood lost and the importance and vascular- 
 ity of the injured parts. They are frequently attended 
 with marks of contusion, and there may be clotted blood 
 effused in their vicinity. It is only when these appear- 
 ances are present that a confident opinion can be given 
 as to their having been produced during life. 
 
 Gun-shot wounds may be considered in this connec- 
 tion. These wounds partake of the character of contused 
 wounds, with more or less laceration, and occasionally 
 exhibit the appearance of burns. They bleed sparingly, 
 if at all; their margins are round and thickened; the 
 bottom of the wound is reddish brown, the surrounding 
 parts ecchymosed and occasionally blackened. In the 
 living they are usually attended with more or less in- 
 sensibility of the parts struck,' and the following inflam- 
 mation is usually extensive and severe. When the 
 projectile has passed through a portion of the body, 
 as a general thing the entrance wound will be smaller 
 than the exit wound, — the edges of the entrance will be 
 depressed and contused ; the edges of the exit project- 
 ing and torn. The entrance wound will be dry and 
 dark-colored ; the exit wound raw and bloody. There 
 will be loss of substance in the former, but none in the 
 latter as a general rule. Such is the description usually 
 given of gun-shot wounds by writers upon medical ju- 
 risprudence and surgery. It should be remembered that 
 substances of very low degree of density, such as plugs 
 
38 MEDICAL JURISPRUDENCE. 
 
 of tallow, light wood, cork, wads of paper, and the like, 
 will, if sufficient velocity be impressed upon them, serve 
 to inflict penetrating wounds into the denser parts of 
 the body, having all the characteristics of wounds in- 
 flicted by projectiles. The effects produced by buUets, 
 however, vary with the shape. and speed of the projec- 
 tife. Where the wound is produced by a rifle-ball at 
 full speed, the above description of the wound is be- 
 lieved to be correct. As the distance from the weapon 
 increases and the velocity of the ball diminishes, the 
 wound of entrance wUl become less circular and regular, 
 and larger and more contused, — the wound sometimes 
 consisting of three triangiilar flaps, which on lifting up 
 can be made to meet at their apices in the centre of the 
 opening. Bullets at full speed perforate or penetrate ; 
 at lessened speedy crush and lacerate. When a dis- 
 charge takes place very near the body the injured 
 tissues will be more or less scorched, blackened and 
 studded with grains of powder; and the entrance 
 wound, larger, ragged, and excavated. With the rifle- 
 ball the course is more frequently direct than with that 
 from the old smooth-bore musket, although tortuous 
 courses are even now, thoughtless frequently, met with. 
 Modern projectiles are said to cause less severe injury 
 of the soft parts than the old spherical balls. The in- 
 jury imparted to soft parts by what are called spent 
 balls and by ricochet shots are the most destructive ; 
 and larger projectiles rolling^ over the surface of the 
 part or moving at a low rate of speed, possess a force 
 which will often crush all parts with which they hap- 
 pen to come in contact. The character of the wound 
 may also be modified somewhat by the hardness of the 
 
WOUNDS, BURNS, AND SCALDS. 39 
 
 ball, and its change of shape in consequence of striking 
 against a large bone. In such cases the size of the exit 
 wound will be very much increased. The wound pro- 
 duced by the so-called" express bullet," in which the ball 
 is light, has a concavity at its point, and is driven by a 
 very large charge of powder, possesses the characteristic 
 last mentioned in a most remarkable degree, even where 
 the ball has not come in contact with any bone. An 
 express ball after penetrating the body will usually ex- 
 pand and fly into many pieces, greatly lacerating the 
 internal organs and producing great shock, much greater 
 than if the ball had passed entirely through the body in 
 its original shape. The medical jurist will, however, 
 rarely have occasion to give an opinion upon wounds 
 produced by this sort of projectile. 
 
 A charge of fine shot fired at a short distance wUl 
 often produce nearly the same effect as that of a large 
 solid ball ; even the explosion of powder alone without 
 ball or wadding, at a very short distance, is capable of 
 producing very severe injuries or even death. It should 
 be remembered, however, that a loaded pistol fired off 
 ■with the muzzle firmly pressed against the body will 
 probably burst or recoil without seriously injuring the 
 person against whom it is fired. The statement made 
 at the beginning of this subject, that the entrance wound 
 is commonly smaller than the exit wound, is denied by 
 some authors, and perhaps under some circumstances 
 may require qualification; but in our judgment it is 
 the better opinion. 
 
 The opening made by a ball in penetrating the clothes 
 is always smaller than that made in the skin below them. 
 
 In this connection the question is sometimes raised as 
 
40 MEDICAL JURISPRUDENCE. 
 
 to whether it is possible to determine from inspection of 
 the weapon the period which has elapsed since it was 
 last discharged. It has been found that when the com- 
 bustion of the powder has been imperfect, the inside of 
 the barrel of the weapon near its muzzle is either found 
 blackened by a coating of charcoal and sulphide of po- 
 tassium shortly after the discharge, — or where the com- 
 bustion has been perfect, whitened by a crust of sulphate 
 and carbonate of potash, — while after an interval of 
 some days, varying with the amount of moisture in the 
 atmosphere, the mixed residue of charcoal and sulphide 
 of potassium has become converted into sulphate of 
 potash, which after a little . longer interval has been 
 found to contain peroxide of iron. These results, how- 
 ever, might vary with the state of the weather, nature 
 of the powder, and the completeness of the combustion 
 to such an extent that in our judgment very little re- 
 liance can in most cases be placed on any conclusions 
 drawn from the appearance of the weapon. 
 
 Any one of the above previously described wounds 
 may be also a poisoned wound ; but wounds of this de- 
 scription will rarely come under the notice of the med- 
 ical jurist. 
 
 Burns and Scalds may be conveniently considered 
 together. A burn is caused by the application of con- 
 centrated dry heat to the body ; a scald by the appli- 
 cation of a hot or boiling liquid. As a rule, scalds are 
 less severe accidents than burns, because water, being 
 the ordinary fluid through which the scald is produced; 
 is never hotter than 212° Fahrenheit; yet when any 
 other chemical compound is the scalding medium, the 
 effect may be as bad as of the worst burns. 
 
WOUNDS, BURNS, AND SCALDS. 41 
 
 Molten metals produce burns which can hardly be 
 distinguished from those caused by solid bodies. Boil- 
 ing oils produce burns as severe in their general char- 
 acteristics — and so far as destruction of parts is con- 
 cerned, in their effects — as hot solids or melted metals. 
 
 Boiling water may produce merely an inflammatory 
 redness ; in severe scalds, however, the skin is commonly 
 soddened, desiccated, and of an ashy-gray color, scarcely 
 distinguishable from slight bums from other causes. 
 Boiling water never produces, however, blackening of 
 the cuticle nor charring nor desiccation of the parts. 
 
 Burns from acids are more properly considered in 
 another connection. It may be stated here, however, 
 that nitric or hydro-chloric acid stains are yellow, while 
 sulphuric acid stains are brown, and that the eschars 
 are soft and not hard as in ordinary burns ; such burns 
 are not surrounded by reddened skin, as in the case of 
 those produced by heat. 
 
 According to Dupuytren there are six degrees of 
 burns : — 
 
 In the first degree there is mere redness and tender- 
 ness of the surface, and after a few hours these symp- 
 toms may abate, with possibly some desquamation of 
 the cuticle. 
 
 In the second degree there is inflammation, manifesting 
 its presence by the effusion of serum beneath the cuticle, 
 forming a blister. 
 
 In the third degree the superficial layer of the true 
 skin is destroyed, the surface appearing of a gray, yel- 
 lowish, or brown color, not painful unless roughly han- 
 dled. The vesicles that exist contain a blood-stained or 
 brown fluid. The papillae of the skin with its nerves 
 
42 MEDICAL JURISPRUDENCE. 
 
 are first destroyed, but in the course of a day or so the 
 dead surface is shed and the nerves exposed, when the 
 pain becomes very severe. 
 
 In the fourth degree the whole thickness of the skin 
 is destroyed, with more or less of the subcutaneous cel- 
 lular tissue, the parts being converted into a hard, dry, 
 and insensible eschar mottled with blood. The skin 
 surrounding the escha;rs may be blistered, but. where it 
 comes in contact with the injured part it will be drawn 
 into folds from the contraction, owing to the drying of 
 the burnt integument. 
 
 In the fifth degree the skin with the deeper parts are 
 involved, — a black, brittle, charred mass taking the 
 place of healthy tissue. 
 
 In the sixth degree the whole thickness of the limb 
 is carbonized. 
 
 Death following burns may take place in two differ^ 
 ent ways : from the depression of the nervous system, 
 owing to the number of cutaneous nerves affected; or 
 later, from the inflammatory reaction involved, exten- 
 sive suppuration, and hectic fever. 
 
 Medico-legal questions in this connection usually 
 arise where fire has been subsequently applied to the 
 corpse to conceal murder. According to Christison, the 
 most immediate effect of the application of heat to the 
 living body is a blush, of redness around the burnt part, 
 removable by gentle pressure, disappearing in no long 
 time, and not permanent after death. Following this 
 almost immediately, is a narrow line of deep redness 
 separated from the burnt part by a stripe of dead white- 
 ness (bounded towards the white stripe by an abrupt 
 line of demarcation), passing at its outer edges by 
 
WOUNDS, BURNS, AND SCALDS. 43 
 
 different degrees into the diffused Hush, but not capa- 
 ble of being removed like it by moderate pressure. The 
 phenomenon which follows these is the appearance of 
 blisters, which, when the agent is a scalding fluid, gen- 
 erally appear in a very few minutes in the living, or 
 may be delayed for hours when the scalds are extensive, 
 as in young children ; while, when the agent is an in- 
 candescent body, this appearance is not of such an 
 invariable occurrence, though often observed very soon 
 after an ordinary burn, caused by the clothes catching 
 fire. 
 
 A line of redness near the bum,' not removable by 
 pressure, and blisters filled with serum are considered 
 by Christison as certain signs that the burn was inilicted 
 during life. The absence of these appearances, however, 
 is said by Dr. Taylor not to point with certainty to the 
 opposite conclusion. Dr. Ogston agrees with the above 
 conclusions of Christison and Taylor, with the qualifica- 
 tion that we must take into account not only the occa- 
 sional failure, under certain circumstances, of vesication 
 after vital burns, but also the non-occurrence in some 
 instances of the redness of the. burnt part ; and in the 
 second place, that vesication without accompanying red- 
 ness on a dead body, would not authorize the conclusion 
 that the burn had been caused during life, as such blis- 
 ters are met with from pemphigus in the living, and in 
 the corpse from the progress of putrefaction. 
 
 Where a body is more or less completely consumed, 
 the sex may sometimes be distinguished by the pelvis, 
 and the age from the bones or teeth. In case of death 
 from burns it frequently happens that there are no char- 
 acteristic post-mortem appearances ; fluid in more than 
 
44 MEDICAL JUEISPEUDENCE. 
 
 usual quantity will frequently be found, however, in the 
 ventricles and at the base of the brain ; also effusions 
 into the serous cavities. The bronchial tubes and lungs 
 generally are usually congested, as well as the stomach 
 and alimentary canal. Perforating ulcers of the duo- 
 denum are common, especially in children and young 
 people ; the heart is sometimes found empty, but more 
 often the right side is fuU and the left empty. The 
 brain, liver, kidneys, and pelvic organs are frequently 
 congested. 
 
 Fractures. The subject of fractures may be conven- 
 iently considered in this connection. It should be re- 
 membered that they do not always arise from external 
 violence, but are sometimes caused by violent muscular 
 action, or in diseased conditions of the bone by ordinary 
 muscular action. Such injuries sometimes occur spon- 
 taneously in the fcdus in utero and are sometimes occa- 
 sioned during delivery; it also occasionally happens 
 that blows or falls of no great severity will cause frac- 
 tures of a severe or fatal kind, only admitting of expla- 
 nation by attention to the surrounding circumstances. 
 
 As to whether the fractures were produced during 
 life, the only test which can be relied upon with confi- 
 dence is the commencement of the reparative process ; 
 the presence of coagulated blood between the ends of 
 the fractured bones is not conclusive. 
 
 In rare cases the degree of violence received, or the 
 character of the instrument by which it has been in- 
 flicted, can be determined from inspection of the frac- 
 tured bone. 
 
 The subject of blood stains will be considered in 
 another chapter. 
 
WOUNDS, BURNS, AND SCALDS. 45 
 
 The prognosis of wounds is a subject which will 
 occasionally demaud the attention of medical jurists. 
 
 1. Prognosis of injuries to the nervous system. 
 Wounds of the head are important chiefly from their 
 liability to disturb the functions of the brain or to 
 involve it in active disease. When strictly local they 
 heal without much trouble, but are liable to be com- 
 plicated with diffuse abscess, erysipelas or irritative 
 fever. When the irritation arising from such wounds 
 is considerable, the brain and its membranes may sym- 
 pathize, or the party be attacked with tetanus, and 
 in this way an injury apparently inconsiderable may 
 prove unexpectedly fatal. Contusions of the head are 
 generally not dangerous if unattended with symptoms 
 denoting concussion. Punctures or any simple frac- 
 tures of the bones of the head, when the brain is not 
 injured, are not in general followed by bad conse- 
 quences, although a guarded prognosis should be given 
 in every such case. Effusion of blood within the 
 cranium is a very common cause of death from vio- 
 lence producing concussion of the brain, even when 
 there is no external mark of injury on the head. The 
 question in such cases arises whether the effusion is 
 due to violence or to disease ; such effusions, when 
 spontaneous, are most usual in the substance of the 
 brain, while if due to violence they are commonly on 
 the surface or between the brain and the skull. 
 
 Injuries to the spinal cord which wound, divide, 
 compress, or disorganize any part of it, generally prove 
 fatal either immediately or after a longer or shorter 
 period. Injuries to the meduUa oblongata are instantly 
 fatal in consequence of the immediate cessation of res- 
 
46 MEDICAL JURISPRUDENCE. 
 
 piration and circulation; it is important, therefore, in. all 
 such cases that the spine be carefully examined, after 
 death. 
 
 2. Injuries to the circulatory system are common 
 causes of death, which may arise either from exhaustion, 
 due to hemorrhage or otherwise, or by the pressure of 
 the effused blood impeding the functions of the vital 
 organs, such as the brain, spinal cord, heart, or lungs. 
 The amount of blood which may be lost without de- 
 stroying life varies with the different states of the consti- 
 tution, and the habits of the party. The proofs of death 
 from hemorrhage are such as indicate that the wounds 
 were inflicted during life, the absence of blood in the 
 larger vessels and important viscera, and the healthy 
 state of the principal organs of the body. 
 
 Life may be immediately destroyed by the admission 
 of air into the veins through a wound. 
 
 Wounds of the neck severing the large vessels, in 
 the absence of surgical assistance are immediately fatal; 
 and even with such assistance they are usually -fatal. 
 
 Wounds of the chest most frequently cause death 
 by syncope from hemorrhage, but a less effusion may 
 destroy life by compression of the heart or lungs. 
 Euptures of the heart or larger vessels within the 
 chest may occur either from pressure or from a blow, 
 without any appearance of external injury. They may 
 also occur spontaneously from disease. 
 
 Wounds of the organs of generation are occasionally 
 fatal when no large vessels have been divided, such as 
 incisions on the inner side of the labia, nymphse, or 
 vagina. There are recorded instances in which a nearly 
 fatal hemoiThage has been caused by coitus. 
 
WOUNDS, BURNS, AND SCALDS. 47 
 
 3. The most important injuries of the respiratory 
 system are of the chest and lungs. Contusions, and 
 fractures of the ribs, wounds of the pleurae and lungs, 
 may prove fatal from shock or asphyxia. In penetrating 
 wounds of the chest, the entrance of the air may cause 
 collapse of the lungs and death by asphyxia. Wounds 
 laying open the larynx and trachea, while not neces- 
 sarily fatal, may cause death by asphyxia from the blood 
 obstructing the air passages, or from fluid swallowed 
 passing into the larynx and causing suffocation. 
 
 4. Injuries of the abdomen may prove fatal by shock, 
 hemorrhage, inflammation, or by interference with the 
 nutrition of the body. It should be remembered that 
 spontaneous ruptures of. some parts of the bowels may 
 sometimes occur and cause sudden death. 
 
 The prognosis of an injury may be modified by age, 
 sex, and constitutional peculiarities ; thus in some per- 
 sons the bones are so thin and brittle as to be easily 
 fractured by slight blows or falls. In what is known 
 as the hemorrhagic diathesis, dangerous or even fatal 
 hemorrhage may follow a trifling blow or cut. 
 
 In the medico-legal inspection where death has been 
 caused by wounds, there are some points needing special 
 attention. The nature of the wound, whether recently 
 inflicted, whether inflicted during life or after death, 
 should if possible be carefully determined. Any weapon 
 found, should be carefully compared both with the 
 clothes and the external wound, and foreign bodies (if 
 any) found in the wound should be carefully preserved. 
 The length, breadth, and depth of the wound should be 
 measured, and its situation and direction carefully noted. 
 The probable manner of infliction and the degree of force 
 
48 MEDICAL JURISPKUDENCE. 
 
 and the weapon employed may often be ascertained 
 from the nature and extent of the wound. The ques- 
 tion as to whether death has been the result of accident, 
 suicide, or homicide, may sometimes be determined from 
 the above circumstances. The manner of dissecting the 
 wound requires careful attention. For this purpose a 
 circular incision should be carried around the wound, 
 three or four inches from it and not interfering with 
 it, and the integument and underlying structures suc- 
 cessively dissected off, from the circumference to the 
 centre; in this way the relations of the parts impli- 
 cated, and the direction and extent of the wound may 
 be accurately determined. The general dissection of 
 the body may then be completed in accordance with 
 directions given in a previous chapter. 
 
CHAPTEE IV. 
 
 THE. SIGNS, MODES, CAUSES, ETC., OF DEATH. 
 
 By somatic death, or the death of the body as a 
 whole, is meant the cessation, of the vital functions, 
 and of the general renewal of tissue consequent on 
 such cessation. 
 
 By molecular death, which may be either partial or 
 complete, is meant the death of a part, tissue, or organ, 
 without the general stoppage of the circulation. The 
 part thus affected becomes obedient to the operation 
 of the ordinary chemical and physical agencies govern- 
 ing the inorganic molecule. 
 
 The signs of death are — 
 
 1. The entire and continuous cessation of the heart's 
 action. This cannot be certainly determined by the 
 mere absence of pulsation at the wrist. In order to 
 decide this question an examination, both by ausculta- 
 tion and palpation, in a perfectly quiet room, are neces- 
 sary; and this examination .should include not merely 
 the regions of the heart proper, but of the chest gener- 
 all)', and a positive conclusion should not be announced 
 until after careful auscultation for two or, three hours, 
 at intervals of fifteen minutes; for recovery has been 
 known to take place after the heart has apparently 
 
 4 
 
50 MEDTCAL JURISPRUDENCE. 
 
 ceased Seating for the period of fifteen minutes. The 
 auscultation is better made with a good stethoscope 
 than with the naked ear. In addition to palpation and 
 auscultation, fine chest movements may be detected by 
 certain mechanical tests, such as sticking needles with 
 little paper flags on their blunt ends into the skin, or 
 placing small pieces of cotton wool drawn into finely 
 pointed cones about two inches in length, over the 
 region of the heart, and of the great vessels of the neck; 
 the room meanwhile must be kept perfectly still and 
 free from draughts. 
 
 Another test is the placing of a ligature tightly 
 around a limb of the body, such as the finger, or 
 around the lobe of the ear. The part beyond the con- 
 striction will, if the person is alive, become bright red ; 
 the tint gradually increasing in depth until it finally 
 assumes a uniform bluish-red color. At the spot 
 where the ligature is applied a narrow white ring will 
 become visible. There will be no change if the person 
 is dead. 
 
 Again, if the person has been dead some hours, no 
 blood will flow upon scarification and application of a 
 cupping-glass. 
 
 Again, if during life clean and bright needles are 
 thrust into the muscles, the steel will quickly oxidize 
 and tarnish ; but after death the needles may remain in 
 the flesh an hour without such oxidation. 
 
 A superficial artery may also be cut down upon and 
 its color and contents ascertained. After death the 
 arteries are pale or yellowish and empty of blood, 
 while during life they pulsate, and have the color of 
 the surrounding tissues. 
 
SIGNS, MODES, CAUSES, ETC., OF DEATH. 51 
 
 If during life a little ammonia solution be subcutane- 
 ously injected, a port-wine congestion is set up in the 
 surrounding tissues, but no such redness results when 
 the operation is performed upon the dead body; at 
 least, not if the body has been dead for some hours. 
 
 2. Another sign of death is the entire and continuous 
 cessation of respiration, which may be determined — 
 
 a. By holding a cold looking-glass over the mouth 
 and nose, when if respiration is present the moisture 
 exhaled will condense upon the mirror; the absence, 
 however, of such condensation is not a conclusive 
 proof of death. 
 
 6. By suspending a feather or other light body near 
 the mouth and nose; here again, the caution above 
 given is applicable. 
 
 c. By standing a glass of water or mercury on the 
 naked chest, whereby the slightest motion will become 
 perceptible. 
 
 With reference to these last three tests, it should be 
 remembered that it is consistent with life that for a 
 short time respiration may be practically imperceptible ; 
 it is only the entire and continuous cessation of respira- 
 tion which is indicative of death. 
 
 3. Insensibility and the loss of voluntary motion, 
 while they frequently occur without resulting in death, 
 should be noticed in this connection. Such insensi- 
 bility and inability to move may arise from asphyxia, 
 syncope, apoplexy, trance, catalepsy, the mesmeric state, 
 and cases of long and persistent sleep, without the 
 person's being dead. 
 
 By way of caution it may be remarked that a physi- 
 cian is not justified in certifying the death of the 
 
52 MEDICAL JURISPRUDENCE. 
 
 person unless the majority df the signs of death are 
 well marked; he should never be saitisfied of the fact 
 of death from one or two appearances merely. 
 
 4. There are certain minor signs which may be here 
 considered — 
 
 a. Dry healt may be applied to the skin ; if this pro- 
 duces a blister containing a serum rich in albumen, 
 while the true skin after the cuticle has been removed, 
 presents a reddened appearance, and more especially if 
 after a short interval a 'deeply injected red line forms 
 around the blister, this is absolute evidence of the 
 vitality of the part to which the heat is applied, and 
 consequently strong confirmatory evidence of the life of 
 the person; but if the blister contains merely air or a 
 little non-albuminous serum, and the true skin after the 
 removal of the cuticle appears dry and glazed and no 
 red line appears around the blister, it is certain that the 
 part so treated is dead, and the evidence is therefore 
 strong that the person himself is dead. 
 
 h: Caustic may be applied to the skin; if the skin is 
 living the eschar is of a black or reddish-brown color ; 
 but if dead either no eschar is produced or the skin 
 turns yellow and transparent. 
 
 c. Another change prior to decomposition is what is 
 known as the facies Hippocratica, which is character- 
 ized by sinking of the eyes, hollowness of the temples, 
 sharpness of the nose and chin, dryness and harshness 
 of the forehead, sallowness of the countenance, flaccidity 
 and paleness of the lips, all which precede death and 
 continue to be recognizable after dissolution. An- 
 other almost constant appearance in the dead body 
 is a more or less flexed state of the fingers and thumbs. 
 
SIGNS, MODES, CAUSES,' ETC., OF DEATH. 53 
 
 the latter from this cause being sometimes bent across 
 the palms and the fingers closed on them. 
 
 5. There are certain changes in and about the eye 
 which are indicative of death; thus — , 
 
 a. The iris becomes insensible to light, or, in other 
 words, the pupil does not change its size with increase 
 or diminution of light thrown upon it. This symptom, 
 however, occurs in many cases of disease and in long- 
 persistent sleep, and may also be produced by the action 
 of certain drugs, such as atropine, eserine, etc. After 
 death the iris becomes more or less flaccid, and external 
 pressure may permanently affect the normal roundness 
 of the pupil. 
 
 6. Again, the cornea becomes insensible ; but this also 
 occurs during certain stages of epileptic fits and in 
 certain cerebral injuries. 
 
 The eye loses its lustre and the cornea its trans- 
 parency, as a rule, soon after death; afterwards its 
 tension becomes lessened and the cornea wrinkled and 
 flaccid from the absorption of the aqueous humor. But 
 here again, the eye may lose its lustre during life, and 
 sometimes its lustre is preserved a long time after death, 
 as after poisoning with the oxides of carbon, cyanogen 
 and its compounds, etc. The same condition has also 
 been observed after death from apoplexy. 
 
 c. Soon after death the conjunctiva shows gray, cloudy 
 discolorations, which rapidly become black. 
 
 d. Loss of tonicity and of the elastic resistance of the 
 eye usually occurs in about twelve or fourteen hours 
 after death ; but this, again, may occur during life. 
 
 e. Where the cornea is clear enough to allow ophthal- 
 moscopic examination, the change of the fundus from 
 
54 MEDICAL JURISPRUDENCE. 
 
 the yellowish-red color of the living to a yellowish- 
 white hue is a strong indication of death. After death, 
 also, the retinal veins show a beaded condition, due to 
 the liberation of gases disengaged from the blood. 
 
 6. Changes in the temperature of the body. The 
 healthy living body has normally a temperature of about 
 98.6° Fahrenheit, or 37° Centigrade, which after death 
 gradually falls to the temperature of the surrounding 
 medium. The post-mortem cooling derives its importance 
 from the fact that this loss of heat is progressive, so that 
 the temperature is many times not merely a sign of death, 
 but an indication of the length of time the body has 
 been dead. The temperature should be taken at regular 
 intervals with a reliable thermometer, the corrections of 
 which are known. Both the external and internal tem- 
 perature should be taken, — the external temperature in 
 the axilla, and the internal in the mouth or rectum. 
 
 The time within which a body ordinarily becomes cold 
 is stated by Casper to vary from eight to twelve hours. 
 Dr. Tidy thinks this period too short, and fixes the 
 time at from fifteen to twenty hours after death. Other 
 writers make the time even longer, — as from eighteen 
 to twenty-four hours. 
 
 In certain cases of disease or where the body has been 
 freely exposed to the air, draughts, etc., the cooling 
 process may be completed within, a much shorter time, 
 even in four or five hours ; while in certain other ex- 
 ceptional diseases or under unfavorable conditions for 
 cooling, even forty-eight or seventy-two hours may 
 elapse before the body is cold. In certain cases, such 
 as death from yellow fever, cholera, Bright's disease, 
 abscess of the liver and other abdominal affections. 
 
SIGNS, MODES, CAUSES, ETC., OF DEATH. 55 
 
 rheumatic fever, small-pox, tetanus, and injuries to the 
 nervous system generally, there may be a post-mortem 
 elevation of internal temperature amounting sometimes 
 to as much as nine degrees Fahrenheit. The following 
 table contains the results of the researches of Dis. 
 Taylor and Wilks on external temperature, the ther- 
 mometer being placed upon the skin of the abdomen. 
 
 
 2 to 3 Hours 
 after Death. 
 
 i to 6 Hours 
 after Death. 
 
 6 to 8 Hours 
 after Death. 
 
 12 Hours or 
 
 more after 
 
 Death. 
 
 Number of ObRerrationB. 
 
 76 
 
 49 
 
 29 
 
 35 
 
 Maximum tempera- 
 ture of the body . 
 
 Minimum tempera- 
 ture 
 
 Average tempera- 
 ture 
 
 F. 
 
 94° 
 
 60 
 
 77 
 
 c. 
 34.4° 
 
 15.S 
 
 25.0 
 
 F. 
 
 86° 
 
 62 
 
 74 
 
 c. 
 30.0° 
 
 16.6 
 
 23.3 
 
 F. 
 80° 
 
 60 
 
 70 
 
 C. 
 26.6° 
 
 15.5 
 
 21.1 
 
 F. 
 79° 
 
 56 
 
 69 
 
 C. 
 26.1° 
 
 13.3 
 
 20.5 
 
 Of internal temperatures, Taylor and Wilks record 
 cases of 76° F. (24.45° C.) seventeen and eighteen hours 
 after death, and of 85° F. (29.45° C.) ten hours after 
 death. 
 
 The following table of external temperatures records 
 the results of 135 observations on the bodies of persons 
 who had died from various diseases. The temperatures 
 were taken by placing the thermometer in the axilla : 
 
 Temperature 
 
 of Body after 
 
 Death. 
 
 2 to 4 Hours. 
 
 4 to 6 Hours. 
 
 6 to 8 Hours. 
 
 8 to 12 Hours 
 or more. 
 
 Maximum 
 
 p. 
 109.4° 
 
 C. 
 43.0° 
 
 F. 
 98.2° 
 
 C. 
 36.8° 
 
 F. 
 95.3° 
 
 C. 
 35.2° 
 
 F. 
 100.4° 
 
 C. 
 37.8° 
 
 Minimum 
 
 89.6 
 
 32.0 
 
 80.6 
 
 27.0 
 
 70.5 
 
 21.4 
 
 62.6 
 
 17.0 
 
 Average 
 
 96.9 
 
 36.1 
 
 90.2 
 
 32.3 
 
 81.7 
 
 27.6 
 
 77.9 
 
 25.5 
 
56 MEDICAL JURISPRUDENCE. 
 
 Authorities differ verv much among themiselves as to 
 the rate of post-mortem cooling. The important fact to 
 bear in mind in this connection is, that the rate of 
 cooling is not uniform; notwithstanding the post-mortem 
 rise of temperature, it is on the whole during the earlier 
 hours after death that the most rapid cooling occurs; 
 during the later hours the loss per hour becomes 
 exceedingly trifling. 
 
 The time occupied by the cooling process may be 
 shortened in death from wasting diseases, after great 
 losses of blood, where the body is exposed to air and 
 cold draughts in a more or less uncovered state, on the 
 floor or on other good conducting surface. It will cool 
 more rapidly in a large well-ventilated room than a 
 small close one. Bodies of children or old persons cool 
 more rapidly than those of adults. Bodies of lean peo- 
 ple cool more rapidly than those of fat. The time of 
 cooling in death from drowning may be shortened by 
 the temperature of the water. Again, the time of cool- 
 ing may be lengthened in acute diseases, generally in 
 sudden death and in cases of asphyxia, except drown- 
 ing. "Warm clothing, non-exposure to draughts, pre- 
 servation in a small warm room, being well covered or 
 on a non-conducting material, will also prolong this 
 process. 
 
 7. Changes in the muscles and the general- condition 
 of the body after death. 
 
 a. Shortly after death the muscles become flaccid, the 
 jaw drops, the eyelids lose their tonicity, the joints 
 become flexible and the limbs flabby. During this 
 period, however, the flabby muscles are capable of con- 
 tracting under appropriate stimuli, such as interrupted 
 
SIGNS, MODES, CAUSES, ETC., OF DEATH. 57 
 
 electric currents, blows, etc. This stage may occasionally- 
 last only a few minutes, or even be non-existent; but it 
 more commonly lasts about three hours. There are no 
 well-attested cases, however, where this stage has been 
 prolonged beyond twenty-four hours. It is to be ob- 
 served that the contractility of a muscle. by electrical 
 and other stimuli is no certain test of life ; and that the 
 non-contractility of a muscle by. such stimuli is . no 
 certain test of death. 
 
 b. At the end of the first stage of flaccidity and 
 irritability follows what is termed the stage of cadaveric 
 rigidity, or rigor mortis, by which is meant rigidity of 
 the muscles accompanied by stiffness of the joints and 
 limbs. As soon as the elasticity and muscular irrita- 
 bility cease, rigor mortis commences. During this stage 
 the muscles retain the precise position they occupied at 
 the time rigidity supervened. This phenomenon is 
 common both to voluntary and involuntary muscles, and 
 is altogether independent of the nervous system, of the 
 presence of the air, and of temperature, although the 
 early supervention of ^rigor mortis may have some in- 
 fluence in quickly lowering the surface temperature. 
 
 The true cause of rigor mortis is believed to be the 
 coagulation of the myosin or muscle fibrine, the albu- 
 minous principle of the muscular tissue. As putre- 
 faction proceeds, ammonia is developed, the coagulated 
 myosin is dissolved, and rigor mortis disappears. The 
 reaction of the living muscle at rest is faintly alkaline ; 
 contracting muscle possesses a faintly acid reaction. 
 During rigor mortis the muscle exhibits a well-marked 
 acid reaction, but when rigor mortis has passed away 
 the niuscles exhibit a well-marked alkaline reaction. 
 
58 MEDICAL JUKISPEUDENCE. 
 
 Rigor mortis in the voluntary muscles usually com- 
 mences at the tldrd or fourth hour after death, and is 
 usually complete at about the fifth or sixth hour; it 
 comes on sooner in the involuntary muscles than in the 
 voluntary. 
 
 Rigor mortis may be late in appearing in cases of 
 sudden death in muscular and well-developed subjects ; 
 under such circumstances, when the muscles have not 
 been previously fatigued or the body weakened by 
 disease, rigidity may not set in under twelve hours, or 
 even longer. Again, if the body is exposed to cold 
 rigor mortis is often delayed; there is, however, no 
 authenticated case where it has been delayed beyond 
 twenty-four hours. 
 
 On the other hand it may appear very soon after 
 death, especially in certain parts of the body. The eye- 
 lids may become rigid within five minutes of death, or 
 sometimes, it is said, before the heart has ceased to beat ; 
 rigidity often sets in very rapidly in the facial muscles. 
 There are numerous recorded cases where rigidity has 
 set in while the body has been warm, and a case of 
 death from typhoid fever is recorded where rigidity 
 commenced while the heart was still beating, and within 
 three minutes after respiration had ceased. 
 
 Living contraction may pass at once into rigor mortis 
 without any appreciable intermediate state of muscular 
 flaccidity, and these cases are confined to no one special 
 mode of death. It has been commonly observed that 
 where immediate rigidity occurs the period just pre- 
 ceding death has been one of great fatigue and physical 
 exhaustion. 
 
 When the last attitude of life is maintained after 
 
SIGNS, MODES, CAUSES, ETC., OF DEATH. 59 
 
 death by rigor mortis, considerable light may be thrown 
 upon the question whether the case is one of homicide 
 or suicide. In such cases the position of the dead body, 
 its relation to the surface on which it rests, the position 
 of the weapon or other thing grasped by the hands should 
 immediately be carefully noted. If a weapon be found 
 loosely held in the hands of the deceased no conclusion 
 of value can be deduced as to the question of suicide or 
 homicide; but if the weapon be found firmly grasped 
 by the deceased, suicide rather than homicide is in- 
 dicated. 
 
 As to the order after death in which the various parts 
 of the body are affected by rigor mortis,, while there are 
 some minor differences among the authorities, they in 
 the main agree. The eyelids appear to be first attacked; 
 after that it passes from above downwards, beginning, 
 according to Casper, on the back of the neck and lower 
 jaw, passing thence to the facial muscles, the front of 
 the neck, the chest and the upper extremities, and last 
 of all the lower extremities. It usually passes off in 
 the same order and once gone never returns, the body 
 becoming as flexible as it formerly was. 
 
 Rigor mortis sometimes passes off very rapidly, so 
 rapidly that it has been reported never to have occurred ! 
 and again it sometimes lasts a long time. The length of 
 time during which it lasts is variously stated, — at from 
 sixteen to twenty-four hours (Taylor), and twenty-four 
 to thirty-six hours in summer, and thirty-six to forty- 
 eight in winter (Tidy). The time of its appearance and 
 the duration of its continuance are modified by age, 
 temperature, and atmospheric conditions, condition of 
 the muscular system, and the mode of death. It is less 
 
60 MEDICAL JDBISPKUDENCE. 
 
 marked in the bodies of middle-aged persons (unless the 
 subject be very muscular) than in the old, where it is 
 most complete. In infants it usually sets in very 
 rapidly. A low temperature and dry air favor a long 
 continuance of rigidity. ■ In all cases of rigor mortis 
 two points require special consideration, — the muscular 
 development of the subject, and the extent of exhaustion 
 and fatigue preceding death. Eigidity often lasts a long 
 time after violent death ; after sudden death in a mus- 
 cular subject it often continues fourteen days or even 
 longer. Where death results from a lingering disease, 
 accompanied by great prostration, or from violence pre- 
 ceded by intense physical fatigue, rigor mortis sets in 
 speedily and disappears quickly; it may even be so 
 slight as to be overlooked. Paralyzed limbs are subject 
 to rigor mortis; in cases of poisoning, rigidity as a rule 
 sets in late and lasts long; in poisoning, the primary 
 question as regards rigidity is not so much the action 
 of the poison as the intensity of exhaustion which has 
 succeeded death. Eigidity usually continues long in 
 cases of habitual drunkards. 
 
 It is said that after death from small-pox, acute rheu- 
 matism, tetanus, meningitis, abdominal diseases, pyemia, 
 and the like, bodies become rigid rapidly and remain so 
 a long time. 
 
 Bigor mortis may be distinguished from other forms 
 of rigidity, such as may occur during life, by forcibly 
 bending the joint ; when a joint stiff from post-mortem 
 rigidity is forcibly bent the rigidity passes away and 
 does not return, provided rigw mortis is completely eS' 
 tablished. If it has not completely set in when the 
 limb is bent, a certain. but less marked stiffness may 
 
SIGNS, MODES, CAUSES, ETC., OF DEATH. 61 
 
 return. When forcibly bent the limb affected by rigor 
 mortis does not return of its own accord to its original 
 position ; but in the rigidity of hysteria, catalepsy, syn- 
 cope, or that caused by the action of certain poisons, the 
 stiffness is not destroyed by forcibly bending; as soon 
 as the force is removed the limb at once returns to its 
 original position. Post-mortem rigidity is also accom- 
 panied by a progressive loss of heat which is not char- 
 acteristic of any disease. 
 
 c. The third stage' of the fchanges in the general 
 condition of the body after death is that of putre- 
 factive decomposition, which is a spontaneous change 
 common to all nitrogenized organic bodies when ex- 
 posed to air, whereby they become resolved into new 
 and simpler products. It is accompanied by the evo- 
 lution of gaseous compounds, for the most part of sul- 
 phur and phosphorus. This stage usually commences 
 when rigidity ceases, altbough in exceptional cases ri- 
 gidity and putrefaction may coexist. Generally, an 
 advanced putrefaction is an infallible sign of death ; par- 
 tial putrefaction after some local injuries, such as the gan- 
 grene of a portion of the body, is not evidence of death. 
 
 Before considering the appearances due to putrefactive 
 decomposition, cadaveric ecchymoses, variously called 
 hypostases, cadaveric livldities, post-mortem stains, su- 
 gUlations, vibices, should be considered, although chro- 
 nologically they belong to the first stage of muscular 
 flaccidity, and are not the result of putrefaction. By 
 cadaveric ecchymoses are meant certain post-mortem 
 stains closely resembling in their general appearance, 
 bruises or contusions, and occurring both externally and 
 internally on the lowest parts of the body. 
 
62 MEDICAL JURISPRUDENCE. 
 
 They are both external and interual. External ecchy- 
 moses usually appear within the eight or ten hours 
 after death, while the body is warm and the blood 
 liquid. When the blood is coagulated and the body 
 cold their progress and formation cease. The blood 
 within a dead body coagulates in much the same man- 
 ner as it does when withdrawn from the living body. 
 When drawn from the body during life or within the 
 first three or four hours after death, it coagulates almost 
 immediately upon its exposure to the air; but when 
 remaining in the body from six to ten hours more may 
 elapse before coagulation. The time required for coagu- 
 lation, whether in or out of the body, depends upon the 
 quantity of fibrin in the blood. As this varies greatly 
 in different diseases, the formation of post-mortem ec- 
 chymoses varies according to the cause of death, — com- 
 ing on quickly in acute inflammations, and slowly in other 
 diseases, where the quantity of the fibrin in the blood is 
 small, as in phthisis. These external ecchymoses, livid- 
 ities, or hypostases may readily be distinguished from 
 appearances likely to be confounded with them, by 
 attention to the following criteria: — 
 
 First, their seat, the superficial layer of the true 
 skin ; secondly, their extent, involving large portions 
 of the body, or to be met with in different parts of it 
 at the same time; thirdly, their circitmference, which, 
 though irregular and slashed, terminates abruptly, and 
 not by gradual fading into the surrounding colorless 
 skin; fourthly, the entire absence of extravasated 
 blood at their site ; and fifthly, by the absence of any 
 trace of contusion or ruffling at the part of the cuticle 
 or true skin. 
 
SIGNS, MODES, CAUSES, ETC., OF DEATH. 63 
 
 If a contusion produced during life is incised, blood at 
 once flows from the cut ; but no effused or coagulated 
 blood escapes upon incision of a post-mortem ecchy mo- 
 sis, although perhaps a few bloody points may be appar- 
 ent. Internal ecchymoses or hypostases also occur in 
 the dependent parts of the several viscera, and this fact 
 will serve to distinguish them from redness due to dis- 
 ease ; they are chiefly found in the posterior part of the 
 brain, the posterior part of the spinal cord, the pos- 
 terior part of the lungs, and the dependent parts of the 
 stomach and intestines. 
 
 Very soon after death the coloring-matter of the bile 
 oozes from the gall-bladder; and the contiguous parts 
 of the stomach and intestines may become thereby 
 stained and of a yellowish or greehisb-yellow color. 
 
 Coming now to putrefaction proper, it may be ob- 
 served that its progress varies considerably according to 
 the character of the soil, temperature, humidity, dryness, 
 etc., and whether the body is immersed in water, — 
 putrefaction therein being slower than in the atmos- 
 phere, — and upon other circumstances. A temperature 
 of sixty to ninety degrees Fahrenheit is the most favor- 
 able to the process of putrefaction ; in water the process 
 is very rapid when the fluid has a temperature of from 
 . sixty-four to sixty-eight degrees, but very slow if the 
 temperature of the fluid is lower than this. Other 
 things- being equal, very young infants putrefy sooner 
 than adults or old people, and females sooner than males. 
 Mutilations, contusions, ecchymoses, and death from 
 acute diseases hasten putrefaction. Copious hemorrhages 
 before death retard it. 
 
 The gaseous products of decomposition in the early 
 
64 MEDICAL JURISPRUDENCE. 
 
 Stages of putrefaction consist principally of sulphuretted 
 and carburetted hydrogen and ammonia, with variable 
 proportions of carbonic oxide, phosphoretted hydrogen, 
 nitrogen, and carbonic anhydride. After the fifth or 
 sixth day the proportions of sulphuretted hydrogen and 
 ammonia diminish, and carburetted hydrogen and car- 
 bonic oxide largely predominate. 
 
 The principal phenomena attending putrefactive de- 
 composition are color changes and the development of 
 gases of decomposition, with their consequences. The 
 order in which the external phenomena of putrefaction 
 occur in bodies exposed to the air, or buried, are thus 
 stated, as average, results only, by Dr. Tidy, whose rules 
 are with some modifications quoted from Casper : — 
 
 From twenty-four to seventy-two hours after death, 
 a light-green color appears about the centre of the 
 abdomen; the eye-balls are soft and yield to external 
 pressure. 
 
 From three to five days after death the green color of 
 the abdomen becomes intensified and general, spreading, 
 if the body is exposed to the air or buried in the ground, 
 in the following order: genitals, breast, face, neck, 
 superior and inferior extremities. If submerged in 
 water the following is the order, the time of appearance 
 being later than in case of air : face, neck, shoulders, 
 sternum, abdomen, and legs. 
 
 From eight to ten days after death the color becomes 
 more intense, the face and neck presenting a shade of 
 reddish-green. The ramifications of the subcutaneous 
 veins on the neck, breasts, and limbs, are very apparent; 
 the patches congregate ; gas begins to be developed in 
 and to distend the abdomen and the hollow organs, and 
 
SIGNS, MODES, CAUSES, ETC., OF DEATH. 65 
 
 to form under the skin in the submucous and intermus- 
 cular tissues. The cornea falls in and becomes concave. 
 The sphincter ani relaxes. The nails remain firm. 
 
 From fourteen to twenty-one days after death the color 
 of the whole body becomes intensely green, with brown- 
 ish-red or brownish-black patches ; the body generally is 
 bloated and appears large from the development of gas in 
 the abdomen, thorax, scrotum, and the cellular tissues of 
 the body generally. The swollen condition of the eye- 
 lids, lips, nose, and cheeks usually obliterates the fea- 
 tures so as to prevent identification of the body. The 
 epidermis peels off in patches, while in certain parts, 
 especially the feet, it will be raised in blisters filled 
 with a red or greenish fluid, the skin underneath fre- 
 quently appearing blanched. The color of the iris is 
 lost. The nails easily separate. The hair is loose. 
 
 From four to six months after death the thorax and 
 abdomen burst ; the sutures of the skull give way ; the 
 viscera become pulpy, or perhaps melt away, leaving 
 the bones exposed. The bones of the extremities separ- 
 ate at the joints. 
 
 At an advanced stage the soft parts gradually disap- 
 pear. Generally, the changes in a body enclosed in a 
 coffin are similar to but slower than those which appear 
 if the body is exposed to • air. After periods varying 
 from a few months to one and a half or two years the 
 soft tissues of a body buried in a coffin usually become 
 dry and brown, and the limbs and face covered with a 
 soft white fungus. After a period of four years the vis- 
 cera become so mixed together that it is difficult, if not 
 impossible, to distingiiish them. At later periods the 
 soft parts as a rule, entirely disappear. The teeth, 
 
 5 
 
6Q MEDICAL JUEISPRXTDENCE. . 
 
 bones, and hair are the most indestructible parts of the 
 body, and may be found in perfect preservation after 
 many years' burial. Children's bones, however, decay 
 more rapidly than adults'. 
 
 Besides the distention of the body by the gases of 
 decomposition already mentioned, they also cause blood 
 displacements and fluid effusions, and sometimes move- 
 ments of the body simulating vital acts. The pressure 
 produced by the gas usually empties the heart and 
 large blood-vessels, and forces the blood either into the 
 superficial capillaries, or into the mucous or serous 
 membranes, or into the vessels of the viscera, caus- 
 ing a diffused and intense redness of the skin and 
 areolar tissue. In post-mortem redness the red color is 
 limited to the course of the vessels, and may thus be 
 distinguished from inflammatory redness, which is more 
 widely spread. The pressure resulting from the devel- 
 opment of gases explains the occurrence of the so-called 
 post-mortem hemorrhages, where liquid blood oozes from 
 a wound before putrefaction has commenced. The fluid 
 effused into the serous cavities, especially , the pleu- 
 rae and pericardium, is caused by the pressure on the 
 overloaded capillaries forcing the serum,, brownish-red 
 in color and homogeneous in nature, through the lining 
 walls-'of the vessels; . . 
 
 The following organs and parts putrefyi rapidly; and 
 as a rule in the order mentioned : — - -i - 
 
 1. The larynx and trachea. '2. The brain of infants (the 
 adult brain putrefies much less rapidly); 3. The stomach. 
 4. The intestines, 6, The spleen. 6. The omentum and 
 mesentery. 7. The liver, which in children putrefies sooner 
 than in the case of .adults. 8. The brain of adults. 
 
SIGNS, MODES, CAUSES, ETC., OF DEATH. 67 
 
 The following organs putrefy slowly, and generally in 
 the order mentioned ; — 
 
 1. The heart. 2. The lungs. 3. The kidneys. 4. The 
 bladder. 5. The gullet. 6. The pancreas. 7. The dia- 
 phragm. 8. The larger blood-vessels, 9. The uterus, which 
 resists putrefaction longer than any of the other soft parts of 
 the body. 
 
 As putrefaction advances in bodies exposed to the air, 
 vermin make their appearance. Eecent investigations 
 tend to show that the time which has elapsed, since 
 death may be approximately determined by a skilled 
 entomologist from the order of development of the 
 insects in the body. 
 
 In exceptional cases the body becomes desiccated and 
 mummified, as where the body is exposed to dry air and 
 protected from moisture. 
 
 Under certain conditions the soft parts of the body 
 may be converted into what is called adipooere, which 
 is an ammoniacal soap, requiring for its formation fatty 
 matter and nitrogenous matter capable by idecomposi- 
 tion of yielding ammonia. It is formed more readily 
 and abundantly in fat than in lean bodies, in children 
 and in young people than in adults. Complete immer- 
 sion of the body in running water fevors its formation ; 
 as does also burial in an overcrowded churchyard, in 
 cess-pool soil, or in deep graves. 
 
 There is also an adipocere having lime and not am- 
 monia for its base, which is commonly harder and whiter 
 than ammonia adipocere. 
 
 Adipocere is a white or yellowish-white or brown, 
 soapy body, of an offensive rancid odor, which, when 
 
68 MEDICAL JURISPKUDENCE. 
 
 perfectly dry, is white, hard, and brittle. It is lighter 
 thaa water, and melts at about two hundred degrees 
 Fahrenheit ; it is very durable. The breast, cheeks and 
 kidneys are the parts first to undergo this change, and 
 later the muscles. The time required for its production 
 is variously stated. Casper says that in his experience 
 it is not formed to any extent under three or four 
 months' submersion in water, or six months' burial in 
 moist earth. 
 
 There are recorded instances in which adipocere has 
 been produced by immersion in water, or in water-closet 
 soil for a period of a month or six weeks ; and there 
 are several recorded cases of adult bodies being found 
 partly adipoceratous after three or four months' submer- 
 sion in water; and there are niany recorded cases where 
 the change has been almost complete after two or three 
 years' burial or submersion. Partial saponification may 
 therefore be expected under favorable conditions after 
 three months' submersion in water or twelve months' 
 burial in earth. 
 
 Modes and Causes of Death. Medical jurists de- 
 scribe three modes of death, namely : by Syncope, or 
 death beginning at the heart ; by Coma, or death begin- 
 ning at the head ; and by Apncea, or as generally but 
 improperly called. Asphyxia, or death beginning at the 
 lungs. 
 
 Death by Syncope may depend upon two distinct 
 causes : where there is a deficiency of blood but no de- 
 ficiency of heart-power, which is called Anaemia; or 
 where there is a deficiency of heart-power but no want 
 of blood, which is called Asthenia. The symptoms of 
 death by anaemia are a mortal paleness of the cheeks 
 
SIGNS, MODES, CAUSES, ETC., OF DEATH. 69 
 
 and lips, cold sweats, dimness of vision, dilated pupils, 
 giddiness, and a weak, irregular, or fluttering pulse. 
 There may be nausea and vomiting, restless movements 
 of tlie limbs, transient delirium with frequent hallucina- 
 tions of the sense of hearing, and flashes of light before 
 the eyes. The breathing becomes irregular, with sighs 
 and often gasping ; there is often hiccough. Insensibil- 
 ity eventually sets in. Convulsions generally super- 
 vene and may be repeated once or twice before death. 
 The heart, if examined soon after death, will be found 
 contracted, and quite, or nearly empty. 
 
 In death by asthenia, the hands, feet, and surface 
 generally become cold ; circulation in the extremities is 
 usually iirst arrested, so that the fingers, lips, nose, and 
 ears become livid. The pulse becomes feeble and fre- 
 quent, and muscular weakness extreme. The senses and 
 intellect retain their full activity to the last ; the clear- 
 ness of intellect distinguishes collapse from concussion 
 in which consciousness is temporarily lost. In asthenia 
 the cavities of the heart after death are not contracted, 
 but are more or less full of blood, or if empty, flabby 
 and dilated. 
 
 In death by syncope proper, we have a combination 
 of anaemia and asthenia. Sudden death from shock is 
 probably the result of syncope, — from causes acting 
 through the nervous system. The general post-mortem 
 appearances after death from syncope are, that the right 
 and left sides of the heart commonly contain an equal 
 amount of blood. As a rule, the brain, lungs, and cap- 
 illary system generally will be found in a normal 
 condition. 
 
 In Coma, or death beginning at the head, there is 
 
70 MEDICAL JURISPRUDENCE. 
 
 stupor more or less profound; external impressions are 
 but feebly recognized ; loss of sensibility and conscious- 
 ness gradually becomes complete. The breathing be- 
 comes slow, irregular, and stertorous, and voluntary con- 
 trol of respiration is lost ; respiration may, however, be 
 imperfectly carried on for a time after consciousness has 
 ceased. Finally, the chest ceases to expand, the blood 
 is no longer aerated, and death ensues. The post-mor- 
 tem appearances in the thorax may differ but slightly 
 from those found in death beginning at the lungs. The 
 arteries and left side of the heart are empty ; the right 
 side of the heart and lungs moderately full, but not so 
 engorged as after death from apncea. Possibly effusions 
 may be found within the head. 
 
 In Apnoea or Asphyxia, where the death begins at the 
 lungs, there is an intense struggle to breathe preceding 
 unconsciousness, vertigo, loss of consciousness, relaxa- 
 tion of the sphincters, general convulsions, and death. 
 As a general thing the right side of the heart, veins, 
 capillaries, and viscera are engorged with blood, while 
 the left side of the heart and arteries are comparatively 
 empty. 
 
 In many deaths, a combination of these three methods 
 will be found, and it is often difficult to say which is 
 predominant. German medical jurists have accordingly 
 adopted a fourth form of death, called comato-asphyxia, 
 where the death begins both at the brain and lungs. 
 
 The Causes of Sudden Death are various. Without 
 professing to give an exhaustive enumeration, there may 
 be mentioned, excluding violence and poisoning, diseases 
 of the heart, especially fatty and brown degeneration, 
 angina pectoris, aortic regurgitation, rupture of the heart, 
 
SIGNS, MODES, CAUSES, ETC., OF DEATH. 71 
 
 aneurism and thrombosis, effusions of blood in the brain 
 or its membranes, pulmonary apoplexy and hemato- 
 thorax, the rupture of viscei-al abscesses, ulcers of some 
 portion of the alimentary tube, extra-uterine fcetation, 
 rupture of the uterus, apoplexy of the ovary, peri- and 
 retro- uterine hsematicele, rupture of the bladder or some 
 other important viscus, cholera, and the accidental 
 obstruction of the pharynx or glottis by foreign bodies. 
 Mental emotions sometimes cause sudden death. 
 
CHAPTEE V. 
 
 DEATH BY ASPHYXIA; DEOWNING; HANGING; STRANGU- 
 LATION; AND SUFFOCATION. 
 
 Asphyxia means the imperfect aeration or non-aera- 
 tion of the blood from want of air. There are certain 
 points of resemblance in death by drowning, strangula- 
 tion, suffocation, and the action of poisonous gases, 
 which may be conveniently considered at this point, 
 reserving characteristic differences for separate treat- 
 ment. 
 
 The general symptoms of death by asphyxia are livid- 
 ity of the whole face and of the extremities, with 
 convulsive movements, at first more or less voluntary. 
 Consciousness is soon lost ; involuntary and unconscious 
 •spasmodic clonic movements of the muscles and limbs 
 follow ; the veins become turgid ; the pulse more and 
 more feeble. There is often frothing at the mouth, the 
 froth sometimes being tinged with blood; blood not 
 unfrequently escapes from the nostrils, vagina, anus, 
 and other mucous tracts. The urine, faeces, and semen 
 may be discharged involuntarily; abortive efforts at 
 respiration continue for a while, but finally cease, and 
 after an interval the heart also ceases to beat. 
 
 Dr. Tidy makes four distinct periods in asphyxia : — 
 
 (1.) A period of intense sensible although ineffectual 
 efforts to breathe. 
 
DEATH BY ASPHYXU, DROWNING, ETC. 73 
 
 (2.) A period of insensibility, with more or less irreg- 
 ular convulsive and involuntary spasms. 
 
 (3.) A period when, though life seems to be at an end, 
 owing to the failure of respiration, it may be again re- 
 suscitated, because of the continuance of the heart's 
 action. 
 
 (4) Its termination in death after the cessation of 
 the action of the heart. . 
 
 The first two periods may occupy from three to five 
 minutes; from the beginning to the end, ten minutes 
 may be regarded as an outside limit. 
 
 The post-mortem appearances of death from asphyxia 
 are lividity of the lips, extremities, and general surface ; 
 hypostases or post-mortem stainings ; the engorgement 
 of the veins over the entire body with dark blood (the 
 arteries being for the most part empty). The lungs are 
 usually congested. The right heart, vena cava, and 
 pulmonary arteries are distended with dark fluid blood, 
 while the left heart, aorta, and pulmonary veins are 
 usually nearly empty. Extravasations of blood will be 
 found on the mucous and serous membranes. The 
 membranes of the brain will usually be found gorged 
 with blood, and numerous bloody spots appear when 
 the brain is sliced. Serum will be found extravasated 
 into the serous cavities, and the mucous membranes will 
 generally be found very turgid. Bigor mortis is said 
 to set in slowly; the viscera will generally be found 
 enlarged and congested with dark venous blood, while 
 the blood itself will be found usually fluid and dark in 
 color. In death, however, from the effects of carbonic 
 oxide the blood will be found of a bright red color. 
 
 In hanging and other violent deaths the genital organs 
 
74' MEDICAL JDRISPETJDENCB. 
 
 are often turgid and erect, while in drowning the penis 
 is often retracted and the scrotum shrunk. 
 
 Drowning. Distilled or rain water having a specific 
 gravity of 1.000 at 60° Eah., and sea water about 1.028, 
 while the human body has a specific gravity of from 
 1.08 to 1.10, slightly greater than that of any water, the 
 naked human body placed in water has a slight ten- 
 dency to sink. Some bodies, however, will not sink in 
 sea water. 
 
 In death by drowning there are two distinct sets of 
 phenomena. First, those due to suffocation, and occa- 
 sionally syncope and other causes ; and secondly, those 
 due to prolonged immersion in water. Under ordinary 
 circumstances, death from drowning results from as- 
 phyxia. Asphyxia commences . in . about two minutes ; 
 and five minutes after submersion, death ordinarily 
 occurs. Although apnoea or asphyxia is the most com- 
 mon cause of death, death may result, or at least its 
 occurrence be modified, by syncope due to shock, fright, 
 drunkenness, hysteria, catalepsy, etc. Death may also 
 result from exhaustion, or concussion, — caused by col- 
 lision of the body with some hard object, as the bed of 
 the river, rocks, etc., — from apoplexy, cramps, or in 
 epileptics, from the sudden advent of an epileptic 
 seizure. 
 
 According to Devergie, death results from true as- 
 phyxia in 25 per cent of cases of drowning, and in the 
 remaining 75 per cent, from asphyxia in a more or less 
 modified form. In all probability, therefore, the gen- 
 eral post-mortem appearances will be those of asphyxia 
 already described. The post-mortem appearances, how- 
 ever, will vary according to the length of time of sub- 
 
DEATH: BY ASPHYXIA, DROWNING, ETC. 75 
 
 mersion, whether the, body was completely submerged, 
 has risen after submersion, etc. 
 
 Among the external appearances iu case, of death by 
 drowning, may be mentioned the following : — 
 
 The position of the body may constitute important 
 evidence ; thus, if a rope or piece of any substance is 
 found tightly clutched in the hand, or if two persons 
 are recovered clasped in each other's arms, the conclu- 
 sion that death has resulted from drowning wiU be 
 greatly strengthened. 
 
 Cutis anserina, ov goose skin, is found in many cases, 
 and although not pathognomonic of drowning, its pres- 
 ence is strongly suggestive of submersion of the body, 
 either during life or soon after death. 
 
 The face in case of drowning is usually pale and 
 placid, though sometimes rosy red. If, however, two or 
 three days in summer, or eight or ten in winter, have 
 elapsed before the body is recovered, or if after recovery 
 it has been exposed for some time to the air, it usually 
 appears red and bloated.. In many cases a watery froth, 
 either white or blood-stained, will be noticed around the 
 nostrils where the body has not been out of the water 
 longer than a day. 
 
 A corrugated condition of the palins of the hands and 
 of the soles of the feet, sometimes called "washer- 
 women's or cholera hand'' may be noted, but is not 
 indicative of submersion during life. 
 
 The pupils are commonly dilated. 
 
 Abrasions or excoriations of the lingers are commonly 
 present, and gravel, sand, mud, etc., are often found 
 under the finger-nails, and fragments of weeds clutched 
 in the hands. 
 
76 MEDICAL JURISPRUDENCE. 
 
 The penis is usually found contracted and retracted, 
 and the scrotum shrunken and wrinkled. 
 
 Post-mortem rigidity is generally present and sets in 
 so rapidly that not unfrequently the body remains stif- 
 fened in the last attitude of life. 
 
 Internal Appearances. The brain in cases of drown- 
 ing is sometimes congested, but not as a rule, very 
 hyperaemio. The blood is generally fluid and of a dark 
 color from want of aeration. The right side of the heart, 
 pulmonary arteries, and venous system are commonly 
 congested with a dark fluid blood, although sometimes 
 the right cavity of the heart is empty, and not unfre- 
 quently the two sides of the heart contain equal quan- 
 tities of blood. 
 
 The larynx, trachea, and bronchi are commonly deeply 
 congested, and the lungs also are usually more or less 
 congested, and so distended as to completely fill the 
 chest. The presence of water in the pulmonary vesicles 
 is strong evidence of submersion during life. Dr. 
 Ogston states, however, that in 48.7 per cent of cases 
 by drowning, no water was found in the air-cells of the 
 lungs. Commonly, though not invariably, a froth, or 
 rather a lather, formed of air, water, and mucus, tinged 
 occasionally with blood, will be found in the air pas- 
 sages and around the lips and nostrils ; although this is 
 usually present, its absence is not proof that the death 
 did not result from drowning. 
 
 The stomach and alimentary canal are often much 
 discolored. The presence of water in the stomach, swal- 
 lowed during efforts to breathe, is a fairly constant ap- 
 pearance ; its quantity and quality should be carefully 
 noted, remembering that a little water in a water 
 
DEATH BY ASPHYXIA, DROWNING, ETC. 77 
 
 drinker's stomach is not significant. If the quantity in 
 the stomach is above half a pint, it may be regarded as 
 having an important bearing upon the cause of death. 
 Its quality may also afford important evidence. 
 
 The liver, spleen, and kidneys are usually gorged with 
 blood ; the bladder rarely contains bloody urine. The 
 nose, lips, fingers, toes, genitals, etc., are sometimes 
 found to have been gnawed by voracious fish. 
 
 The question as to how soon after death by drowning 
 a body rises to the surface, depends upon a variety of 
 circumstances, such as the season of the year, — bodies 
 rising more rapidly in warm weather; the depth of the 
 water, — bodies rising more easily in shallow than in 
 deep water ; the character of the dress ; weights or me- 
 chanical impediments to the rising of the body; the 
 nature of the body, being fat or lean, and the specific 
 gravity of the water, — ' bodies rising less rapidly in fresh 
 than in salt water. Dn Tidy states that, as a rule, the 
 body floats after from five to eight days, and that the 
 popular notion of a body floating in three days is con- 
 trary to his experience, although it may in shallow 
 water float as soon as twelve hours after submersion. 
 
 M. Devergie's conclusions as to how long the body 
 has been under water, formed on a large experience at 
 the Paris morgue, are substantially as follows : — 
 
 During the first four or five days there is little 
 change ; post-mortem rigidity may in some cases continue 
 to the fourth day, especially if the water is cold. 
 
 The fourth or fifth day the skin of the palms, and 
 particularly that of the ball of the thumb and the little 
 finger, and the lateral surface of the fingers begin to 
 whiten. On the sixth or eighth days this extends to 
 
78 MEDICAL JURISPEUDENCE. 
 
 the soles of the feet. The skin of the face softens, 
 and is of a more or less faded white than the rest of 
 the body. 
 
 On the fifteenth day the face is slightly swollen and 
 red ; a green spot begins to form on the skin of the mid- 
 sternum; the hands and feet are quite white, except the 
 dorsum of the latter ; the skin of the palms is wrinkled ; 
 the subcutaneous cellular tissue of the thorax is of a red 
 color, and the upper part of the cortex of the brain is 
 green. 
 
 In one month the face is reddish-brown, the eyelids 
 and lips green and swollen, and the neck slightly green ; 
 a brown spot with green areola, about six inches in di- 
 ameter, occupies the upper and middle part of the ster- 
 num. The skin is very wrinkled and the hair and nails 
 still adherent. The scrotum and penis are much disr 
 tended by gas, so that the latter is sometimes erect. 
 The lungs are emphysematous with the gas of putre- 
 faction. 
 
 At six or seven weeks the neck and thorax are very 
 green, and the cuticle at the wrists begins: to be de- 
 tached. 
 
 At two months the body is covered with slime, which 
 penetrates through the clothes ; the face is enormously 
 swollen and brown, the lips parted so as to expose the 
 teeth. The skin on the middle of the abdomen> on the 
 arms, forearms, thighs, and legs continues natural From 
 this time the skin with the nails attached begins to 
 come off like a glove from the hands and feet ; the hair 
 falls off or can be easily detached by pulling ; the veins 
 are almost completely empty of blood and filled with 
 gas. If, at the moment of death the. right cavities of 
 
DEATH BY ASPHYXIA, DROWNING, ETC. 79 
 
 the heart were gorged with blood, the internal surface of 
 the right ventricle will appear of a jet-black color. 
 
 At two and a half months the green color of the skin 
 extends to the arms, forearms, and legs ; the nails are 
 quite. detached. Some adipocere wiU be formed on the 
 cheeks, chin, breasts, armpits and internal parts of 
 the thighs ; the abdomen is greatly distended by gas. 
 The muscles are not yet much altered in color. 
 
 At three and a half months the scalp, eyelids, and 
 nose are destroyed. The skin of. the breast is generally 
 of a greenish-brown color ; the centre of the abdomen 
 presents an opaline appearancCj scattered over with 
 small erosions caused by the water; larger erosions are 
 found on other parts of the body ; the hands and feet 
 are bare of skin. There is a space between the lungs 
 and the plewra costalis fiUed with reddish serum. 
 . At four and a half months the face and scalp are so de- 
 stroyed as to leave the skull bare, — the remains of the 
 face, neck, and part of the thighs being converted into 
 adipocere. As to the formation of this substance, see 
 page 67, ante. 
 
 Small eminences indicating the commencement of 
 calcareous incrustations are observed on the prominent 
 parts. The brain presents traces of adipocere on its an- 
 terior parts. 
 
 The changes above described will proceed more 
 rapidly in very hot tveather or in putrid pools and 
 ponds, but more slowly in cold water or in salt water, or 
 where the body is closely invested by clothing. The 
 general order of events, however, remains the same. 
 
 In determining the question whether drowning was 
 the cause of the death, or whether the person was already 
 
80 MEDICAL JURISPRUDENCE. 
 
 dead when thrown into the water, it should be remem- 
 bered that no one post-mortem appearance can be re- 
 garded as conclusive ; a correct conclusion can only be 
 formed by the consideration of all the facts revealed by 
 the autopsy. What these facts are has already been 
 stated. It should be remembered, however, that the 
 most characteristic signs of death by drowning are not 
 permanent, and that their continuance is shorter in sum- 
 mer than in winter; while the characteristic signs 
 may remain fifteen days in winter, they may disappear 
 within three days in summer. In a post-mortem after 
 a supposed drowning, all abnormal and diseased con- 
 ditions, such as might of themselves have caused death, 
 should be noted, it being possible that the body has 
 been thrown into the water after death from natural 
 causes. 
 
 Very little water is required to drown ; so long as 
 the face is covered it is sufficient. 
 
 The determination of the question T^hether the drown- 
 ing was accidental, suicidal, or homicidal, in the absence 
 of marks of injury, or even in the presence of marks 
 which may have been self-inflicted or caiised by the 
 water or by objects in the water, is very difficult, if not 
 impossible. The presence, however, of certain marks of 
 violence, etc., such as a cord around the neck, stabs, 
 pistol wounds, etc., is suggestive of homicide. The 
 question whether the wounds were inflicted before death 
 and were the cause of the death may sometimes be de- 
 termined by considerations stated in the chapter on 
 Wounds. Whether they are suicidal, accidental, or hom- 
 icidal is frequently impossible to determine ; and when 
 it can be determined, must depend upon the application 
 
DEATH BY ASPHYXIA, DROWNING, ETC. 81 
 
 of the ordinary rules of evidence and not upon the med- 
 ical expert. 
 
 Death by Hanging. By death by hanging is meant 
 death caused by the partial or total suspension of the 
 body by the neck by means of a ligature of some sort, 
 the constricting ibrce being the weight of the body 
 itself. 
 
 In hanging, death may result from asphyxia, cerebral 
 hypersemia, a combination of asphyxia with apoplexy, 
 syncope, or injury to the spinal cord and the pneumo- 
 gastric nerves. According to Casper, out of eighty-five 
 cases nine cases were caused by apoplexy, fourteen cases 
 by asphyxia, and sixty-two cases by mixed conditions. 
 Whether death resulted from one or the other of these 
 causes will depend upon the tightness of the ligature, 
 the position at which it crosses the neck, and whether 
 or not force is employed, as well as the degree of force. 
 Where the ligature is very tight, or a loose ligature 
 crosses the neck above the os hyoides, asphyxia will pre- 
 dominate over coma ; where the ligature is loose, and the 
 larynx is protected by the cord pressing against the os 
 hyoides, then coma will predominate over asphyxia. 
 A combination of asphyxia and coma is commonly 
 the cause of death in cases of hanging by suicide, 
 and where no violence has been exerted, the ligature 
 both preventing the return of blood from the head, — 
 thereby inducing congestion of the brain, — and pre- 
 venting the entrance of air to the lungs, thereby 
 causing apncea. 
 
 Dr. Tidy states his conclusions thus : " (1) Given 
 pressure both on the air-tubes and blood-vessels, 
 pressure on the air-tubes being only partial, death will 
 
 6 
 
82 MEDICAL JURISPEUDENCE. 
 
 probably result from a combination of asphyxia and 
 apoplexy, but from asphyxia primarily. (2) Given a 
 pressure in such a position that the air-way is more 
 or less protected, death may occur from apoplexy and 
 will then be slow. (3) Given a complete pressure, so 
 that the entrance of air into the lungs is entirely 
 prevented, death will result from asphyxia, and wiU 
 be rapid and possibly even instantaneous." 
 
 In cases where violence has been exerted, as in felo- 
 nious and homicidal cases of hanging, when sufficient 
 force is applied to break the transverse and other liga- 
 ments, or to fracture the odontoid process of the axis, 
 death will be rapid, if not instantaneous. Under such 
 circumstances the medulla oblongata can scarcely es- 
 cape severe injury ; and as this contains the centres 
 of respiration and circulation, death will ordinarily be 
 instantaneous. 
 
 In most cases of hanging unattended with violence, 
 there are three distinct stages : first, a short stage of 
 semi-unconsciousness, lasting from thirty seconds to 
 three minutes; secondly, a stage of subjective death 
 but of objective life, varying from ten minutes onwards ; 
 and lastly, a stage of general death, lasting until the 
 occurrence of rigor mortis. 
 
 Without repeating those appearances common to 
 death by apncea or coma, the post-mortem appearances 
 after death by hanging are as follows : — 
 
 The body may be found in rigor mortis in almost 
 any position. The position of the head will vary ac- 
 cording to the position of the knot or of the liga- 
 ture ; the usual position in suicide is for the head to 
 be forcibly flexed forwards ; the face is sometimes pale 
 
DEATH BY ASPHYXIA, DROWNING, ETC. 83 
 
 but more often swollen and congested; the tongue is 
 usually enlarged and livid, either protruding or com- 
 pressed between the teeth ; the eyes are nearly always 
 staring and prominent and the pupils dUated; blood- 
 stained froth is sometimes found about the nose and 
 lips; the fists are often shut down so tightly that the 
 finger-nails penetrate the palms ; the neck usually ap- 
 pears stretched, and will probably show the marks of 
 the ligature. If the ligature is very soft and the body 
 cut down instantly after death there may be no mark 
 of the ligature ; the mark, when it exists, is usually 
 oblique, following the line of the lower jaw ; it is usu- 
 ally non-continuous where there is only one turn of the 
 cord, but where it has passed around the neck more than 
 once one mark may be circular and the other oblique. 
 The appearance and character of the mark of course 
 vary with the nature of the ligature and its method of 
 application, the vitality of the tissues, and the period 
 that has elapsed after death. Its size and depth do not 
 necessarily correspond with the size of the ligature, al- 
 though the narrower the ligature, and the longer the 
 suspension, the deeper as a rule will be the mark. 
 It is usually a well-defined groove or furrow, single or 
 double, regular or irregular, like its cause. If the person 
 is young and the tissues healthy and the suspension brief, 
 the mark may be a slight depression without change of 
 color or at most a red blush ; more frequently, however, 
 the bottom of the furrow appears white, and its edges 
 are usually slightly raised and red. The most common 
 appearance, however, according to Dr. Tidy, presented 
 by the mark is that of a dry, hard, yellowish-brown, 
 parchment-like furrow ; which condition was found by 
 
84 MEDICAL JURISPRUDENCE. 
 
 Dr. Ogston in 32i per cent of his cases. This condition, 
 however, is not apparent till the body has remained sus- 
 pended after death for several hours, and it does not 
 prove suspension during life. 
 
 The state of the genital organs is often one of turges- 
 cence ; the penis is often more or less erect, and there 
 is often an emission of seminal or prostatic fluid ; the 
 urine and fiEces are sometimes expelled; there is in- 
 variably a flow of saliva from the mouth, which be- 
 ing a vital act, may be regarded as evidence that the 
 suspension took place during life. 
 
 The internal post-mortem appearances in cases of 
 hanging other than those described under the head 
 of asphyxia and coma, are the fracture or dislocation of 
 the cartilages of the larynx and, rarely, the fracture 
 of the OS hyoides ; there may also be a dislocation of 
 the cervical vertebrae, accompanied with rupture of the 
 ligaments and fracture of the odontoid process; the 
 inner and middle coats of the carotid artery may be 
 ruptured ; there may also be lesions of the skin or of 
 the deeper-lying soft parts ; the larynx and trachea 
 are usually deeply congested ; the condition of the lungs 
 and heart will vary accordingly as death resulted from 
 syncope, asphyxia, etc. ; the stomach is often so con- 
 gested as to resemble the effects of irritant poisoning ; 
 the cerebral vessels are rarely much congested. 
 
 As to -whether hanging -was the cause of death or 
 not, it must be remembered that the mark of a cord 
 is not conclusive proof of death by hanging; nor is 
 its absence conclusive evidence that death did not re- 
 sult from hanging. The fact that the body is found 
 in such a position that the feet can touch the ground is 
 
DEATH BY ASPHYXIA, DROWNING, ETC. 85 
 
 not evidence that the death did not result from hanging. 
 Suicide by hanging is consistent with almost any posture 
 of the body ; persons so dying have even hanged them- 
 selves lying at full length on a bed. On the whole, 
 the medical jurist can seldom give a certain answer to 
 the question whether death was caused by hanging. 
 
 The determination of the question whether the hang-? 
 ing was accidental, suicidal, or homicidal must usually 
 depend upon the circumstances of the case, and the gen- 
 eral rules of evidence, with which the medical jurist 
 has no concern. It may be remarked, however, that the 
 probabilities are in favor of suicide ; it must be remem- 
 bered also that hanging may occur by accident. 
 
 Death by Strangulation. — By death by strangulation 
 is meant death resulting from pressure on the neck ap- 
 plied otherwise than by the weight of the body itself, — 
 as by the fingers and thumb, knee, ligatures, etc. Death 
 by strangulation is generally due to apnoea, and hence the 
 post-mortem appearances of asphyxia are usually more 
 marked than in death by hanging. The face and extremi- 
 ties are usually livid and swollen; there are minute 
 ecchymosed spots on the skin of the face, neck, chest, 
 and conjunctivae ; blood occasionally issues from the 
 mouth, nostrils, ears, and eyes ; the eyes are congested 
 and prominent, usually wide open with dilated pupils ; 
 the tongue is frequently swollen, protruded, dark-col- 
 ored, and sometimes bitten ; the hands are commonly 
 clenched. The marks on the neck will vary according 
 to the nature of the force employed. Where the cause 
 is manual pressure, marks of the thumb and one or more 
 fingers, together with scratches caused by the nails, are 
 usually found on the front of the neck. Where strangu- 
 
86 MEDICAL JUEISPETJDENCE. 
 
 lation is caused by a ligature, a mark usually more 
 entirely encircles the neck than in hanging, and is 
 generally lower and less oblique. Where the pressure 
 is caused by a hard body wrapped in a handkerchief, 
 etc., there may be bruises of considerable size at one 
 spot on the neck. Generally effused blood will be 
 found in the subcutaneous areolar tissue and muscles 
 under the mark. The inner and middle coats of the 
 carotid arteries may be ruptured ; the lining membranes 
 of the larynx and trachea are always more or less con- 
 gested ; extreme injury to the neck, though it sometimes 
 occurs, is not common. In homicidal throttling ex- 
 tensive lesions of the larynx usually occiir. The brain 
 is sometimes congested but usually normal ; the lungs 
 are sometimes congested and sometimes normal ; some- 
 times patches of emphysema due to the rupture of the 
 superficial air-cells, either singly or in groups, are found 
 in the lungs ; the heart is sometimes empty and some- 
 times full of dark fluid blood ; the genitals of both male 
 and female are sometimes congested ; involuntary dis- 
 charges of urine, faeces and seminal fluid may or may 
 not occur; the stomach is often congested, sometimes 
 normal ; the blood is usually very dark and very fluid. 
 
 It is very difficult to determine whether death was 
 actually caused in any instance by strangulation. A 
 medical jurist would not be justified in pronouncing 
 death to be the result of strangulation by anything short 
 of distinct external marks. 
 
 Whether a given case of strangulation was suicidal 
 or homicidal is a difficult question, and must be deter- 
 mined by the ordinary rules of evidence. 
 
 Death by Suffocation. — By suffocation is meant the 
 
DEATH BY ASPHYXIA, DROWNING, ETC. 87 
 
 exclusion of fresh air from the lungs hy means other 
 than external pressure on the trachea. Within this 
 definition are included both drowning and smothering. 
 Drowning has ah-eady been considered ; and in this con- 
 nection death by smothering alone will be considered. 
 
 Suffocation may be variously caused, — by direct 
 pressure on the thorax ; by covering the head with bed- 
 clothes, shawls, etc. ; in case of infants, by overlying ; or 
 by anything^ which will prevent the entrance of air into 
 the lungs. The air passages may be closed internally 
 by foreign bodies either in the air passages or in the 
 oesophagus. Suffocation has also been caused from ob- 
 structions caused by the tongue, epiglottis, and velum 
 palati, during the administration of ansesthetics while 
 the patient is lying down. It has also been caused by 
 blood from the nose and from wounds of the mouth or 
 throat ; by scalds or other irritations of the epiglottis ; 
 tumors pressing on the throat ; the bursting of an ab- 
 scess in the pharynx or tonsils; and in various other 
 methods too numerous to mention. 
 
 In cases of complete suffocation, experiments render 
 .it probable that death will occur on an average in from 
 two to five minutes. 
 
 The post-mortem appearances in death from suffoca- 
 tion are principally those of asphyxia already described, 
 although it is said these appearances are not so well- 
 marked as might be expected. If external violence has 
 been used there may be flattening of the nose and lips ; 
 ecchymosed scratches upon the throat may be found. 
 Patches of lividity, and of dotted or punctiform ecehy- 
 moses will usually be found on the skin and conjuncti- 
 vae ; the lips and extremities are usually livid ; the face 
 
88 MEDICAL JUEISPRUDENCE. 
 
 may be pale or violet, but is often placid ; the eyes are 
 usually congested ; mucus and sometimes blood-stained 
 froth is found about the mouth and nose ; the blood is 
 usually dark-colored and very liquid ; the brain and the 
 vessels of the pia mater are generally congested; fre- 
 quently the right side of the heart is more or less full of 
 blood, but occasionally the heart has been found empty ; 
 the trachea is usually of a bright-red color, and often 
 contains bloody froth ; the oesophagus and trachea frer 
 quently exhibit evidence of injury ; the lungs are some- 
 times very congested, at other times ngrmaL 
 
 Tardieu and others lay a special stress on the exist- 
 ence of punctiform subpleural ecchymoses, which are 
 usually found at the root, base, and lower margin of the 
 lungs. That these punctiform ecchymoses are not in- 
 fallible signs of death from smothering, seems to have 
 been proved by Dr. Ogston, for they are sometimes ab- 
 sent in cases of death by suffocation, and they may be 
 present when death is due to some other cause. 
 
 The kidneys are generally congested. In a post-mor- 
 tem examination in a case of suspected smothering, care- 
 ful examination should be made of the air passages for 
 foreign bodies. 
 
 As there is no absolutely certain anatomiCEil appear- 
 ance characteristic of death by strangulation, the ques- 
 tion whether death is so caused does not admit of a 
 positive answer from post-mortem appearances alone; 
 but must be determined from these in connection with 
 the other evidence of the case. 
 
 The question whether the death was accidental, sui- 
 cidal, or homicidal is one to be determined by the legal 
 rather than the medical jurist. 
 
CHAPTER VI. 
 
 DEATH FROM HEAT ; COLD ; LIGHTNING ; AND STARVATION. 
 
 The average temperature of the body in health is 98.6° 
 F., or 37° C. in the mouth and axilla ; or from .9° to 
 1.3° r. higher in the vagina or rectum. The tempera- 
 ture may range 1.8° F. above or below the above 
 average consistently with health. In disease or after 
 accidents, the temperature may rise, or fall below the 
 normal. In certain diseases it may range as high even as 
 115° F., and there are recorded instances of the tempera- 
 ture falling as low as 75° F. ; but such high or low tem- 
 peratures are very exceptional. It may be stated as a 
 general rule that if the temperature of a warm-blooded 
 animal be raised for any length of time by any means 
 to the extent of from 11 to 13 degrees F., death is 
 certain ; and that if the normal temperature is for any 
 length of time depressed from 18 to 27 degrees F., death 
 is equally certain. The very young and the very old 
 have limited powers of heat production, and cannot 
 therefore well endure extreme cold. Young adults bear 
 cold the best, and young males better than females of 
 the same age. With proper precautions, however, ex- 
 treme heat and extreme cold may be tolerated for some 
 time. Death from cold is usually accidental, although 
 there are recorded instances of the application of cold 
 for the purpose of homicide, especially in the case of 
 
90 MEDICAL JURISPRUDENCE. 
 
 new-tom infants. A new-born child, if left unclothed or 
 exposed to the air in a cold room, will soon die. Insane 
 persons are said to be more susceptible to the effects of 
 cold than sane persons, although frequently insensible 
 so far as their feelings are concerned. In the cases of 
 wounded persons, exposure to cold will also undoubtedly 
 increase their danger. 
 
 As to the post-mortem appearances in death from cold, 
 rigor mortis generally sets in slowly and lasts for a long 
 time. Dr. Ogston, from the inspection of sixteen bodies 
 after death from cold, comes to the conclusion that where 
 all the hereinafter described appearances are encoun- 
 tered in the same case, in the absence of any other ob- 
 vious cause of death, they point with high probability 
 to the death's having been caused by cold. In adults 
 these peculiar appearances are : — 
 
 First, an arterial hue of the blood generally, except 
 when viewed in mass within the heart. The presence 
 of this coloration was not noted in two cases. 
 
 Second, an unusual accumulation of blood on both 
 sides of the heart, and in the larger blood-vessels, arterial 
 and venous, of the chest. 
 
 Third, pallor of the general surface of the body, and 
 aneemia of the viscera most largely supplied with blood. 
 The only exceptions to this were moderate congestions of 
 the brain in three cases, and of the liver in seven. 
 
 Fourth, irregular and diffused dusky-red patches on 
 limited portions of the exterior of the body encountered 
 in non-dependent parts ; these patches contrast forcibly 
 with the pallor of the skin and general surface. " The 
 above appearances," says Ogston, " were not, however, so 
 universally met with in the children as in the adults. 
 
DEATH FROM HEAT, COLD, ETC. 91 
 
 The arterial hue of the blood was absent in one ; the 
 anfemia of the larger viscera in all but one instance. 
 The pallor of the surface was present, nevertheless, in 
 all but one of the children, and the dusky-red patches 
 on the whole of them." He states in conclusion, how- 
 ever, that " the subject of death by cold, so far as it can 
 be ascertained by the inspection of the dead body, re- 
 quires further elucidation than has yet been bestowed 
 upon it." 
 
 Certain parts of the body may be found frozen, but 
 this is usually a post-mortem phenomenon ; putrefaction 
 does not occur at a freezing temperature. 
 
 Death by Heat. — Eespecting the immediate cause of 
 death by heat, " our ignorance " says Dr. Ogston, " is still 
 great." During the heated season death from sun-stroke, 
 insolation, or thermic fever is not uncommon. Something 
 more than mere heat is probably necessary to induce 
 thermic fever; for there is a recorded instance where 
 a man in good health has remained in the hot room 
 of a Turkish bath continuously for four days without 
 injury to his health, the day temperature averaging 
 140° F., and the night temperature 125.° 
 
 There are three classes of cases included under the 
 general term "sun-stroke." The first, which is said to be 
 very rare, is acute meningitis or phrenitis. In the sec- 
 ond, there is heat exhaustion with collapse, a rapid, 
 feeble pulse, cold moist skin and a tendency to syncope. 
 In the third class there is thermic fever ; and of this 
 fever the name " sun-stroke '' is considered by Dr. Wood 
 a misnomer, — it being caused by the action of external 
 heat independently of its source. The phenomena of 
 sun-stroke and heat apoplexy are said to depend on the 
 
92 MEDICAL JURISPRUDENCE. 
 
 action of the superheated blood upon the nerve centres 
 and large internal organs. But for the further con- 
 sideration of this subject the student must be referred to 
 technical works on the practice of medicine. 
 
 The post-mortem appearances are, as a rule, negative ; 
 that is, there are no constant lesions, and in some cases 
 nothing abnormal is found. 
 
 As to the so-called cases of spontaneous combustion, 
 while it is possible that iinder certain circumstances, as 
 for instance, in hard drinkers, the body may be preter- 
 naturally combustible, the alleged cases of spontaneous 
 human combustion do not seem to be entitled to much 
 consideration. 
 
 Death by Lightning or Electricity. — In cases of deatll 
 by lightning, death may be caused by shock, by the 
 severity of resulting burns and wounds, or by the disor- 
 ganization of tissues and rupture of structures necessary 
 to life. 
 
 Where the death has been instantaneous, characteris- 
 tic appearances are not invariably met with in the body. 
 Burns and blisters are common effects ; wounds and a 
 bruised condition of the parts are not uncommon ; liArid 
 streaks and ecchymosed spots are frequent ; frequently 
 the marks assume a peculiar arborescent appearance 
 depending upon the course of the veins, or the disposi- 
 tion of metallic bodies about the person, which marks 
 are said to be very indicative of death by lightning. 
 Various nervous and other symptoms often follow 
 a severe shock by lightning which does not cause 
 death. 
 
 The indications of this form of death are strengthened 
 by evidence in the vicinity of the dead body of the 
 
DEATH FROM HEAT, COLD, ETC. 93 
 
 effect of tte electric current on trees, buildings, etc., or 
 upon domestic animals in the vicinity. 
 
 Death by Starvation. — There are two sorts of starva- 
 tion, chronic and acute. By the former is meant the 
 withholding of food either sufficient in quantity or pro- 
 per in quality to support life. It may also result from 
 mal-assimilation of food in disease, nausea in pregnancy, 
 and from other causes. 
 
 By acute starvation is meant the deprivation of all 
 food from a person previously well fed. In chronic 
 starvation hunger is not a marked symptom ; in acute 
 starvation intense hunger appears to be a symptom of 
 comparatively short duration. 
 
 The general symptoms of starvation appear to be those 
 of great nervous depression ; the pulse is usually slow 
 and soft ; the features collapsed ; the voice hollow and 
 the breath offensive. There is usually a marked debil- 
 ity, with great languor, listlessness, irritability, and des- 
 pondency. The skin is usually harsh and dry, and 
 frequently, especially in chronic cases, becomes covered 
 with a brownish-colored, filthy-looking coating. There 
 is great emaciation ; pain and irritation in the stomach 
 are usually troublesome. As a rule, the bowels are 
 very costive and the body generally feels cold. The 
 mucous membranes of the outlets of the body are fre- 
 quently red and inflamed ; the temperature is generally 
 lowered ; there is great loss of weight, — amounting, it 
 is said, in fatal cases, to an average of forty per cent 
 of the entire weight. 
 
 As to the time of death in starvation, much depends 
 upon the previous condition of the body, access to fresh 
 water, existence of warmth, age, etc. Old people seem 
 
94 MEDICAL JURISPRUDENCE. 
 
 to bear want of nourishment best; middle-aged next; 
 those just arrived at puberty are less able to endure it, 
 and children are the least able. The time of the re- 
 corded cases of death from starvation, without taking 
 into account access to water, varies from the seventh to 
 , the sixtieth day. The average period of death in case 
 of complete deprivation of food would seem to be from 
 seven to ten days. The longest authentic period of 
 total deprivation of food in human beings, according to 
 Woodman and Tidy, is about six weeks. In the case 
 of Griscom, reported by Dr. Lester Curtis, of Chicago, 
 the fast extended forty-five days without fatal results. 
 The cases of deprivation of food longer than this, and 
 most of those much shorter, may well be regarded with 
 suspicion. 
 
 Our knowledge of the post-mortem appearances in 
 cases of starvation is principally derived from chronic 
 cases. In such cases the body is always greatly emaciated, 
 and there is an almost entire absence of fat ; sometimes, 
 however, one part is much more emaciated than an- 
 other. The condition of the skin has already been noted ; 
 the muscles are commonly soft, pale, and wasted ; the 
 heart is generally not quite empty ; it is usually, how- 
 ever, more or less contracted, and sometimes soft and 
 bloodless. The oesophagus is usually small and con- 
 tracted. The condition of the stomach has been variously 
 recorded as natural, as small and contracted, as corru- 
 gated, as loose and flabby. It frequently contains a lit- 
 tle dark, gelatinous fluid. The small intestines are 
 generally contracted both in length and calibre, and are 
 commonly thin and transparent ; they are sometimes 
 empty, sometimes contain a little dirty mucus, and are 
 
DEATH FKOM HEAT, COLD, ETC. 95 
 
 sometimes distended with gas. The large intestines' 
 are usually transparent, and frecLuently contain hard, 
 fsecal matter ; the omentum is usually transparent ; the 
 liver is usually healthy but contracted ; the gall-bladder 
 is usually full ; the pancreas is invariably atrophied, and 
 the bladder invariably empty ; the tissues of the uterus 
 are often soft and relaxed. 
 
 A contracted state of the stomach and bladder, and a 
 shrunken and transparent condition of the intestines 
 and omentum, with a more or less atrophied but other- 
 wise healthy condition of the viscera, appear to be the 
 prominent post-mortem appearances after death from 
 starvation. 
 
CHAPTEE VII. 
 
 PKEGNANCY. 
 
 The general opinion of the profession is generally 
 believed, at least up to a very recent period, to be the 
 same as that expressed by Dr. Emmett, who in his 
 •work on Gynecology has said, "Pregnancy may be 
 suspected, but we have no sure and at the same time 
 lawful means of proving its existence before quickening, 
 or until the enlarged uterus has risen from the pelvis 
 into the abdominal cavity ; when this has occurred, if 
 pregnancy exists the beating of the festal heart may 
 be detected, or the motion of the child may be felt, 
 and either of these must be accepted as conclusive 
 evidence." 
 
 While this statement is probably correct, still, preg- 
 nancy can hardly exist without furnishing evidence of 
 its existence ; and although perhaps its existence can- 
 not be demonstrated conclusively before quickening, 
 it may under many circumstances be made highly 
 probable. 
 
 In determining whether a living woman is, or is not 
 pregnant, it should be emphasized at the outset that 
 the medical jurist should not rely upon the statements 
 of the woman herself. The signs which present them- 
 selves prior to the end of the iifth month or the begin- 
 
PREGNANCY. 97 
 
 iiing of -'the^Bixtli are not to be regarded as entirely 
 conclusive; among these may be mentioned — 
 
 1. The cessation of the menses. 
 
 2. Various sympathetic disorders, such as morning 
 sickness, vomiting, loss of appetite, sailivation, headache, 
 and toothache; Morning sickness commonly com- 
 mences from the second to the sixth week after con- 
 ception, and generally ends about the fourth month. 
 
 3. Changes in the mammae. These changes usually 
 begin with pregnancy and become clearly perceptible 
 at the end of six weeks or two months. The breasts 
 grow'.'larger, firmer, and ■ more knotty. At; the end of 
 sisc or seven weeks an areola or decided darkening 
 (this only applies to a first pregnancy, as it is apt to 
 retain -its color and/. breadth after women have borne 
 one or more children), will be. moticed around the 
 lapple, varying, in diameter from, one half to two or 
 three inches. Upon this dark ground are to be noted 
 from twelve to twenty follicles or tubercles of a lighter 
 color. I The superficial veins also become prominent as 
 ,pregnancyiadvances,vand sometimes circular streaks will 
 be seen by slightly stretching. the skin. :The nipples 
 become more prominent and swollen, and now begin to 
 secrete; a 'milk'like fluid which- may be squeezed there^ 
 from. ) The skin 'around ;the nipples is in most cases 
 soft and moist. ' 
 
 4. Abdominal symptomsK During the first two months 
 of pregnancy ;there is little ohailge in the; size of the 
 abdomen^ if anything, it is a little flatter. About the 
 third >month, however, the abdomen begins: to increase 
 in size ; ■ the skin is gradually stretched and the navel 
 obliterated; and from! this .time the. abdomen steadily 
 
 7 
 
98 MEDICAL JUKISPRUDENCB. 
 
 increases in size till nearly the end of gestation. At 
 the end of the eighth month, when the uterus has 
 reached the ensiform cartilage, the navel becomes very 
 prominent. 
 
 Dark pigment-cells are deposited, especially along 
 the mesial line of the abdomen, extending from the 
 pubes to the umbilicus or the sternum. They are most 
 marked in a dark-complexioned woman. 
 
 5. Changes in the Vagina and uterus. The vagina 
 in pregnancy is generally somewhat relaxed, its mucous 
 membrane congested, giving it a violet tinge ; the inner 
 surface of the vulva also presents the same appearance. 
 This condition generally continues until the fourth or 
 fifth month. In this connection mention should be 
 made of the state of the urine during pregnancy. The 
 deposit known as "kiestine" was once thought to be 
 diagnostic of pregnancy, but at the present time it is 
 Regarded as a sign of little value. 
 
 The state of the os and cervix uteri deserves particular 
 attention. Soon after impregnation, on digital exami- 
 nation per vaginam, the cervix will be felt to be fullerj 
 rounder, and more spongy or elastic than in its unim- 
 pregnated state, while its orifice will have lost its 
 transverse shape and well-defined edge and become 
 rounder and thicker. Gradually, as the period of preg- 
 nancy advances, it not only becomes less prominent, but 
 from and after the sixth month more and more flat- 
 tened, till about the time of delivery, when it can no 
 longer be felt. For the first three months it is low 
 down in the vagina; a little earlier than the fifth 
 month it rises with the ascent of the uterus into the 
 abdomen, and from this period it recedes farther from 
 
PREGNANCY. 99 
 
 the external parts, and ceases to be distinguishable as 
 a projecting body. The absence of these changes in the 
 OS or cervix uteri is of more value than their presence. 
 
 The changes in the body of the uterus are important; 
 During the first three months the degree of its develop- 
 ment is ascertained with difficulty ; by the end of the 
 fourth month the fundus of the uterus may be felt, 
 especially in a thin person, above the anterior wall of 
 the pelvis. During the fifth month it has usually risen 
 between the pubes and the umbilicus. During the 
 sixth month the fundus rises as high as the umbilicus. 
 The seventh month it is on a level with a point midway 
 between the umbilicus and lower end of the sternum ; 
 and at the end of the eighth month it has reached its 
 highest point, the level of the ensiform cartilage, from 
 which it settles to a somewhat lower position before 
 delivery. 
 
 A new sign has recently been brought to the notice 
 of the profession by Dr. Hegar of Freiburg, which seems 
 to be of considerable promise and has recently attracted 
 much attention. This sign is said to consist of an 
 unusual resilience, compressibility, softness, bogginess, 
 yielding and thinning of the lower uterine segment, '■ — 
 that is, the section immediately above the insertion of 
 the sacro-uterine ligaments. The remainder of the body 
 of the uterus is often firm and hard, and its shape is 
 stated to be more fan-like, or like that of a balloon, than 
 the usual pear shape. This enlargement is especially 
 marked antero-posteriorly; the change is most apparent 
 at the middle portion of the lower segment in the mesial 
 line, the sides of the organ being much firmer and more 
 resistant. 
 
100 MEDICAL JUEISFEtJDENCE. 
 
 : > Ddring theiourth' month, and thereafter^ a low mttr- 
 muiing oncooing sound, like that *niade" by gently; How* 
 ing over the mouth. of a wide bottle, but "with no impulse, 
 may sometimes be madeout; this is called the ^5uterine 
 or placental souffle,-^' this,; however, is not a certain 
 sign of pregnancy, as it- may be caused . by a ttimor 
 ptessing upon the^aorta 6v the iliac vessels. 
 ' 6. Evidence afifotded by the condition of the foetus; 
 This subject may be considBred under three headd: 
 first, its passive movements;- secondly, indications of ita 
 vitality afforded by the stethoscope; and thirdly,- active 
 movements of the foetusi usually called quickening. ' ' 
 ■ a. The passive movements- of the feetus may be 
 demonstrated by what is known as "balottement;" 
 that' is to say, an- impulse'; given to' the feetus by the 
 finger applied, to theios uteri fiaongh the vagina while 
 the woman is in a standing position, or lying with the 
 trilnfc in a senii-recumbent- position, the- foetus being 
 raised through the fo'g't* or amnii by; the finger giving the 
 impulse, to return a^in to its original position at the 
 lowest part: of the uterus. It is seldom' satisfactory 
 earlier tfen about the end of the fourth, or later than 
 about the end of the sixth month of utera gestation: 
 This sign is a sign- of considerable value,but probatbly 
 not Conclusive.' The following signs are, however, con- 
 clusive. ■ ' • - 
 •6. Byrthe use of the stethoscope applied to the uter- 
 ine region of the. abdomen, the' pulsations of the foetal 
 heart, may frequently be heard; although they can, ac- 
 cording to Dr. Tidy, seldom . be satisfactorily 'made' out 
 earliei^.than the end of the fifth month. . According to 
 Dr. Lusk, they may generally be made out by ausculta" 
 
PEEGNANCY. 101 
 
 tion by 'the. eigbteenth to. tbe twentieth week; under 
 favorable circumstanoeScthey have been detected as early 
 as the 'fifteenth to the -sixteenth week.' They resemble 
 the ticking of a watch under a pillow, and vary, in fre- 
 quency from 120 to 160 beats per minute. 
 
 c. The active movements of the foetus ■afford further 
 conclusive proof of pregnancy ; these active movements, 
 called quickening, are, according to Dr, Tidy, experienced 
 usually 'by the pregnant -female between the sixteenth 
 and the twenty-fourth week, but may -occur as early as 
 the twelfth. According to Dr. Lusk, modern investi- 
 gations place the time at which the fcetus first begins 
 to' employ its muscles at about the tenth week. It is, 
 however, according to him, somewhat rare for these 
 movements to excite the attention of the mother before 
 the sixteenth to tiie eighteenth ■week, though experir 
 eneed matrons may itecognize them at an earlier period. 
 As a subjective symptom quickening is of little value, 
 but as an objective symptom where care is taken not to 
 confound it with thte contractions of the uterus itself or 
 with the abdomitial muscles, it is conclusive. This 
 foetal impulse- may, according to Dr. Tidy> often be 
 felt externally about the third or fourth month. Ac- 
 cording to Lusk, active foetal- movements, such as may 
 be reeognized by >the' medical expert, seldom assume 
 much distinctness before the sixth month.- ' When 
 recognized distinctly they are conclusive.'. 
 
 The signs of pregnancy discoverable by a post-mortem 
 examination are, aside from the subjective . symptoms, 
 fchiefly those which- would ^be observed in the living; 
 besides these, however, the presence of the ovum or 
 the existence of a distinct foetus with its placenta and 
 
102 MEDICAL JUEISPRUDENCE. 
 
 membranes would be demoustrated upon a post-mortem 
 if the woman were actually pregnant. 
 
 A true corpiis luteum should be present in one or both 
 ovaries. By true corpus luteum, or tbe corpus luteum of 
 pregnancy, is meant the cicatrice formed after the dis- 
 charge of the impregnated ovum; by a false corpus luteum 
 or menstrual corpus luteum, is meant that which is formed 
 after the discharge of the unimpregnated ovum at each 
 menstrual period. This subject has in the past afforded 
 a fruitful field of controversy. Without entering into 
 the full consideration of the subject (for which the 
 reader is referred to standard works on obstetrics and 
 physiology) it may be said that the subject has lost 
 much of the importance formerly attributed to it, for 
 the reason that pregnancy may exist without the for- 
 mation of any true corpus luteum, and that corpora lutea 
 may be found where there has been no pregnancy what- 
 ever, and that even in aged women long past the child- 
 bearing period. 
 
 The question sometimes arises for decision by the 
 medical jurist, whether a woman has or has not been 
 pregnant at some period in the past, and may be par- 
 ticularly important in certain cases of disputed identity 
 after death. The presence of an intact hymen is of 
 course very strong evidence that no mature or nearly 
 mature child has been born in the natural way. Cse- 
 sarean section would leave a long scar. If the breasts 
 and genital organs preserve their elasticity and virginal 
 character, the evidence is strong although not con- 
 clusive against previous pregnancy. The reader is 
 referred in this connection to the signs of pregnancy, 
 ante. As a general rule, no absolutely certain opinion 
 
PREGNANCY. 103 
 
 can be given at the autopsy whether a woman has or 
 has not borne children; but as a question of proba- 
 bility some reliance may be placed on the internal 
 appearance of the uterine walls, more especially as 
 respects their convexity. In the multiparous uterus, 
 the anterior and posterior surfaces of the body of the 
 uterus are more rounded than in the virgin uterus. The 
 fundus instead of being flat is convex, so that there is 
 considerable protuberance above a line drawn from one 
 Fallopian tube to the other; the vaginal portion of the 
 neck is altered, being usually larger and more prominent 
 in the vagina. The os uteri, instead of presenting a 
 transverse fissure or smooth round aperture, is more 
 open and puckered; the depression is more evident, and 
 the orifice considerably larger. The uterus after ges- 
 tation rarely returns to the size of the nulliparous organ; 
 its diameters are all increased ; the cavity of the body 
 of the multiparous uterus is also considerably enlarged ; 
 the OS internum is less distinct and the canal of the 
 cervix shorter; the penniform rugae are considerably 
 obliterated ; the cavity of the body is less distinctly tri- 
 angular in shape, — the angles into which the Fallopian 
 tubes enter being less marked. Again, if the posterior 
 commissure or fourchette be intact it is morally certain 
 that the woman has not given birth to a child at full 
 term. The posterior commissure is, however, rarely 
 affected by sexual intercourse, even in the case of pros- 
 titutes ; although it may be destroyed by extreme vio- 
 lence short of the birth of a child, its ruptured condition 
 is strong evidence of the woman's having borne a child, 
 while its intact condition is strong evidence of non- 
 delivery, or at least of non-delivery at full term. 
 
104 MEDICAl JURISPRUDENCE. 
 
 As to the time which must elapse after- delivery before 
 a woman can again become pregnant, it is to be re- 
 marked that the time for the restoration of the genital 
 organs to their normal condition is' very different 'in 
 different women; and the time' which must intervene 
 between the delivery of one child and the concepfcioft of 
 a second has been variously stated at from fourteen 
 days to one month. 
 
 The subject of the duration of pregnancy, superfo;- 
 tation and other kindred subjects, will be considered in 
 the chapter on Legitimacy AND Paternity. - 
 
 In concluding this chapter, it should be always re- 
 membered that a medical man has no right to examine 
 a woman in a case of suspected pregnancy without her 
 fuU consent, unless under the orderof a court of com- 
 petent jurisdiction. 
 
CHAPTEE VIII. 
 
 DELIVEEY. 
 
 The signs of recent delivery in the living may become 
 a matter of inquiry in cases of suspected concealment of 
 birth and child-miirder as well as in some other cases. 
 The degree 'of certainty in such inquiries depends much 
 upon the time that has elapsed since the birth of the 
 chili The evidence to be derived from an inspection 
 of the child will be considered in another connection. 
 If the examination of the alleged' mother be conducted 
 within a week, most of the following symptords' will 
 be present; but if the examination be delayed much 
 beyond a week or ten days the evidence of recent 
 delivery will be inconclusive if not negative. The signs 
 of recent delivery at or near full term, are as follows : — 
 
 A peculiar "pallid expression of couhtenahce ; eyes 
 sunken, with a dark areola under and around them ; a 
 pecuUar odor of the body is also present ; the skin is 
 usually soft, moist, and relaxed; the pulse will be a little 
 quickened and more than usually soft and compressible. 
 
 The time occupied by the following signs is divided 
 by Dr. Ogston into three periods ; — 
 
 The first period which is of an average duration of 
 forty-eight hours, embraces the time from the moment 
 of delivery to the approach of, the milk fever.^ If the 
 
 1 According to Liisk, since the general introduction of the ther- 
 mometer into practice, and the better understanding of the causes of 
 
106 MEDICAL JURISPRUDENCE. 
 
 woman be examined during this period the vulva will be 
 found gaping; the labia and nymphse torn and swollen, 
 and the fourchette, if the delivery is the first one, lac- 
 erated ; the vagina will be found soft and dilated and 
 more or less bathed in mucus ; the mouth of the uterus 
 very much dilated and "soft. The uterus itself may be 
 felt to be quite bulky by the hand placed above the 
 pubes; the abdomen itself will be relaxed and in folds; 
 the brown line noticed as a sign of pregnancy may also 
 be observed, and minute clefts, at first pink, afterwards 
 white like ordinary scars, termed "linese albicantes," 
 inay be seen crossing each other in all directions. 
 
 At the end of some hours after delivery the lochial 
 discharge commences, consisting at first of pure blood 
 withput special odor, and becoming toward the end of 
 the second day, pale and watery. About the third or 
 fourth day after delivery it is almost entirely suppressed 
 under the influence of the milk fever. 
 
 The second period, which continues usually from 
 thirty-six to forty-eight hours, includes the duration of 
 the milk fever and the swelling of the breasts. The so- 
 called milk fever usually commences on the third day 
 
 febrile temperature in the puerperal state, the existence of a distinct 
 milk fever referable to functional disturbances in the breasts during 
 the period in question has been found to be an exceptional occurrence. 
 Under noiToal conditions the temperatures of the third day do not rise 
 above 100.5° F. With this sub-febrile increase there is, however, often 
 considerable general disturbance, indicated by slight chilly sensations, 
 headache, anorexia, and a quickened pulse, — which, however, disappear 
 in the course of twenty-four hours, — with profuse perspiration and an 
 abundant secretion of milk. As the term milk fever is, however, in 
 common use, and there is physiologically at this time a temperature 
 above that of health, it will be convenient in use to retain the term. 
 
DELIVEEY. 107 
 
 after delivery, but sometimes it begins on the first or 
 second day, or even as late as the fourth or fifth ; it is 
 best marked in women who do not nurse their children ; 
 it is preceded by headache, heat and dryness of the 
 skin; the pulse is at first small and hard, and then 
 becomes fuller, and in a few hours the breasts swell ; 
 moisture on the surface and an abundance of acrid sweat 
 succeeds. In from six to twenty-four hours the fever 
 abates and a watery milk flows from the nipples, les- 
 sening the swelling and the tenderness of the breasts, 
 which, however, disappear slowly. 
 
 The third period of from four to five days is indicated 
 by the characteristic discharge of the lochia, which, 
 about the fourth or fifth day, as the milk fever subsides, 
 reappears as a more or less consistent yellowish-white 
 fluid, with a characteristic odor distinguishing it from all 
 other genital discharges. It quickly becomes sero- 
 purulent, and may thus continue from fifteeen days to 
 three months, or even to the return of the menses ; this 
 fully insures the discharge of the fluids contained in the 
 uterine walls, and the contraction of the uterus, which 
 in five or six weeks has nearly resumed its former di- 
 minished volume in the unimpregnated state; for it 
 never becomes quite so small as before. About this 
 time, if the woman has not nursed her child, the menses 
 usually reappear. The marks of contusion and dis- 
 tention about the vulva usually entirely disappear 
 within two or three days after delivery, and it is chiefly 
 during the flrst and second of the above periods, which 
 are only approximative, that the fact of recent delivery 
 can be properly verified. The most characteristic sign 
 during the first period is the sanguineous discharge with 
 
108 MEDICAt JURISPRUDENCE. 
 
 the odor of the liquor umnii. The milk fever. ia the 
 second stage may be very slight, and does not always 
 occur. The lochia proper which characterizes, the third 
 period is a valuable sign, more conclusive when it con- 
 tinues for some time ; but when long continued at may 
 be confounded- with the leueorrhceal; diachkrge,; into 
 which it sometimes changes. 
 
 It should be remembered, that the proof of recent 
 delivery at full term in the living female, can only 
 safely be predicted upon the; presence of all or nearly 
 all of the signs above enumerated.; and that after the 
 eighth or tenth day, these signs: in general cease to be 
 distinguishable. According to Dr. Lusk, however, an 
 approximate estimate, of the date of confinement may 
 be made during the first two., weeks after: deKveryj 
 
 The signs, of recent delivery before full term; are the 
 same in kind, though, less in degree than.. those at full 
 term, and are therefore much more liable, to. mislead. 
 In premature labor and in abdrtion,^ the signs of de- 
 livery, at whatever time investigated; will; be. found 
 indistinct in proportion to the immaturity of ..thei ovum. 
 In premature labor in the later months,, .the: signs of 
 delivery will be nearly as distinct as at full, .term; 
 but after abortion at. an early period,! so little • change 
 is made in the condition of the. uterus and other, parts, 
 and the woman may exhibit :othej'wise, so few signs of 
 pregnancy even when examined a day or two ajterjthe 
 occurrence, that it may be fouud impossible, to form 
 any definite opinion, unless the structure of the- ovum 
 can be miade out froni the substance expelledr from tie 
 uterus. 
 
 It ought to be remembered, howeyer, that the birth 
 
- : DELIVEEY. 109 
 
 of i cbiid ' in the" case of socie women causes so slight' 
 a'disturbance as hardly to interrupt fthem, in the pursuit 
 of their ordinaiy avocations, and that we are liable to 
 underrate the strength and endurance of a recently 
 delivered female. , , . ; 
 
 The question sometimes arises whether it is possible 
 for a woman to be delivered in a state of unconscious- 
 ness. Although such cases are very rare, there can be 
 no question that it is possible and has sometimes 
 occurred. There is one recorded instance of delivery 
 while in an induced hypnotic state. 
 
 As to the evidence of delivery in the remote past, it 
 is to be observed that it seldom admits of being clearly 
 proved. The absence of the fourchette, the perineal 
 cicatrice, the irregularity of the cervix uteri and the 
 milk in the breasts, are none of them conclusive ; milk 
 has been found in the breasts of virgins, old women, 
 and even of men. 
 
 As to the signs of delivery discoverable upon post- 
 mortem, besides those already mentioned, it may be 
 stated that shortly after delivery the articulations of 
 the pelvis are found to be more movable than usual ; 
 the shape of the uterus is more globular than in the 
 virginal state ; its walls are thicker, more spongy and 
 vascular, and its dimensions larger. Eemains of the 
 decidua may be found lining the interior of the uterus 
 except where the placenta was attached, at which place 
 the uterine surface will either be raw and bloody, with 
 openings into the uterine sinuses, or will be covered 
 with mammillae from albuminous deposits; and the 
 Fallopian tubes and openings will appear swollen and 
 vascular. These appearances gradually fade and noth- 
 
110 MEDICAL JURISPRUDENCE. 
 
 ing satisfactory can be learned after the tenth day, 
 and even then the examination will sometimes be 
 fruitless. 
 
 With respect to the corpus luteum nothing need be 
 added to what has already been said. 
 
CHAPTER IX. 
 
 BIRTH. 
 
 This topic regards primarily the infant, and the 
 mother only secondarily. It is often a matter forensi- 
 cally of great importance to determine whether a child 
 has or has not been born alive ; also at times, whether 
 a child at birth is mature or immature. The subjects 
 of Infanticide and Abortion will be considered in 
 another chapter. 
 
 The meaning of the term "live birth" at the common 
 law is, "that there must be a manifestation of some 
 certain sign or signs of life by the child after it is com- 
 pletely born ; '' by which is meant that the child must 
 be completely external to its mother. It is not, how- 
 ever, necessary to this definition that the cord should 
 have been divided or the placenta separated. Such 
 being the definition of live birth it follows that the 
 time of a child's birth is the moment of its complete 
 expulsion from the body of its mother. 
 
 The evidence of life derived from an examination of 
 a child immediately after its. birth, may consist — 
 
 1. Of muscular twitchings. Mere muscular move- 
 ment independent of breathingj while very unlikely 
 to be mechanical or independent of vital power, can 
 hardly be regarded as sufficient evidence of live birth in 
 a criminal inquiry ; certainly not unless observed by an 
 
112 MEDICAL JURISPRtTDENCE. 
 
 experienced person accustomed to careful observation of 
 vital phenomena. 
 
 2. Eespiration, by which we mean breathing as 
 evidenced by chest movements, is a certain sign of 
 life. The contrary,. however, is not true; a child may 
 be alive without respiration. 
 
 3. Crying after complete delivery is conclusive proof 
 of live birth, but a child may be alive without crying. 
 It is also well: settled that; a child may in some rare 
 cases cry- during the time; of its expulsion from the 
 mother {vagUixs uterinus vel vaginalis), and ;yeb be com- 
 pletely dead when legally born ; and also that, a child 
 may be bom alive and not ery for some time there^ 
 after. 
 
 4. Pulsation in the cord, being caused;'' by the um-* 
 bilical or rhypdgastric arteries and due to the action of 
 therchiid's;heart, is a clear sigii of life. ' i 
 
 5. The beating ;of the child's hsart after complete 
 birth is the crucial test of live birth; ■ and is sufficient 
 to establish this fact in the absence of all the other 
 signs of live birth. " > 
 ' . The evidence of still birth jnay consist in the absence 
 of the fdregoingsigiis of live birth. ; . 
 
 ; The fact; of theichild's being dead, when born; will of 
 course be conclusively established if the ibody is found 
 in a statet)f::putrefaction at the time of. birth," — such 
 putrefaction being the result of intraruterine macera^ 
 tion in the Mqvvramnii.. .The appearance of the body 
 so born (dead ■is' thus described by; Casper.: "It- is im- 
 possible to mistake the appearance of a child bom 
 putrid. The .swollen cutis ; the vesicular elevation of 
 the-'outideior itsicomplete peeling off; the, grayishs 
 
BIRTH. 113 
 
 green coloration of the body ; the putrid navel-string ; 
 the well known stench, etc., do not constitute the 
 diagnosis, since every child even when born alive, 
 undergoes these putrefactive changes in their turn at 
 the proper time after its death. On the contrary, most 
 of these characteristics are not exhibited by a child 
 bom putrid. ... In the first place a child born putrid 
 is remarkable for its penetrating stench which cannot 
 be concealed by a thin coffin or chest, etc. ; and which 
 though so repulsive and indestructible, is not yet the 
 usual well known odor of putrefying bodies, but has 
 something sweetish, stale and indescribable about it, 
 which makes it all the more unendurable. ... A child 
 born putrid has not a shade of green upon its skin but is 
 more or less of a coppery red, here and there of a pure 
 flesh color; peeling of the cuticle is never absent, but 
 close to recent patches of this character older ones are 
 found upon the body, the bases of which are already 
 dark and hardened. The excoriated patches are moist, 
 greasy, and continually exude a stinking sero-sanguino- 
 lent fluid, which soaks through all the coverings of the 
 body. The general form of such bodies is as remarka- 
 ble as their color. While every highly putrefied corpse 
 preserves for long the roundness of the contour of the 
 body, though its form is disfigured and distorted by 
 intumescence, it must strike everj' one, when a child 
 born putrid is placed before him, how great a tendency 
 is displayed by it to flatten out and, as it were, to fall 
 to pieces. The thorax and abdomen lose their round- 
 ness ; their contour forms an ellipse, from the soft parts 
 sinking outwards towards both sides. The head itself 
 (the bones of which are loose and movable, as in every 
 
 8 
 
114 MEDICAL JURISPEUDENCE. 
 
 child's body) becomes flattened, and the face thereby! 
 repulsively disfigured, as the nose is flattened and the 
 cheeks fall to opposite sides." 
 
 The foetus may remain in the uterus months in- 
 this condition, and sometimes in twin pregnancies, by 
 compression, one of the infants is caused to become 
 flattened and atrophied so as exactly to resemble a 
 little gingerbtead figure. 
 
 The evidence of live or still birth afforded by a post- 
 mortem examination of the body of a child, will be 
 considered in the chapter on Infanticide. 
 
 The subject of the maturity or immaturity of a new- 
 born child,- will be considered in the chapter on Legiti- 
 macy and Paternity. 
 
CHAPTER X. 
 
 ABORTION. 
 
 ■ Without undertaking a legal definition of the term 
 abortion, which doubtless will be found to differ in dif- 
 ferent States, and without insisting upon the distinction 
 which the accoucheur makes between abortion and pre- 
 mature labor, the term may in this connection be con- 
 sidered as applied to labor brought on at any stage of 
 pregnancy, and may be considered under three heads. 
 
 1. Natural abortion, which includes miscarriage, or 
 the expulsion of the ovum or of a non-viable foetus ; 
 and premature labor, or the expulsion of the child after 
 it is viable. 
 
 • 2. Artificial abortion, or the induction of premature 
 kbor for the purpose of saving the life of the mother 
 and, if possible, of the child. 
 
 3. Criminal abortion. 
 ' The full consideration of natural and artificial abor- 
 tion belongs to technical treatises upon obstetrics. It 
 may be observed, however, that natural abortion may 
 be caused by various accidental or pathological con- 
 ditions of either the mother or the child, or may be 
 caused partly by both. It is often very difficult to 
 detect the cause, and it is beyond the scope of this 
 work to enter into the further consideration of this 
 subject. 
 
116 MEDICAL JURISPRUDENCE. 
 
 As to artificial abortion, there can be no doubt that, 
 after due consultation, with the object of saving the life 
 of the mother or child, or both, operations for the pur- 
 pose of inducing abortion or premature labor are en- 
 tirely justifiable; indeed, their legality is sometimes 
 recognized by statute. The cases where the induction 
 of abortion or premature labor are justifiable are certain 
 cases of pelvic deformity; some cases of obstinate 
 vomiting during pregnancy'; where pregnancy is com- 
 plicated with insanity; and various other pathological 
 conditions. 
 
 The term abortion is popularly understood as apply- 
 ing to the expulsion of the contents of the womb before 
 the sixth month of gestation ; but it is believed that 
 the statutes upon the subject generally make no such 
 distinction. 
 
 The production of abortion is generally made a statu- 
 tory felony, and hence punishable by imprisonment for 
 a greater or less time in the penitentiary. It should 
 also be remembered that if' the dea:th of the mother is 
 caused, as is not unfrequently the case, owing to the 
 usual ignorance of the operators or the dangerous nature 
 of the drugs employed, the crime is murder, although 
 the accused had the' full consent of the woman to the 
 operation, and did not intend to cause death. 
 
 A- full discussion of the legal questions involved be-, 
 longs more properly to professed treatises- iipon the crim- 
 inal law. In this connection we will consider only the 
 means of producing abortion, and the evidence of abor- 
 tion afforded by an examination of the female during 
 life, or after death, or of the substances expelled from 
 the womb, instruments or drugs used, etc. 
 
ABORTION. 117 
 
 The means used to produce criminal abortion are 
 
 various. They usually consist in the administration of 
 ecbolic or abortifacient drugs ; that is, medicines which, 
 by exciting uterine contractions, cause the expulsion of 
 the contents of the uterus. Almost every drug in the 
 pharmacopoeia has been, at times, employed for this 
 purpose. The drugs usually employed belong either to 
 the class of emetics, purgatives, diuretics, or emmena- 
 gogues. It should be remembered that most of the 
 drugs which have been administered for this purpose 
 are not only uncertain in their action, but owing to the 
 manner and amount administered, are usually extremely 
 dangerous. 
 
 Violent exercise or brutal violence employed in a 
 general manner, such as copious general bleedings, roll- 
 ing down hill or downstairs, long walks, etc., have been 
 much resorted to>^ and often without effecting their pur- 
 pose. Over-tight lacing has also been adopted for the 
 same purpose. It is needless to remark that the more 
 violent of these means are almost as apt to cause death 
 as abortion. 
 
 Abortion is frequently induced by mechanical in- 
 juries to the uterus or its contents. This is usually 
 accomplished by rupturing or piercing the membranes 
 by some mechanical means, such as the uterine sound, 
 catheters, injections of water, etc. The destruction of the 
 ovum or the rupture of the membranes of course arrests 
 gestation ; but after the membranes are pierced some 
 days may elapse before the expulsion of the uterine 
 contents ; and as in the case of abortifacients so with 
 mechanical means, the most violent at times fail to pro- 
 duce the desired effect. 
 
118 MEDICAL JURISPRUDENCE. 
 
 The evidence derived from the examination of the 
 woman during life is not unfrequently negative. Very 
 much will depend upon the period of gestation at which 
 the crime was committed ; if committed at an advanced 
 period of gestation, what has been said in a previous 
 chapter upon delivery is here applicable. The symp- 
 toms of abortion during the earlier periods of gestation 
 are of an exceedingly evanescent character and may be 
 simulated by menstruation. The signs of abortion, in 
 the living are commonly stated to be a relaxed condi-j 
 tion of the, vulva and passages ; patulousness of the o& 
 uteri, presence of the lochial secretion, and the character- 
 istic smell common to puerperal women ; distention p^ 
 the breasts; general anaemic condition; excitement of 
 the pulse, and dryness of the skin. The os uteri may be 
 lacerated, and there may be marks of violence on the; 
 uterus and vagina, depending of course, upon the period, 
 of gestation at which the abortion was committed. 
 
 If the abortion happened naturally at an early period 
 of utero-gestation, the signs usually found may be veiy 
 slight or altogether wanting. After the third month, 
 the insertion of the placenta may be detected by a rough 
 place on the inner uterine wall. In making a postTmor- 
 tem, punctures, lacerations, and incisions of the uterus 
 should be carefully looked for, and care should be taken 
 that the uterus is not wounded in making the post-mor- 
 tem, altliough it is not usually difficult to distinguish 
 wounds made before from those inflicted after death 
 The stomach and intestines, bladder and kidneys should 
 be particularly examined for marks of irritant poisoning. 
 It should be remembered in this connection that the 
 uterus of a woman who has died during menstruation, is 
 
ABORTION. 119 
 
 thickened and presents a swollen condition of its mucous 
 lining, and is generally hypersemic. 
 
 As to the ezamination of substances ezpelled from 
 the uterus, if a foetus is found it should be carefully ex- 
 amined for wounds, etc., and an endeavor made to deter- 
 mine whether it was born alive, its age, etc., in the 
 manner pointed out in the chapter on Infanticide. 
 
 If any instruments or drugs are found in the posses- 
 sion of ihe accused, which are supposed to be the means 
 used in producing the abortion, they should be carefully 
 marked and preserved so as to ba capable of future iden- 
 .tificatibn, and dieoiical or microscopic examination, if 
 necessary. 
 
CHAPTER XI. 
 
 INFANTICIDE. 
 
 There appears to be some difference of opinion among 
 continental jurists as to the meaning of the term "newly 
 born ; " but according to the English and American law, 
 no importance is attached to these distinctions, as it is 
 equally murder to destroy the life of a child which has 
 been completely born, according to the sense given that 
 term in the last chapter, as it would be feloniously to 
 kill an adult. In order, however, to constitute the 
 crime of murder at the common law, it is necessary that 
 the whole body of the child should have been born into 
 the world prior to the extinction of its life. It is not 
 necessary that the umbilical cord should have been 
 severed nor that the child should have breathed, if it 
 otherwise had life and independent circulation. The 
 full period of gestation need not have passed. If a 
 person intending to procure abortion causes the pre- 
 mature expulsion of the child, whereby it dies after 
 birth from this premature exposure, this has been held 
 to be murder. Cutting off the head, however, before 
 the birth of the body, is not murder at the common 
 law. 
 
 The questions which will ordinarily be propounded to 
 the medical jurist in connection with the crime of infan- 
 ticide are thus stated by Dr. Ogston : — 
 
INFANTICIDE. 121 
 
 i. Has the prisoner been recently delivered ? 
 
 2. Was the child mature ? 
 
 3. Was it the child of the prisoner ? 
 
 4. Was it dead or alive at its birth ? 
 
 5. If alive, what was the cause of its death ? 
 
 The first inquiry has been already considered in the 
 chapter on Delivery. The second inquiry will be con- 
 sidered under the head of Legitimacy and Paternity. 
 The solution of the third question wiU usually depend 
 upon the application of the ordinary rules of evidence. 
 Much light will be thrown upon the determination of 
 this question from a comparison of the state of the child 
 with that of its alleged mother, keeping in mind the 
 facts already stated in the chapter on Delivery. It is 
 important in questions of this kind to fix the age of the 
 infant, or the time it may have survived birth ; and the 
 date of the child's birth is to be settled, first, by ascer- 
 taining the date of its death, — that is, whether it died in 
 the maternal passages, or if after, birth, how long after- 
 wards ; and secondly, by determining the period which 
 has elapsed after its death. The indications of the death 
 of an infant in utero have already been to some extent 
 considered. Indications of its death in the maternal 
 passages, or at or immediately after its birth, will be 
 considered further on in this chapter. 
 
 The determination of the time the child has survived 
 its birth rests upon the succession of changes in its 
 body following birth, necessitated by the new physio- 
 logical relations in which it is placed after leaving the 
 uterus ; and this inquiry need not extend farther than a 
 few days after its birth ; as, if the child has survived 
 even a few hours it can rarely be destroyed without 
 
122 MEDICAI, JURISPRUDENCE. 
 
 leaving clear testimony of its having been bora alive. 
 The changes above referred to are invariable in tbeu: 
 occurrence, and when time has been allowed for their 
 appearance are, except as otherwise below; indicated, 
 sure indications of the. child's having survived birth. 
 These changes are as follows : — 
 
 1. Expulsion of. the meconium, which is a dark-greeq 
 or olive-colored matter of a pulpy consistence, and. which 
 accumulates in the intestines of the foetus in the later 
 months of intra-uterine life, and is discharged occasion- 
 ally at birth or at periods varying from a few hours to a 
 day or even more after birth ; it is sometimes found in 
 the liquor amnii, and in breech presentations is some-; 
 times expelled before the delivery of the head, so that 
 the discharge of a portion of this matter cannot be re- 
 garded as conclusive evidence that the child was alive 
 at the time of its expulsion. 
 
 2. The fall or dropping-off of the umbilical cord. In 
 the infant after its birth, whether alive or still-born, if 
 the death has not long preceded the birth, the cord is 
 fresh, firm, bluish, rounded, more or less spiral, and 
 more or less plump. The first change in the living in- 
 fant after the division of the cord is the shrivelling of 
 the part attached to the infant, commencing at its cut 
 extremity and proceeding to the point of attachment to 
 the abdomen. This portion of the cord then softens, 
 while around its point of attachment there is a marked 
 reddening or injection of the abdominal integuments. 
 The cord next dries up, becoming at the same time 
 brownish from its summit to its base and more or less 
 translucent, and now presents a flattened or ribbon- 
 shaped appearance, while through its parchment-like 
 
INFANTICIDE. 123 
 
 walls the contracted blood-vessels withia may be seen. 
 This desiccation usually begins on the first or second 
 day after birth, and is completed by the end of the fifth 
 day. In the dead child, the cord, instead of a. brownish, 
 generally assumes a grayish hue. Its investing mem- 
 brane forms a pulpy pellicle; it loses its previously 
 spiral form and its vessels have not sensibly dimin- 
 ished in size. It is to be remarked, however, that 
 some of the usual changes in the living cord may be 
 produced accidentally or artificially in the dead child : 
 thus, its parchment-like condition has been imitated by 
 drying, or submitting it to pressure. Its spiral condi- 
 tion is not invariably met with in the child which has 
 survived its birth. The separation of the cord from the 
 body usually takes place the fifth or sixth day, some- 
 times a little earlier or later. During this process, the 
 base of the cord slowly ulcerates, the umbilical artery 
 being first divided, and somewhat later, the vein ; this 
 ulceration, with oozing of sero-purulent matter, and the 
 existence of inflammatory appearances after the detach- 
 ment of the cord (that is, up to the tenth or fourteenth 
 day, at which cicatrization occurs), being a vital process, 
 is of course clear evidence of live birth. In the natural 
 faU of the cord the membranes are divided circularly 
 and cleanly without any detached fibres, which is sel- 
 dom the case when the cord has been forcibly torn 
 away ; the separation of the membranes also naturally 
 precedes the division of the vessels. Where the cord 
 has been violently torn off the raw and bloody edges of 
 the part sufficiently distingiiish this from the cicatriza- 
 tion after its natural separation. When decomposition 
 has taken place, or when the cord has become dry, it is 
 
124 MEDICAL JURISPRUDENCE. 
 
 not always easy to determine whether its division was 
 by a sharp or by a blunt instrument. 
 
 3. The obliteration of the internal vessels peculiar to 
 the foetus, namely, the umbilical arteries, umbilical vein, 
 the ductus venosus, ductus arteriosus, and foramen ovale. 
 The older writers on medical jurisprudence state that 
 •the obliteration of these vessels and of ihQ foramen ovale 
 occurs in a particular order and at stated times after 
 birth, — the umbilical artery closing in from twenty-four 
 hours to three days ; the umbilical vein a little later ; 
 the ductus arteriosus in about a week ; and lastly, the 
 ■foramen ovale. Modern investigation, however, show? 
 that their obliteration occurs, both as to time and order, 
 in a very indeterminate manner, and accordingly little 
 reliance can be placed upon their condition as an evi- 
 dence of live birth. _j 
 
 4. Another sign of the child's age is the desquam%- 
 tion of the cuticle. This should not, however, be con- 
 founded with the peeling off of the epidermis from 
 putrefaction after death. The desquamation of the 
 cuticle, properly so-called, has not, says Dr. Ogston, 
 been observed to take place sooner than twenty-four 
 hours after birth. It usually commences at the child's 
 abdomen and extends successively to the chest, arm- 
 pits, groins, back, the extremities, the feet and hands. 
 The shedding is usually in the shape of scales, rarely 
 powdery dust, and may be expected to be complete in 
 healthy infants in from thirty to sixty days; but in 
 weakly or diseased children it may continue for an iur 
 definite period. Where it occurs at all. Dr. Ogston 
 considers that the child must have lived at least one 
 day. 
 
INFANTICIDE. 125 
 
 The series of changes above noted are regarded as only 
 approximate in point of time. 
 
 i The evidence of development derived from the state 
 of ossification of the bones will be considered in the 
 chapter on Personal Identity. 
 
 In considering the question whether the child was 
 dead or alive at its birth, it is well to bear in mind the 
 natural causes of death, and those which may result 
 from violence not criminally employed for the purpose 
 of causing the death of the child. The consideration of 
 the natural causes of death is beyond the scope of this 
 work; it may be stated, however, that among those 
 causes are congenital debility, various diseased condi- 
 tions of the vital organs, protracted labor, hemorrhage, 
 death of the mother before the delivery of the child, 
 fatal hemorrhages from various parts of the newly-born 
 child, the most common of which is hemorrhage from 
 the funis or navel, as where the cord is not properly 
 secured by ligatures, etc. It should be remembered, 
 however, that while fatal hemorrhages may occur from 
 an unligatured cord, such fatal results are very rare. 
 " The question whether the child was dead or alive at 
 its birth may be considered under two heads : — 
 
 1. The proofs of still birth. Such signs are those which 
 go to prove, first, that it was immature ; secondly, that 
 it was born with organs in such a state of congenital 
 malformation — or, thirdly, of iutra-uterine disease — 
 as negatives the possibility of its surviving birth; or 
 fourthly, that it must have died in the uterus or 
 maternal passages before time had been afforded for 
 the commencement of respiration or any other vital 
 changes which take place immediately after birth. 
 
126 MEDICAL JUKISPRUDENCE. 
 
 The subject of immaturity has already, in part, been 
 considered, and will be further considered in the chap- 
 ters on Paternity and Identity. The subject of the 
 death of the child in utero, and intra-uterine maceratiou 
 has already been considered. The subjects of intra-uter- 
 ine disease and congenital malformation more properly 
 belong to professed treatises on obstetrics, etc. 
 
 2. The question whether the child has been born 
 alive is, however, usually the principal point to be de- 
 termined ; and the principal obstacle in the way of a 
 satisfactory determination of this point is the senseless 
 and inhuman rule of the common law, that the body of 
 the child must have been entirely born before murder 
 may be committed against it. This, however, is a ques- 
 tion addressed to the legislature, and the medical jurist 
 can only be expected to show that the infant died by 
 violence or wilful neglect at the time of or subsequent to 
 its leaving the uterus ; and that but for such violence 
 or neglect, there was nothing to prevent it from continu- 
 ing to live in the external world. While it would no 
 doubt be murder to kill a newly-born infant, born living, 
 but which had not as yet breathed, with the exception of 
 those cases in which the injuries are of such a charac- 
 ter as would of themselves destroy life, and could only 
 have been inflicted after the child had been born, it 
 will be very difl&cult, if not impossible, to prove the 
 commission of such crime. In such a case, the entire 
 absence of those changes in the organs of respiration 
 and circulation which distinguish extra-uterine from 
 intra-uterine life, will render it impossible for the med- 
 ical jurist to decide by mere inspection of the body; 
 whether or not the child has been born alive. In such; 
 
INFANTICIDE. 127 
 
 a case the proof of the crime must depend upon other 
 evidence. Practically, therefore, the only cases which 
 the medical jurist will be called upon to investigate 
 are those in which respiration has been established prior 
 to the death of the child. The evidence in such cases 
 may be considered under three aspects : — 
 
 a. The evidence afforded by changes in the organs 
 of circulation. 
 
 I. In the digestive organs. 
 
 c. In the respiratory organs. 
 
 (a) The signs of extra-uterine life derived from the 
 organs of circulation are the obliteration of the umbiU- 
 eal' vessels, the ductus arteriosus, the ductus venosus, 
 and the foramen ovale, due to the new course taken by 
 the blood on the establishment of respiration ; but 
 enough has been said upon this subject in a previous 
 part of this chapter. 
 
 (6) The evidences of extra-uterine life derived from 
 the ezamination of the alimentary canal are as follows : 
 Food or medicine found in the child's stomach are of 
 course conclusive upon the question of live birth. The 
 food most likely to be found will be milk, farinaceous 
 articles, or sugar. In some cases opium in some form 
 has been found in the stomach. 
 
 In instances of drowning and smothering, the fluid or 
 other substances in which the child has been immersed 
 may be found in the stomach. According to Tardieu the 
 presence of air bubbles in the glairy mucus generally 
 found in the stoma,ch, which he believes can only have 
 arisen from the swallowing of saliva and mucus col- 
 lected in the mouth and throat, and which is aerated by 
 respiration, — the process, in his. opinion, requiring the 
 
128 MEDICAL JURISPEUDKNCE. 
 
 period of only a few minutes (from ten to fifteen at 
 most), — is evidence of live birth. 
 
 As to the evidence afforded by the presence or ab- 
 sence of meconium, see ante. 
 
 (c) The proof of live birth principally relied upon, 
 however, is that afforded by the series of changes in the 
 respiratory organs. The time required for effecting the 
 changes below-described varies with the condition of 
 the infant, from a few minutes in the mature, healthy, 
 and vigorous infant, to two hours or even more in the 
 case of premature, weakly, or diseased infants, although 
 cases where so long a time is required are exceptional 
 
 Previous to the admission of air to the lungs, the 
 lungs, on opening the chest, do not appear to fill the 
 thoracic cavity, but occupy a comparatively small por- 
 tion of the chest; the pericardium occupies a promi- 
 nent place in front, and the heart is quite uncovered by 
 the lungs, which are placed laterally and posteriorly. 
 When, however, the lungs have been expanded by the 
 admission of air, the pericardium is nearly covered by 
 them, and the convexity of the diaphragm is lessened.. 
 The volume of the lungs, however, is not of itself a con- 
 clusive test of respiration. 
 
 The tissue, consistence, feeling, and color of the 
 lungs are important to be considered in this connection. 
 Lungs not penetrated by air have sharp, well-defined, 
 incurved margins, are dense and fleshy, and do not crep- 
 itate when handled or cut, and no air can be expressed 
 from their cut surfaces under water, and little or no 
 blood is contained in their tissues. Their color varies 
 from a chocolate hue to that of the healthy adult liver. 
 On the other hand, lungs which have been inflated with 
 
INFANTICIDE. 129 
 
 air, whether naturally or artificially, feel spongy and 
 light, and crepitate on being cut or handled. Although 
 their margins appear sharp, a close examination will 
 show that they are really rounded or projecting in 
 tongue-like processes ; they appear vesicular, and when 
 the inspiration has been natural, blood may be squeezed 
 out of them. By the entrance of air into the foetal lung 
 upon the establishment of respiration, its previous liver 
 or chocolate, color is changed to a more or less lively 
 rose-red. This change of color, however, is said by 
 Dr. Taylor not to be an invariable consequence of the 
 child's having lived after birth. Lungs that have in- 
 spired air, whether naturally or not, very generally ex- 
 hibit near their margins bright red stripes or patches ; 
 but in the lungs of children which have breathed natu- 
 rally there are, according to Dr. Ogston, further visible 
 on their surfaces, defined patches of bright red, relieved 
 by the dark-purplish intervening insular spots, which 
 form the ground tone of the whole. This last mottled 
 or marbled aspect is considered by Casper and other 
 continental authorities as a sure test of natural respira- 
 tion ; although, according to Casper, its absence does 
 not lead to the opposite conclusion. 
 
 The so-called static test, by comparing the absolute 
 weight of the lungs with that of the body of the infant 
 (although foetal lungs on the establishment of respiration 
 necessarily become heavier), does not seem to possess 
 much practical value. 
 
 The hydrostatio test, however, possesses great value, 
 and in the hands of a careful inspector can rarely lead 
 to an erroneous conclusion. It must be remembered, 
 however, that this test. is a test of respiration and not of 
 
 9 
 
130 MEDICAL JURISPRUDENCE. 
 
 live birth in the legal sense of the term. In making 
 this test, after securing the large vessels prior to their 
 division, the heart, lungs, and thymus gland should be 
 removed from the chest, and the whole immersed in a 
 vessel sufficiently large to permit them freely to float or 
 sink, filled preferably with rain or river water at a tem- 
 perature of about 60° Fahrenheit. The inspector should 
 note whether the parts collectively swim or sink, and if 
 the latter, whether the viscera reach the bottom quickly, 
 or slowly. The lungs should then be detached from the 
 heart and thymus gland, and separately tried in the 
 same way; they should afterwards.be cut into fragments 
 and examined in detail in the same manner, and the 
 fragments should afterwards be compressed so as to ex- 
 pel the air as far as possible, and once more tested in 
 the same manner. The general conclusion derived from 
 this test is, that if the lungs swim, the infant has 
 breathed ; and that if they sink, it has not breathed. 
 
 Gas in the lungs resulting from putrefaction may be 
 distinguished from that resulting from respiration by, 
 the fact that the former collects in large bubbles, may 
 be easily expelled by pressure, and possesses a putrid 
 odor ; whereas the contrary is the case with gas in the 
 lungs resulting from respiration, in which case no degree 
 of compression short of that which will entirely break up 
 their tissues will cause lungs inflated naturally to sink. 
 
 The objection to this test, that the lungs of the still- 
 born infant may be inflated artificially so as to cause 
 them to float independently of natural respiration, does 
 not seem to be in practice a valid one. Numerous at- 
 tempts have been made by medical jurists to expand the 
 lungs. of still-born infants artificially, and have almost 
 
INFANTICIDE. 131 
 
 without exception, entirely failed. The quantity of air 
 which may thus be introduced into the lungs has been 
 found to be inconsiderable ; and even this, as it seems, 
 may be readily forced out by compression. Considering 
 the difi&culty of making such inflation, the ignorance of 
 anatomy of alleged criminals likely to resort to such in- 
 flation, and their want of proper instruments and the 
 skill to use them, the objection does not seem valid. 
 This examination should, however, in order to be enti- 
 tled to its full weight, be made by an inspector having 
 a competent knowledge of pathological conditions which 
 may be found in the lungs of the new-born infant ; for it 
 is possible that the condition of the lungs may be so 
 changed by disease as to render them specifically heavier 
 than water. Such diseases are tubercle, scirrhus, pul- 
 monary oedema, sanguineous congestions, and perhaps 
 other conditions which, however, will be clearly mani- 
 fested if the examination is made by a competent 
 observer. 
 
 The cases of respiration before the entire birth of the 
 child (vagitus uterinus vel vaginalis) which have already 
 been referred to do not, when properly considered, in- 
 validate the previous conclusions ; for, as we have already 
 stated, the hydrostatic test is a test of respiration, and 
 not of live birth in the legal sense of the term. These 
 cases are, moreover, very rare, and none of those recorded 
 were instances of unassisted or solitary labor ; in all of 
 these cases, either instruments or the hands had been 
 introduced, so as to permit the entrance of air into the 
 vagina or uterus. 
 
 Besides the above three tests, another test of live 
 birth has been suggested by Dr. 'Wreden, of St. Peters- 
 
J.32 MEDICAL JURISPRUDENCE. 
 
 burg. According to him, the gelatinous substance which 
 .fills the middle ear of the unborn infant gradually dis- 
 appears and is replaced by air after the establishment of 
 respiration, and is never encountered in the child -which 
 has lived for twenty-four hours, although it does not 
 entirely disappear during the first twelve hours. Dr. 
 Wendt of Leipsic, and Dr. F. Ogston, Jr., confirm the 
 conclusion of Dr. Wreden, that this substance can only 
 be expelled by the establishment of full respiration; 
 but Dr. Ogston found that the time of its disappearance 
 varies from a few hours to two or three weeks. 
 
 . 5. Lastly, we come to the consideration of the causes 
 of the infant's death. The evidences of death in utero 
 have already, in part, been considered under the head of 
 intra-uterine maceration. Various diseases may cause 
 the death of the foetus before its birth, including dis- 
 eases communicated directly by infection from the mother; 
 such as scrofula, small-pox, etc., or, more remotely, from 
 the father through her, as in syphilis, which is a very 
 fruitful cause of the death of the foetus. The death of 
 the infant before birth may also be caused by mal-for- 
 mation arresting development, atrophy, tuberculosis, etc. ; 
 it may also be caused by falls, blows, pressure, etc. The 
 consideration of the various diseases, etc., which may 
 cause the death of the foetus belong more properly to 
 professed treatises on Obstetrics. See also ante, chap- 
 ter on Abortion. 
 
 The death of the child may also occur in a variety of 
 ways during labor, r— as from natural feebleness of con- 
 stitution, imperfect development, malformation,prematur- 
 ity, etc. Tedious labor is a fruitful cause of death. Death 
 of the child during delivery, where the labor has been 
 
INFANTICIDE. 133 
 
 protracted and difficnlt, is most commonly from ceretral 
 hypersemia, apoplexia neonatorum. In these cases we 
 may have congestion of the membranes of the brain and 
 of the cerebral sinuses, and extravasations of blood be- 
 tween the pericranium and occipital aponeurosis, beneath 
 the pericraniuin, or within the cranium ; and these ap- 
 pearances may be so marked as to account for the death 
 of the infant, or so slight as to be compatible with its 
 recovery. A not uncommon consequence of tedious 
 labor, whether the infant survives or not, is what is 
 called caput mceedaneum, which is a sero-sanguinolent 
 effusion under the pericranium, giving rise to a diffused 
 swelling at the seat of the effusion, located at the parts 
 of the head which are presented, most frequently over 
 one of the parietal bones. Sub-pericranial effusions of 
 blood, called c&pJmlhoBmatomata, occasionally result from 
 protracted labor, and are compatible with survival after 
 birth; they usually appear after birth, increase in the 
 course of two or three days from the size of a half-mar- 
 ble to that of a chestnut or half of a hen's egg, remain 
 stationary for a few days, and disappear slowly from a 
 month to six weeks afterwards, leaving for a time a 
 slight elevation of the skull at the part. Prior to the 
 absorption of the clot, a fibrinous exudation is poured 
 out around the detached adge of the pericranium, dur- 
 ing the subsequent absorption of which a process of ossi- 
 fication sometimes sets in, converting the fibrinous ring 
 into an osseous ridge, while that part of the cranium 
 over which the clot has been situated is roughened by 
 the formation of new bone on its surface. 
 
 Fractures of the skull may occur during labor in con- 
 sequence of a relative disproportion of the head to the 
 
134 MEDICAL JURISPRUDENCE. 
 
 pelvis, or of the defoimity of the latter. They are, how- 
 ever, of very rare occurrence, and in distinguishing such 
 fractures from felonious injuries to the child, it should 
 be remembered that the amount of violence done to the 
 head by the prolicide is usually much greater than is 
 encountered in cases of fractures during labor. 
 
 It should be remembered in this connection that the 
 long bones of the extremities of the child are sometimes 
 broken or dislocated in utero or during delivery. 
 
 Children sometimes perish during labor from the pre- 
 mature arrest of the foetal circulation, which may arise 
 from the detachment of the placenta, prolapse of the 
 cord in head presentations, or compression of it by the 
 head, or by the body or the head in foot presenta- 
 tions, and from the cord's becoming twisted around the 
 child's neck or limbs, and thus suffering compres- 
 sion. Under such circumstances the arrest of the cir- 
 culation leads to instinctive efforts on the part of the 
 child to breathe, and therefore to death by a species of 
 asphyxia. 
 
 In cases where the cord has become twisted around 
 the child's neck during labor, thereby causing death by 
 asphyxia or coma, in the great majority of instances no 
 mark is made on the neck by the cord; exceptional 
 cases are, however, recorded in which furrows and dis- 
 colorations of the skin have been found at the points 
 which have suffered compression. 
 
 Among the natural causes of the death of the infant 
 subsequent to delivery may be mentioned certain mal- 
 formations incompatible with extra-uterine life; and 
 immaturity hindering its surviving birth. 
 
 The infant may die after delivery from natural feeble- 
 
INFANTICIDE. 135 
 
 ress, or from the presence of disease which commenced 
 before birth, such as tuberculosis, sj'philis, etc. 
 
 There are recorded instances, also, in which the child 
 has perished after delivery from occlusion of the mouth 
 and nostrils by the membranes, where the child and 
 membranes are suddenly discharged en masse. 
 
 Experiments by Dr. Casper also show conclusively 
 that death may be occasioned in consequence of a frac- 
 ture of the skull by the child's falling from the genitals 
 of the woman in a standing posture, in case of a sudden 
 or unexpected delivery. 
 
 While it may be that the infant may perish after 
 delivery from the rupturing of the umbilical cord and 
 consequent fatal hemorrhage in cases of a sudden ex- 
 pulsion and consequent fall of the infant, there do not 
 appear to be any authenticated instances of such fatal 
 hemorrhages. 
 
 A child may be smothered in the bedclothes or by 
 being overlaid, either accidentally or criminally; but 
 there are no means of distinguishing the one case from 
 the other. The child may also after birth perish by its 
 face falling into the mother's discharges, or by being 
 accidentally dropped into a privy when labor has come 
 on suddenly at stool. 
 
 Criminal practices against the life of an infant are 
 usually perpetrated at the conclusion of labor. It will 
 often be impossible in practice to distinguish those cases 
 where the death of the child has arisen from want of 
 suitable warmth or nourishment, absence or unsuita- 
 bility of the ligatures of the cord, etc., where it is 
 accompanied with a criminal intent, from cases where 
 there is no criminal intent. 
 
136 MEDICAL JUBISPBUDENCE. 
 
 The life of the infant has been destroyed by punctures 
 of the fontanelles, of the orbit, nucha, twisting of the 
 neck after delivery of the head, strangulation, and 
 wounds inflicted through the several inlets and outlets 
 of the body. The body of the infant whose death is 
 suspected to have been caused by criminal violence 
 should be carefully inspected for such injuries. Death 
 may also be caused by strangulation, blows or injuries 
 about the head, incised wounds, drowning, suffocation, 
 smothering, etc. The appearances characteristic of death 
 thus caused will be found discussed in the chapters upon 
 Wounds, Drowning, Stkangulation, etc. 
 
 In a case of death by drowning, unless the child had 
 lived long enough to have established respiration, this 
 mode of death would leave no traces on the body. 
 
 In cases of suspected poisoning of new-born infants, 
 it should be remembered that the internal surface of 
 the oesophagus is often injected in new-born children 
 after death, such injection assuming the form of ramifi- 
 cation of vessels or of longitudinal striae, which might 
 be mistaken for the effects of certain irritant poisons. 
 
 Ulcerations of the stomach, attended with the collec- 
 tion of a brown or blackish bloody fluid, are sometimes 
 also discovered, which might give rise to a suspicion of 
 poisoning. Similar appearances have also been found 
 in the intestines, thus affording sufficient data by which 
 to account for the death of the child from natural 
 causes. 
 
 We cannot better close this chapter than by giving 
 Dr. Ogston's method of making an tnspeotion of the 
 body of an infant suspected to have been the victim of 
 foul play. The medical jurist, says he, ought at the 
 
INFANTICIDE. 137 
 
 outset to make himself acquainted with all the partic- 
 ulars of the case, — the place where the child was founds 
 the circumstances attending its removal thence, and 
 the facts relative to the suspected party if suspicion 
 rests upon any one. He should, if possible, visit the 
 place where the body was discovered ; he should theii 
 examine the wrappings of the child, if there are any ; 
 the marks upon them, if any ; the thread with which 
 they had been sewed ; character of the ligature, if any, 
 around the cord, etc. In this way the laother may 
 sometimes be discovered. 
 
 These preliminaries having been attended to, the 
 examiner should proceed to the external inspection of 
 the infant's body, noting — ^ 
 
 1. Its general conformation, and especially any defect 
 or vice which might effect its viability. 
 
 2. Its degrees of freshness or putridity. 
 
 3. The color of the skin. 
 
 4 The degree of adhesion of the cuticle and of the 
 nails. 
 
 5. The extent of the saponification if it has com- 
 menced, or of the emphysema if gases are generated 
 under the skin, etc. 
 
 6. The natural openings should be examined as to 
 their being pervious or otherwise, with the discharges 
 which may have proceeded from them. 
 
 7. If any punctures, incised wounds, contusions or 
 ecchymoses exist, their situation, extent, and depth 
 should be especially noted. 
 
 8. The body should be weighed and measured, ob- 
 serving with what point of the abdomen the centre of 
 its length corresponds. 
 
138 MEDICAL JURISPKUDENCE. 
 
 9. The state of the navel should be particularly 
 attended to, observing if any part of the cord remains 
 attached to the belly, whether it is fresh or shrivelled 
 and dry, or free or not from inflammation and vascu- 
 larity ; whether it is spare or plump ; whether it has 
 been tied or not; if tied, at what distance from the 
 navel ; the degi'ee of torsion of the remains of the cord j 
 its translucence, the volume and course of its vessels, if 
 they contain blood or if any can be expressed from 
 them ; whether it has been cut through or torn, and if 
 the former, whether with a blunt or sharp instrument. 
 
 10. If the placenta is found, the divided ends of 
 the cord should be compared to see if they correspond, 
 and the length of the remains of the cord, both placental 
 and foetal, should be measured. 
 
 11. The sebaceous coating, if present, should be looked 
 for chiefly in the arm-pits, groins, and hands ; its pres- 
 ence shows that no care had been taken by washing 
 for the child's preservation. 
 
 12. The hairs should be noted as to their color, length, 
 and quantity. 
 
 This external general inspection completed, the ex- 
 aminer should proceed to the special inspection, begin- 
 ning with — 
 
 1. The head, — ascertaining its form and dimensions 
 in different directions ; carefully removing the hairs and 
 examining the scalp ; dividing the scalp by a crucial 
 incision, or from ear to ear; ascertaining the state of 
 the internal surface of the scalp, of the bones and 
 sutures, and the size and appearance of the fontanelles ; 
 removing the skull-cap in the usual direction with a 
 pair of stout scissors ; examining the brain in situ, and 
 
INFANTICIDE. 139 
 
 retnoviug it along with the medulla oblongata in order 
 to inspect the top of the spine and the base of the 
 skull. 
 
 2. The front of the neck should then he attentively 
 looked at for any grooves caused by ligatures, ecchy- 
 moses or abrasions, after which the larynx and verte- 
 bral column may be inspected. 
 
 3. The cavity of the mouth should now be laid open 
 to ascertain if any plug had been introduced and left 
 there, or if any traces of irritants or corrosives appear. 
 
 4. To ascertain the state of the chest, the clavicles 
 should be divided with a pair of scissors, avoiding the 
 subclavian vessels, and afterwards the cartilages of the 
 ribs, folding down the sternum and leaving it attached 
 to the abdominal parietes. The situation and volume 
 of the pectoral viscera can now be noted, as well as the 
 state of fulness or vacuity of their vessels. It should 
 now be observed whether the lungs cover the peri- 
 cardium or lie unexpanded and deep in the chest ; 
 whether their margins are sharp or rounded ; what 
 is their color and consistence; whether uniform or 
 mottled ; whether their capillaries are injected or not ; 
 whether they are fresh, emphysematous, or putrid. 
 Their appearance can be compared with that of the 
 thymus gland and the appearance of that gland noticed. 
 The pericardium should now be opened and its appear- 
 ances, externally and internally, examined ; the thymus 
 gland turned up, the left lung being pushed to the right, 
 and the state of the ductus arteriosus ascertained. After 
 the application of double ligatures to the vence cavce, the 
 aorta, pulmonary artery, and the trachea, the lungs and 
 thymus gland should be removed from below upwards. 
 
140 MEDICAL JURISPRtlDENCE. 
 
 and the hydrostatic test applied. The heart should 
 next be opened to ascertain the quantity and distribut 
 tion of the blood in its interior and the state of the 
 foramen ovale. The heart, lungs, and thymus gland 
 should then be separated from each other, — after secur- 
 ing their connecting vessels with double ligatures, ^ the 
 lungs weighed, and their weight compared with that of 
 the body. Note whether they sink or float — whether 
 in whole or in part, and whether buoyantly or not — 
 when thrown into water ; and, after cutting them into 
 fragments, what portions sink and what float ; if the 
 former, whether they are sound or diseased, and what the 
 disease, if any. On handling and cutting the lungs, it 
 should be observed whether they have a spongy or solid 
 feeling, and whether they crepitate or not. By com- 
 pressing the fragments in air, the amoimt of blood or 
 other fluids which they may contain can be ascer- 
 tained ; while by doing so under water, the presence 
 or absence of air can be discovered ; and if they con- 
 tain air, the size of the air bubbles given out will assist 
 in the discrimination as to whether it was contained in 
 the air cells or in the subpleural or interlobular areolar 
 tissue, and their odor if fetid will serve to characterize 
 putrid lungs. 
 
 5. The best mode of opening the abdomen so as not 
 to interfere with the umbilical vessels is to remove the 
 sternum at the base of the chest, to carry an incision 
 from the xyphoid or ensiform cartilage to a point a little 
 above the umbilicus, to prolong the incision downwards 
 and outwards at a little distance from the navel to the 
 anterior superior spinous process of the ilium, and thence 
 across the pubes to meet the continued incision on the 
 
INFANTICIDE. 141 
 
 opposite side. The examiner should now search the 
 abdomen for effused blood and sanguinolent serum or 
 other effused fluids ; for marks of putrefaction ; for 
 ruptures of the liver, or ecchymoses indicative of effused 
 blood in its interior ; for rupture or softening of the 
 spleen. The state of the umbilical vessels should be 
 noted, whether open or contracted, full or empty ; the 
 state of the stomach, whether it contains milk or other 
 alimentary matters, or mucus containing air bubbles ; 
 and in what part of the intestines the meconium, if 
 present, is to be found, or if they contain air. The ex- 
 ploration of the bladder, kidneys, and genitals, external 
 and internal, complete this part of the examination. 
 
 6. The spine should be explored throughout. 
 
 7. To complete the inspection, it only remains for 
 the examinator to ascertain whether any ecchymoses 
 exist on the trunk or limbs, for this purpose making 
 free incisions in the latter; and to turn his attention 
 to the bones in order to ascertain the state of their 
 development. 
 
 See the chapters on Medico- Legal Inspections, 
 Legitimacy and Paternity, and Peesonal Identiit. 
 
CHAPTEE XII. 
 
 DEFLORATION AND KAPE ; SODOMY. 
 
 Definitions, etc. — By " defloration " is meant the act 
 of depriving a female of her vii^inity ; and by " rape " is 
 meant carnal knowledge of a woman by force and 
 against her wilL Cases of the former will seldom come 
 before the medical jurist. 
 
 The age of consent by the common law is fixed at 
 twelve years ; this age has, however, been variously 
 changed by statute to ages from ten to fourteen years. 
 Carnal knowledge of a child under the age of consent 
 also constitutes the crime of rape, a child of such ten- 
 der years being considered incapable of giving a legal 
 consent. According to the doctrine of the common 
 law, a boy under fourteen is incapable of committing 
 rape whatever may be his physical capacity. In the 
 State of Ohio, however, this doctrine has not been 
 adopted ; in that State a boy under the age of fourteen 
 is prima fade incapable of committing this offence, 
 but on proof of the existence of such capacity, he may 
 be convicted of this crime. The same point has also 
 been ruled in the Supreme Court of New York, but 
 does not seem to have been adopted elsewhere. 
 
 By the law as it at present exists both in England 
 and in this country, emission is not necessary to the 
 
DEFLORATION AND RAPE; SODOMY. 143 
 
 complete commission of this offence. Penetration is, 
 however, necessary; but both the English and the 
 American courts hold that nothing more is required 
 than res in re, without regard to the extent of penetra- 
 tion ; and according to the prevalent doctrine, mere 
 vulvar penetration is sufficient, — the fact of the hymen's 
 not being ruptured being only presumptive evidence 
 against penetration. 
 
 Without entering into the consideration of the legal 
 aspects of this offence, which more properly belongs to 
 a treatise upon the criminal law, it is proper in this 
 connection to consider the subject under three heads : 
 
 1. Violation of the female under the age of puberty. 
 
 2. Violation of the female after puberty but prior to 
 her having otherwise had se.xual intercourse. 
 
 3. Violation after puberty and where the female has 
 been accustomed to such intercourse. 
 
 Before entering into the consideration of these three 
 topics, it may perhaps be well to state the physical 
 signs of virginity. No female should be examined for 
 the purpose of ascertaining whether or not she is a 
 virgin during the period of menstruation. The physical 
 signs indicating virginity are, — 
 
 1. The presence of an intact hymen, which is a mem- 
 brane stretched across the . entrance to the vagina, in 
 which there is an opening towards the orifice of the 
 urethra. This opening may assume a variety of forms, 
 as that of an irregular, circular diaphragm broken at its 
 upper third or in some cases perforated by a central 
 opening ; or, which is its most common appearance, it 
 may consist of a semi-circular fold of integument 
 stretched across the lower border of the vaginal orifice, 
 
144 MEDICAL JURISPRUDENCE. 
 
 the free border concave and notched and its extremities 
 losing themselves in the labia miTiora. It sometimes 
 assumes other forms, such as a complete septum pierced 
 by numerous minute openings ; and there are recorded 
 instances of its being imperforate and completely block- 
 itig the entrance to the vagina. Its normal condition is 
 such as to permit thp passage of the finger into the 
 vagina without injuring its border, of mucous mem- 
 brane ; and. there would seem to be no doubt that if 
 this aperture was slightly larger than usual, and the 
 male organ small, repeated intercourse may be had with- 
 out rupturing it or without other change than an in- 
 creased dUatability of the aperture, or perhaps minute 
 tears or indentations on its free border. In some 
 females the. hymen may be in so relaxed a state, by 
 the discharges of leucorrhcea or otherwise, as to dimin- 
 ish its liability to rupture by sexual intercourse. ' If, 
 however, the aperture is small, it wUl almost always be 
 ruptured by the first coitus. There are recorded cases, 
 however, where- an unruptured hymen has continued 
 throughout pregnancy and has not been ruptured until 
 delivery. Dr. Lusk records the case of a young woman, 
 nineteen years of age, who, possessed a perfect hymen, 
 the opening of which was of the ordinary size, yet so 
 distensible was its tissue that a one inch speculum was 
 repeatedly introduced for purposes of examination with- 
 out in the slightest degree affecting its integrity. There 
 is said to be in Meckel's museum at Halle, a specimen 
 of the female genitals where the hymen is perfect al- 
 though the woman had given birth to a seven months' 
 child. Dr. Lusk states that in his experience, however,, 
 in the examination of young, nulliparous prostitutes for 
 
DEFLORATION AND BAPE; SODOMY. 145 
 
 uterine disorders, he has always found a torn hymen, 
 but in no case carunculoRmyrtiformes. 
 
 Although the existence of the hymen in any case has 
 even been doubted by some writers, there can, we think, 
 be no doubt of its constant existence at some period. 
 With respect to this subject Casper makes the state- 
 ment that when a forensic physician finds a hymen still 
 preserved, even its edges not being torn, and along with 
 it a virgin condition of the breasts and external genitals, 
 he is then justified in giving a positive opinion as to 
 the existence of virginity. 
 
 While not prepared to indorse so strong an opinion 
 as this to its fullest extent, still such a condition — espe- 
 cially if the aperture is small, and the membrane un- 
 dilatable and of ordinary shape and structure and nor- 
 mally placed -r- is without doubt strong evidence of 
 virginity, though perhaps not absolutely conclusive. 
 Notwithstanding this, however, the presence of an in- 
 tact hymen must not be considered as conclusive proof 
 that rape has not been committed, especially consider- 
 ing the fact that the crime may be completed by simple 
 vulvar penetration. It should also be remembered that 
 in children this membrane is more deeply placed than 
 in the adult, and can only be readily seen in them on 
 the forcible separation of the thighs. 
 
 Although the presence of an unruptured hymen in a 
 female arrived at puberty is very strong evidence of 
 virginity, it may be destroyed by surgical operations, 
 by a medical examination of the genital organs, by 
 self-abuse, and by various other forms of mechanical 
 violence. It has even been alleged that riding, danc- 
 ing, and leaping may in exceptional cases destroy it, — 
 
 10 
 
146 MEDICAL JURISPRUDENCE. 
 
 allegations, however, which, considering the location of 
 the hymen, are in our opinion to be received with con- 
 siderable scepticism. 
 
 2. The absence of the carunculcB myrtiformes is 
 usually regarded as evidence of virginity. Two or more 
 of these are vaginal ; the others — which are hymeneal, 
 and are the remains of the ruptured hymen — only 
 prove the rupture of the hymen, and furnish no evidence 
 as to the cause of its rupture. 
 
 3. The entirety of the fourchette, fossa navicularis, 
 and posterior commissure of the labia, are regarded by 
 some as another evidence of virginity. Of these it may 
 be said that while they seldom survive the first labor 
 at term, they are not, as a rule, affected by sexual in- 
 tercourse unless under circumstances of considerable 
 violence ; so that while destruction may be evidence 
 of prior delivery or at least of the passage of some large 
 body through the genital passages, their presence fur- 
 nishes very little evidence of virginity. 
 
 4. A narrow and rugose state of the vagina is some- 
 times considered a mark of virginity. It not unfre- 
 quently, however, exists in young, healthy married 
 women prior to child-bearing, and is not always oblit- 
 erated after a single confinement at an early age. 
 Mere sexual intercourse, unless under circumstances of 
 great violence, would not alter its condition ; while on 
 the other hand leucorrhoea or other pathological condi- 
 tions might destroy this condition in females who had 
 never had sexual intercourse. 
 
 5. A plump and elastic condition of the breasts, with 
 slight development only of the nipples, is mentioned by 
 medical jurists as another evidence of virginity. The 
 
DEFLORATION AND RAPE; SODOMY. 147 
 
 areola is altered by conception, but not by mere sexual 
 intercourse ; and although the breasts may be slightly 
 affected by constant intercourse, and considerably so by 
 advancing age and feeble general health, the evidence 
 of virginity afforded by their general condition would 
 seem to be very slight. 
 
 6. The integrity of the perinmum, while always found 
 in virgins, is not affected by sexual intercourse unless 
 accompanied by great violence ; and is therefore of very 
 little value as an evidence of virginity. It is, however, 
 almost always slightly lacerated in first labor. 
 
 7. In healthy virgin females before the decline of life, 
 the labia are usually bulky, smooth, vermilion-hued, 
 elastic, and in contact with each other, concealing the 
 orifice of the vulva entirely ; and the nymphee are 
 smaller in proportion in a virgin state of the genitals, 
 and lie more concealed by the labia when the thighs 
 are nearly in contact. Ifevertheless, indulgence in 
 libidinous desires and manipulations would doubtless 
 produce in them a similar effect to that produced by 
 sexual intercourse. The normal size and condition of 
 the clitoris affords a presumption of virginity ; and its 
 enlargement, facility of erection, and the laxity and 
 mobility of its prepuce, raises a presumption of non- 
 virginity. But here, again, it should also be remembered 
 that the practices above referred to may produce the 
 same as or greater changes than sexual intercourse. 
 
 The concurrence of all these physical signs of vir- 
 ginity affords strong evidence of this condition ; and yet 
 it behooves the medical jurist to be very careful in ex- 
 pressing a decided opinion upon this subject ; for there 
 is a recorded instance of a common prostitute's preserv- 
 
148 MEDICAL JURISPBUDENCE. 
 
 ing so many of the signs of virginity that a very- able 
 physician after a careful examination was unable to 
 determine whether or not she was a virgin. 
 
 1. Coming to the first of the divisions above indi- 
 cated, namely, violation of the female under the age of 
 puberty, in such cases extensive marks of local injury 
 should be looked for, and in their absence it cannot be 
 admitted that complete coition has taken place. This 
 will be evident when we consider the undeveloped state 
 of the sexual organs in the female at this age, and the 
 disproportion between the adult penis and the narrow 
 canal of the vagina. Instances are sometimes met with 
 of violence produced in this way on children so serious 
 as to prove fatal to life. In one case recorded by Dr. 
 Ogston, a post-mortem examination disclosed the ex- 
 ternal organs of generation and the perinasum torn and 
 violently inflamed, the vagina torn away from the 
 uterus, and a large rent in the peritoneum, with bloody 
 fluid effused into the abdominal cavity. Injuries of all 
 degrees may be inflicted between this extreme and the 
 other extreme of mere vulvar penetration without en- 
 trance into the vagina and injury to the hymen ; in the 
 latter case there may be no trace of violence, but the 
 crime may be complete, in the legal sense, in the entire 
 absence of marks of injury about the external genitals. 
 In the simpler cases there may be slight irritation of 
 the vulva, characterized by heat and moderate redness 
 of the parts'; more frequently, however, there will he 
 swelling and contusion of the labia, intense redness of 
 the hymen and vaginal outlets, and the whole of these 
 parts will be so painful as to make any examination of 
 them difficult, if not impossible. Excoriations, super- 
 
DEFLOEATION AND RAPE; SODOMY. 149 
 
 ficial erosions, and even real ulcerations are not unusual. 
 In this connection it should be remembered that diseases 
 of the genitals occasionally occur in female children 
 which unless care is used may be confounded either 
 with the effects of local violence or with venereal dis- 
 ease. One form of such local disease in young females 
 consists of a purulent discharge from the genitals closely 
 resembling gonorrhoea. A muco-purulent vaginal dis- 
 charge win probably be found within a few hours after 
 a rape upon a young girl ; this discharge is not gonor- 
 rhoeal but results from the inflammation arising from the 
 irritation of connection. It is usually at first bloody, 
 but rapidly changes to a greenish tint, finally becoming 
 glutinous ; it is commonly attended with great smarting 
 and with constant desire to scratch the genitals ; but 
 the existence of such a discharge, although it is impor- 
 tant evidence, is not proof of rape. It is a weU-known 
 fact that the majority of females, whether virgins or not, 
 suffer at times from leucorrhcea ; while in the case of 
 female infants and young children inflammation of the 
 vulva and of the vagina, giving rise to infantile leu- 
 eorrhoea, is common. It is generally considered that 
 there are no certain diagnostic signs by which, under all 
 eiicumstances, such discharges may be distinguished 
 from leucorrhcea, unless it be by a pure culture and 
 microscopic examination for the discovery of the so- 
 called gonococcus ; but in the present state of our 
 knowledge, the specific nature of this so-called gono- 
 eoccus, whUe probable, can hardly be said to be proved. 
 
 Another severe form of genital inflammation some- 
 times found in young children, and which terminates 
 in a destructive and gangrenous form of ulceration is 
 
150 MEDICAL JURISPRUDENCE. 
 
 the disease called noma, which might be mistaken for the 
 results of attempted violation. A further description of 
 this disease is beyond the scope of this treatise. 
 
 Light may be thrown upon the case by a careful in- 
 quiry as to the time when the discharge first appeared ; 
 for if gonorrhoea or syphilis be clearly marked in the 
 female at the time of the examination, and such exam- 
 ination has been conducted immediately after the al- 
 leged rape, it may be considered as certain that the 
 venereal disease did not result from the alleged rape ; for 
 both gonorrhoea and syphilis have a distinct period of 
 incubation, which in the former disease varies from 
 some hours to three or four days or even more, and in 
 the latter from ten to forty-four days or even longer. 
 The existence, therefore, of a profuse discharge a few 
 hours after an alleged rape, or of secondary or tertiary 
 symptoms soon after, would be almost conclusive evi- 
 dence that the disease was contracted prior to the 
 alleged rape. 
 
 It must also be remembered that this disease may have 
 resulted from other causes than intercourse, and hence 
 if sufficient time has elapsed for the development of the 
 disease, the existence of the disease is not very strong 
 evidence of the commission of the crime. If an exam- 
 ination of the male shows that he has not either of said 
 diseases, of course this is strong exculpatory evidence ; 
 if on the other hand he is found suffering from the same 
 disease as the female, this may be evidence against him. 
 
 2. Coming now to the subject of the defloration or 
 violation of a virgin after puberty, it may be Stated at 
 the outset that the proof of such violation by medical 
 evidence is much more difficult than in the case of 
 
DEFLOEATION AND RAPE; SODOMY. 151 
 
 children. In order to establish the offence in such 
 cases there must be evidence — 
 
 a. That previous connection with another person 
 could not have taken place. 
 
 6. That the alleged intercourse took place at the time 
 alleged. 
 
 c, That it was by force and against the will of the 
 woman. 
 
 The evidence bearing upon the first point has already 
 been considered at the beginning of this chapter, under 
 the heading, physical signs of virginity. 
 
 As to the two other points, where both parties are 
 above the age of puberty, and the penis of the male is 
 disproportionately large as respects the female, a recent 
 connection, when it has been fully effected, will produce 
 effects in the female the same in kind, though less in 
 degree, as in the case already considered. This dispro- 
 portion may exist where the male is in the vigor of 
 manhood, and the female just past the age of puberty, 
 and her sexual organs not yet fully developed. It may 
 also exist where both parties are of mature age, but the 
 male is large and vigorous, and the female small or not 
 so fully developed. In such cases the following ap- 
 pearances may be encountered, namely: bruising and 
 excoriation of the clitoris and labia ; laceration of the 
 mucous membrane of the external parts, with ecchymo- 
 ses under the membrane ; vascular injection in the 
 vicinity of the excoriations ; rupture of the hymen and 
 sometimes of the fourchette, and even excoriation of the 
 lining membrane of the vagina within its external ori- 
 fice. Besides these, the vulva may be swollen, tender 
 and painful to the touch, while the chemise may be 
 
152 MEDICAL JUEISPEUDENCE. 
 
 stained in front with seminal fluid, and behind and in 
 front with blood. These appearances may sometimes 
 present themselves to some extent where the venereal 
 congress has been entirely voluntary on the part of 
 both, especially where the parties have been actuated 
 by strong and ungovernable desire. These appearances 
 of the genitals must be looked for early; in almost 
 every instance they will have become obliterated by the 
 third or fourth day, by which time the lacerations will 
 have healed and the torn hymen be in such a state as 
 to make it difficult to say whether it has been ruptured 
 recently or at an earlier period. 
 
 In the cases above described the male has been supr 
 posed to be more vigorous and fully developed than the 
 female ; when, however, the parties are more nearly 
 equal in this respect the effects of a first connection 
 will be likely to be much less noticeable, though some 
 of them will probably be found. When the genital 
 organs of the female have become relaxed by long con- 
 tinued leucorrhceal discharges, profuse menstruation, ad- 
 vanced age or other causes, the signs of recent defloration 
 will be still more faint. 
 
 It should be remembered that local injuries such as 
 those which may be produced by first coitus, and those 
 which may be caused by the forcible introduction of 
 foreign bodies, cannot with certainty be distinguished,; 
 and that there are recorded instances in which such in- 
 juries have been produced by the assailant not in the 
 usual way, but by other means than by the introduction 
 of his penis. These questions must be solved by the 
 ordinary rules pf evidence. 
 
 The subject of seminal and blood stains which have 
 
DEFLORATION AND EAPE; SODOMY. 153 
 
 already been referred to, as well as marks of bruises, 
 scratches, etc., will be further considered post. 
 
 3. Coming now to the third division, namely, where 
 tbe female is known to have been accustomed to sezuaJ 
 Intercourse, it may be stated that the proof in these 
 cases must usually be made out by the application of 
 the ordinary rules of evidence, and usually little assist- 
 ance can.be rendered by the medical jurist. Of course 
 the signs of virginity and of defloration are not elements 
 of the inquiry. 
 
 It should be remembered, however, that in these 
 cases, where the disproportion between the bulk of the 
 penis and the size of the vagina is very great, the ap- 
 pearances above-described may to a greater or less ex- 
 tent be produced even where the woman is not a virgin ; 
 especially may this happen where the intercourse is 
 effected with brutality, or where several men in suc- 
 cession have forcibly had connection with the same 
 woman. In this class of cases, as well as in children 
 and virgins, bruises, scratches, or other injuries of the 
 person will often be met with. Seminal stains will 
 probably be found, and venereal disease may follow the 
 intercourse. The evidence, however, to be derived from 
 the existence of venereal disease is much less trust- 
 worthy than in the cases previously described. It is not 
 necessary in this connection to add anything to what 
 has been said upon this subject. In either of the last 
 two cases pregnancy may result from the alleged rape ; 
 but in the case of married women or women living in 
 adultery the evidence afforded by such impregnation 
 will of course be of no value. 
 
 Blood-stains on women who are accustomed to sexual 
 
154 MEDICAL JURISPRUDENCE. 
 
 intercourse will not be found unless the intercourse is 
 effected under circumstances of exceptional brutality. 
 
 There are recorded instances of sexual intercourse 
 having been had with a woman during a deep sleep, 
 without her having been conscious of the fact. Where 
 the woman has been accustomed to sexual intercourse, 
 or where the sleep is pathological or induced by drugs, 
 this is not impossible ; but that intercourse may have 
 been had during natural sleep with a woman not accus- 
 tomed to sexual intercourse, or, as a rule, even with a 
 woman so accustomed, is not to be believed except upon 
 the most conclusive evidence. There is one recorded 
 case where rape was committed upon a woman in a 
 state of mesmeric coma. 
 
 The allegation is sometimes made in cases of alleged 
 rape that the accused exhibited chloroform upon a 
 handkerchief to the woman, who thereupon instantly 
 became unconscious. Such allegations are entirely op- 
 posed to universal experience and are not to be believed. 
 Experiments have been made to determine whether a 
 person may be brought under the influence of chloro- 
 form during natural sleep without awakening him ; in 
 the vast majority of cases it has been found impossible 
 of accomplishment. There are, however, a few cases in 
 which it has been done as an experiment by medical 
 men experienced in its administration; that it could 
 be accomplished by one not so experienced is hardly 
 credible. 
 
 N"ot unfrequently charges of rape while under the in- 
 fluence of chloroform have been made against dentists ; 
 and in some instances conviction has followed such 
 charges. While a dentist who would administer such 
 
DEFLORATION AND RAPE; SODOMY. 155 
 
 an ansesthetic without the presence and assistance of a 
 competent medical man is, perhaps, deserving of some 
 punishment, such charges are to be looked upon with 
 considerable suspicion ; for it must be remembered that 
 not unfrequently women while under the influence of 
 chloroform experience erotic dreams which have such a 
 semblance of reality that they are with difficulty per- 
 suaded of their non-reality when consciousness has been 
 restored. 
 
 It should be a universal law of practice with all medi- 
 cal men never to administer any anaesthetic except in 
 the presence and with the assistance of another compe- 
 tent medical man if possible ; or at least, never without 
 the presence of some other reliable witness. 
 
 An ezammation of the accused may often furnish 
 important evidence in a case of alleged rape. The sub- 
 ject of venereal disease has already been sufficiently 
 considered. Scratches, especially on the face, hands, 
 and penis, tears of the clothes, and spots of blood, semen, 
 or dirt, should all be noted. Sometimes a laceration of 
 the frcenum prceputii will be found, especially if the 
 accused is not accustomed to sexual intercourse. 
 
 Coming now to the stains on the woman's linen, — 
 they are usually of two sorts, one pale and the other 
 colored. The colored stains are usually on the back 
 part of the chemise, and consist principally of blood. 
 There are two sorts : one of a deep red, rich in coloring 
 matter equally diffused over the stain ; and the second 
 sort of a much lighter red, or rather, reddish-yellow 
 color at the centre of the stain, and their margins hav- 
 ing a defined reddish line. The former of these stains 
 arises from pure blood ; the latter from a sero-sanguino- 
 
156 MEDICAL JUEISPEUDENCE. 
 
 lent discharge, becoming gradually less and less red. 
 The subject of blood stains and their microscopical ex- 
 amination wiU be more fully considered in another 
 place. 
 
 Besides the reddish stains arising from blood above- 
 described, there may be found broad diffused yeRow- 
 ish ones caused by urine ; those of a yellow or green- 
 ish-yellow color due to feculent matter; light-yeUow, 
 diffused and stiffened patches from muco-purulent or 
 mucous discharges, etc. Seminal stains found on the 
 linen after coition are usually situated in front, at a 
 point corresponding with the vulva, although they are 
 occasionally found behind. 
 
 In the examination of a woman alleged to have been 
 violated, the pubic hairs should be carefully examined 
 for Bpermatozoa, which adhere very closely to them. In 
 general appearance a seminal stain is colorless and stiff; 
 by transmitted light it is of a somewhat grayish-brown 
 tinge ; when warmed it becomes of a pale-yellow tint, 
 which is quite characteristic, and happens with hardly 
 any other discharge, healthy or morbid. "When warmed 
 or moistened with warm water, the characteristic odor 
 of seminal fluid is evolved. If a small portion of the 
 stained fabric be digested in a watch-glass with a few 
 drops of water for about ten minutes, and the water 
 carefully squeezed out from the fabric, and to the solu- 
 tion a drop of nitric acid be added, the glass being 
 placed in a good light on a piece of white paper, if the 
 stain is seminal there wiU be no precipitate, but the 
 liquid will turn to a yellow color. In pure seminal 
 stains the guaiacum test gives no blue reaction. "Where 
 the garment upon which the stains occur is dirty or 
 
DEFLORATION AND RAPE; SODOMY. 157 
 
 colored, the above tests are of no value ; and, as a gene- 
 ral rule, the detection of the characteristic spermatozoa 
 by microscopic examination is the only test which in 
 practice ought to be relied upon; and nothing should 
 be admitted to be a seminal stain unless complete sper- 
 matozoa are found. 
 
 Human spermatozoa have a flattened, almost oval 
 head, with a long, slender, filamentous tail ; the entire 
 length varying from -^^ to g^^ of an inch, — although 
 some may be found that do not exceed j;oVo' °^ ^^ ^^'^^ 
 in length. The tail is usually five or six times as 
 long as the head, which is about -q-^-q-^ of an inch in 
 diameter. The shape of spermatozoa varies in different 
 animals. Human spermatozoa are quite tenacious of 
 life, and there are recorded instances in which active 
 spermatozoa have been found in the vaginal mucus 
 several days after intercourse. There is one case on 
 record in which they were found alive fourteen days 
 after the rape. They have a remarkable power of resist- 
 ing putrefaction, and even after they are dead and the 
 stain has become dry, they may by the aid of a micro- 
 scope be easily distinguished by their characteristic 
 shape even months after their emission. 
 
 Microscopical literature abounds with descriptions of 
 the technique of their examination. Without entering 
 into this subject in detail, it may be stated that the ex- 
 amination should be made with the power of 300 or 400 
 diameters, and that in preparing material for examina- 
 tion the stained portion of the fabric should be cut out 
 with as little handling as possible, placed in a clean 
 watch-glass and moistened with three or four drops of 
 cold distilled water. After having allowed it to soak 
 
158 MEDICAL JURISPRUDENCE. 
 
 for about ten minutes, moving the fabric about gently 
 with a glass rod, the water may be squeezed out with the 
 end of the rod and specimens of the liquid and deposits 
 placed on a glass slide, covered with a cover-glass and 
 examined. If no spermatozoa are at first found, the 
 fabric may be carefully unravelled and different por- 
 tions subjected separately to examination. An aqueous 
 solution of methyl blue or fuchsia will often serve to 
 differentiate the spermatozoa. 
 
 It should be remembered, however, that spermatozoa 
 do not always occur in the seminal fluid, especially in 
 the prostatic fluid which has been ejaculated after one 
 or more prior emissions ; and also that in some cases of 
 disease no spermatozoa are found. Their absence also 
 is not unusual in the seminal fluid of the old and the 
 feeble, so that the failure to find spermatozoa in the 
 alleged seminal stain wiU not invalidate a charge of 
 rape ; and their discovery, upon the other hand, is at the 
 most, only evidence of the fact of previous sexual inter- 
 course without determining whether it was voluntary or 
 involuntary. The expert microscopist will not be likely 
 to confound human spermatozoa with anything else, 
 There are, however, certain fungi which are said to re- 
 semble spermatozoa; their tails, however, are clumsier, 
 and they refract light differently. 
 
 An animalcule called trichomonas vaginalis is some- 
 times found in the vaginal mucus of females not remark- 
 able for their cleanliness, which has been supposed to 
 bear some resemblance to seminal animalculse. The 
 heads of the trichomonads, however, are very much 
 larger than those of spermatozoa, and are, moreover, fur- 
 nished with several cilise, while the spermatozoa have 
 
DEFLORATION AND RAPE; SODOMY. 159 
 
 none. Internally, moreover, the trichomonads are granu- 
 lar, which is not the case with spermatozoa. 
 
 The third element of the crime of rape, namely, that 
 the intercourse was by force and against the will of the 
 female, has already been somewhat considered in what 
 has preceded. As a rule, independent of the marks of 
 violence on the person of the woman, evidences of a 
 struggle, etc., this element of the crime must be estab- 
 lished by the ordinary rules of evidence with which the 
 medical jurist has nothing to do. This topic may, with 
 propriety, be left to the officers charged with the admin- 
 istration of the law. 
 
 Sodomy. — Sodomy, sometimes called " buggery," 
 sometimes " the offence against nature," and sometimes 
 " the horrible crime not fit to be named among Chris- 
 tians," consists of a carnal copulation by two human 
 beings with each other against nature, or by a human 
 being with a beast. Unlike rape, sodomy may be com- 
 mitted between two persons both of whom consent ; it 
 may be committed between husband and wife, between 
 two men, or a boy and a man. By " sodomy " is ordi- 
 narily understood the offence between man and man, or 
 between man and woman ; where the victim is a boy, 
 sodomy is usually termed " pcederastia." 
 
 By " bestiality " is meant intercourse by the human 
 kind, male or female, with an animal, male or female, 
 other than the human kind. The term " buggery " in- 
 cludes unnatural intercourse both with mankind and 
 with animals. 
 
 According to Lord Coke, emission is a necessary ele- 
 ment of the crime of sodomy, but at present time by 
 statute both in Eagkbad and in this country, penetration 
 ^^ _ PW 
 
160 MEDICAL JURISPRUDENCE. 
 
 is sufficient, as in rape, without proof of emission. A 
 penetration of the mouth is not sodomy, neither is an 
 unnatural connection with a fowl, — a fowl not coming 
 under the term " beast." 
 
 As to the appearance of, and the effects produced 
 upon the criminals, it is said that if the crime has been 
 habitual and frequent, there will be the usual evidence 
 of sexual excess, and premature decay of strength, the 
 apparent age of the person far exceeding the real, etc. 
 The penis is said to be commonly found elongated ; the 
 glans more than usually bulbous and conical, and the 
 urethra twisted. The natural fold about the anus of 
 the passive criminal, and those that radiate towards the 
 anus, become rapidly obliterated by repetitions of the 
 crime, giving the skin of the part a smooth appearance ; 
 moreover, a peculiar funnel-like or trumpet-shaped de- 
 pression or hollow of the nates is usually observed. 
 This appearance, however, it should be observed, may 
 be produced by other than criminal practices, such as 
 the necessity in some people of pushing back piles or 
 slight protrusions of the rectum forced out during defe- 
 cation. Where the crime is committed on one unac- 
 customed thereto, the passive agent, if examined soon 
 after, will exhibit a certain amount of bruising and in- 
 flammation, with a slight laceration of the sphincter. 
 There may be congestion and abrasion of the anal mu- 
 cous membrane without injury to the sphincter; in 
 some cases seminal stains will constitute important 
 evidence. 
 
 Where that form of sodomy known as bestiality has 
 been committed, the principal medical evidence will 
 consist in the finding of spermatozoa on the person or 
 
DEFLORATION AND RAPE; SODOMY. 161 
 
 clothes, or on the hairs of the animal ; or in identifying 
 the hairs of such animal on the accused, both of which 
 may he done by the aid of the microscope. If the hairs 
 of the animal be found adhering to stains of blood, 
 mucus, or semen, on the underclothing of the accused, 
 this fact will have considerable weight. 
 
 11 
 
CHAPTER XIII. 
 
 IMPOTENCE AND STERIUTY. 
 
 Questions respecting impotence and sterility more 
 frequently arise upon bills for a divorce; although 
 impotence may sometimes be alleged as a defence in 
 rape, or may be given in evidence upon the issue of 
 bastardy or illegitimacy of a child, and perhaps in other 
 cases. 
 
 Marriage between two persons of the same sex is void, 
 because none of the ends of matrimony can be accom- 
 plished thereby. The subject of doubtful sex will, how- 
 ever, be considered in another chapter. 
 
 In order that a marriage may be valid, the parties, 
 both of opposite sexes, should have their sexual organ- 
 ization and capabilities essentially complete; impo- 
 tence, therefore, is everywhere considered suf&cient 
 ground for decreeing the nullity of a marriage. In 
 countries governed by the common law, a marriage will 
 be good if there is an adequate power of mere copula- 
 tion, though in the ordinary case pregnancy cannot be 
 made to follow ; but the copula must be adequate as 
 such or the marriage will be invalid ; yet if pregnancy 
 is actually produced by an otherwise inadequate copula, 
 this, according to Mr. Bishop, will render the marriage 
 unimpeachable. The doctrine settled by the weight of 
 
IMPOTENCE AND STEEILITY. 163 
 
 auttority is believed to be that the ground df interfer- 
 ence by the court in cases of impotency is the practical 
 impossibility of connection. It is not necessary, as it 
 ■seems, that there be a structural defect rendering copu- 
 lation impossible ; if it is impracticable that will, be re- 
 garded as suf&cient.. It has been held in several cases 
 that, where there is a practical impossibility of copula- 
 tion, which, however, the evidence disclosed might be 
 lemoved by surgical treatment which would not en- 
 danger the life of the respondent, if the respondent re- 
 fuses to submit to such treatment, a decree dissolving 
 the marriage will be granted. Where, however,, there is 
 Capacity of body, but the respondent merely refuses to 
 Submit to the embraces of the complainant, this constir 
 tutes no ground for a decree. The defect, then, must 
 either be incurable or, according to the better opinion, 
 it must be such as practically prevents sexual inter- 
 course ; and if curable, the respondent must have posi- 
 tively refused to submit to treatment for that purpose. 
 Where, however, the medical evidence shows that the 
 malformation might possibly at great risk of life and by 
 an operation of doubtful success, be removed, the peti- 
 tioner is not bound to call upon the respondent to sub- 
 rait to such a risk, and this state of facts is deemed 
 equivalent to a permanent and incurable malformation. 
 
 It appears to be settled that mere incapacity of con- 
 ception where there is capacity for copulation is not 
 sufficient gi-oUnd whereon to found a decree of nuUity. 
 
 The causes of impotence in the male are chiefly the 
 following : — 
 
 1. Extreme youth, before the arrival of puberty, is of 
 course accompanied by impotence. . The ages of fourteen 
 
164 MEDICAL JUEISPKUDENCE. 
 
 in the male and twelve in the female are recognized Igr 
 the common law as the earliest ages at which a vaUd 
 marriage can be contracted. These ages have been 
 changed somewhat by statute in different States. Pu- 
 berty is sometimes anticipated, there being recorded in- 
 stances of puberty in boys as early as four or five years, 
 and in girls of the presence of menstruation almost from 
 birth. On the other hand, puberty is often deferred 
 until quite an advanced age. Mere old age cannot be 
 regarded as involving sexual incapacity, although the 
 sexual powers are usually very much diminished by 
 old age. 
 
 This general subject, however, will more properly be 
 considered in the chapter on Xegitimacy anu Patek- 
 
 NITT. 
 
 2. The impotence which more frequently is a ground 
 for a decree of nullity is that which arises from con- 
 genital or other defects. The subject of hermaphrodism 
 will be considered in another connection ; suf&ce it to 
 say here that if it exists to such an extent as to defeat 
 the ends of marriage, it is ground for a decree. The en- 
 tire absence of the penis, whether congenital or the result 
 of disease or accident, is clearly ground for a decree. 
 When there is any intromittent organ, however small; 
 the medical jurist should be very cautious in pronounc- 
 ing a man impotent. It should be remembered that 
 impregnation may occur with an unbroken hymen and 
 where the male organ is so short as only to be capable 
 of depositing semen within the vulva. It. may, per- 
 haps, be stated that a chaise of impotence on account 
 of the abnormal condition of the male organ will not be 
 regarded as sustained short of evidence of the absolute 
 
IMPOTENCE AND STERILITY. 165 
 
 and complete loss of the penis, or of its most extraor- 
 dinary development. Each case, however, as it seems, 
 should be decided on its own facts- in accordance with 
 the general principles above stated. 
 
 An extreme degree of hypospadias or epispadias may 
 in some instances amount to incapacity. Some other 
 malformations, or complaints, such as the abnormal 
 dirfection of the penis, its attachment to the abdomen j 
 |)hymosis, paraphymbsis, etc., are sometimes alleged as 
 causes of impotency. As in most cases they may h& 
 (iorrected by a slight surgical operation, there would 
 seem not to be ground for divorce in such cases. 
 
 No reported case has come to our notice deciding the 
 question whether the absence of both testicles, the 
 power of copulation remaining, however, is a ground for 
 a divorce. The absence of one testicle, or the non- 
 descent of the testicles, is clearly consistent with the 
 abihty to procreate, and there would seem to be no 
 doubt that in such case there is no ground for a divorce. 
 This subject will, however, be considered further in the 
 chapter on Legitimacy and Paternity. 
 
 3. Tmpotericy may be caused by disease of the male 
 sexual organs, such as syphilis, cancer, or tuberculosis. 
 Masturbation may be a cause both of sterility and im- 
 potency. 
 
 ' Injuries to the head and spine, and certain general 
 diseases, may in some instances produce impotency. 
 
 Complete sexual incapacity or impotence in the 
 female is very rare. The most common congenital 
 cause, perhaps, of such condition is the entire, or almost 
 entire, absence of the vagina. In one reported case the 
 vagina was contracted in depth, admitting the penis to 
 
16S MEDICAL JURISPRUDENCE. 
 
 perhaps less than half the "usual extent, and ending iii a 
 cul-de-sac, without communicating with any of the in- 
 ternal organs ; there appeared to be an entire absence 
 of the uterus. The defect being deemed incurable and 
 not admitting of complete copulation, the marriage was 
 set aside. 
 
 In some cases an attempt' has been made to form an 
 artificial vagina by operation, where none exists, but 
 such attempts can hardly be said to be successful, and 
 doubtless the woman could not be called upon to submit 
 to such an operation. Mere occlusion of the vagina by 
 adhesion of the labia, or by an imperforate hymen may, 
 however, in most instances be remedied by a slight 
 operation ; and if the woman should decline this operar 
 tion, according to the rules already stated, a decree 
 should be granted. - A decree has been granted in 
 several instances where there" has been so very great a 
 degree of sensibility of the vagina, accompanied in some 
 instances by spasms, or perhaps by hysteria, as to 
 amount practically to an impossibility of having sexual 
 connection. IJpon the principles already stated,: even 
 though such defects might be remedied by surgical; or 
 medical treatment, if the respondent should refuse to 
 submit to such treatment a decree should be granted. . 
 
 This subject and the kindred subject of sterility will 
 be further considered in the chapter'on Legitimacy and 
 Paternity. See, also, the next chapter. 
 
CHAPTER XIV. 
 
 ^ SEX, HEEMAPHRODISM, AND MOUSTKOSITIES. 
 
 - Bex. — The question of the sex of an individual is 
 not unfrequently one of considerable importance, both 
 as a matter of identification of the individual (which 
 will be more fully considered in a subsequent chapter)- 
 and also in determining the rights of property depend- 
 ing upon courtesy, descent, etc. 
 
 ■ If a body or considerable portions of a body are found, 
 there will be little difficulty in determining the sex if 
 the genital organs are present, except in rare instances 
 of doubtful sex. . ^ 
 
 ' Besides the general contour of ttie shoulders and hips 
 noticed below, the breasts of the female are, as a rule, 
 more developed than those of the male. The pubic 
 hairs of the male extend higher towards the umbilicus' 
 than those of the female ; the distance between the 
 navel and the pubes in the male is shorter than between 
 the navel and the scrohiculus cordis; in females the 
 reverse is the case. Males have more hair on the body, 
 but less and shorter hair on the head. In the male the' 
 ponium Adami and the larynx are larger than in the 
 female. The average male head is larger and the brain 
 heavier than in the case of females. 
 ; Where a body is found in a state of decomposition, it 
 should be remembered that the uterus has remarkable- 
 
168 MEDICAL JURISPRUDENCE. 
 
 powers of resisting putrefaction, and the sex may often 
 be determined from it when recognition from other 
 organs has been rendered impossible by decomposition. 
 
 It should be remembered that until the age of puberty 
 there is little difference in the general characteristics 
 of isolated bones or complete skeletons of the two sexes, 
 although generally. male children are somewhat taller 
 and heavier than females of the same age. 
 
 The general characteristics of skeletons or of the indi- 
 vidual bones of adults, are as follows : — , ,j 
 
 In the male, the shoulders are broader than the hipsj 
 the bones usually present rougher and more prominent 
 markings at the points of attachment of the muscles 
 than those of the female, and the male skeleton gen- 
 erally exceeds that of ' the female both in height and 
 Weight. 
 
 . In the female, the hips are broader, thighs shorter 
 and larger, and the tuberosities of the. ischia and the 
 acetabula farther apart. The female skull is said to be 
 sinaller, more oyoid, more bulging at the sides, and lar- 
 ger behind the foramen magnum than that of the male. 
 The face mote oval, frontal sinuses less strongly marked, 
 nostrils more delicate, jaws and teeth smaller, and; the 
 chin less prominent. The chest of the female is said to 
 be deeper than that of the male ; the sternum shorter 
 and more convex ; the ensiform cartilage thinner and 
 ossified later in life; ribs smaller and the cartilages 
 longer. The vertebral column is longer and the bodies 
 of the vertebrae deeper in the female than in the male. 
 The bones of both upper and lower extremities are 
 generally smaller and lighter in the. woman than in the 
 man. 
 
SEX, HEEMAPHRODISM, ETC. 169 
 
 / In many instances, however, it would seem to be 
 impossible to determine the sex of an individual from 
 an inspection of the skeleton without an examination 
 of the pelvis. The male pelvis presents a narrow but 
 deep excavation with smaller apertures ; its bones are 
 thick, its muscular impressions well marked and its 
 
 angles abrupt and-prominent, -. - - , 
 
 : The female pelvis is not so deep as that of the male 
 but considerably exceeds it~in Its"" transverse arid antero- 
 posterior dimensions. The cavity is more capacious, 
 its apertures larger;- its^ walls less massive and rough, 
 while its general contour is less angular and abrupt 
 The ate of the ossa, i%%6minata, spread further outwards, 
 the anterior superior spinous processes and the tube- 
 rosities of the ischia and the acetabula being removed 
 to a greater distance from the median line, whence 
 iirises the prominence of the hips in women. The 
 sacrum is wider and less curved, and the sacro-verte- 
 bral angle less prominent than in the male. The o64 
 twator foramen is somewhat triangular in form- and 
 smaller in size than the male ; the ischiatic spines pro- 
 ject less into the cavity of the pelvis ; the coccyx is 
 more movable and the symphysis pubis less deep ; the 
 upper aperture is more nearly circular, its margin 
 smoother and more rounded, the pubic arch is wider 
 and more curved, and the rami are everted so as to 
 present shelving surfaces. rather, than angular edges to 
 any object descending through the perineal strait, 
 The angle beneath the arch of the pubis is more obtuse 
 than in the male. In the male this angle varies from 
 75 to 80 degrees, while in, woman it varies from 90 to 
 100 degrees. 
 
170 
 
 MEDICAL JUKISPEUDENCE; 
 
 The above peculiarities of form are such as to permit 
 the expansion of the uterus and the passage of the child 
 in parturition. : 
 
 The dimensions of male and female pelves according 
 to. Dr. Tidy are as follows: — 
 
 ■ 
 
 Male. 
 
 Female. 
 
 
 u 
 
 Inches, 
 Lines. 
 
 Inches. 
 , Lines. 
 
 Between the antero-superior spinous processes 
 
 7 8 
 
 8 3 
 4 6 
 4 5 
 
 4 
 i 
 6 
 
 5 
 3 
 3 3 
 
 8 6 to 10 o' 
 
 9 4 " U 1 
 
 5 0" 56 
 4 5" 55 
 4 0" 44 
 4 7 " 4 8 
 
 6 2" 64 
 4 7" 48, 
 4 0" 45 
 4 4". 5 
 
 Between the middle points of the cristse of the 
 ilia , . , . . . ■ , 
 
 The transverse diameter of the abdom- ) 
 " oblique inal strait of the true > 
 " aritero-posterior pelvis ) 
 ;; tfiinsverse diameter of the' cavity | 
 " Sfposterior of the true pelvis ^\ 
 " transverse diameter of the perineal | 
 " , antero-posterior ., straitofthetrue pelvis j 
 
 The diameters of the female pelvis are, according to' 
 Dr. Lusk, as follows : — ' . ' : ...'^ 
 
 The diameters of Superior Strait or Brim ; — 
 
 Antero-Posterior or (anatomical) conjugate, 4J inches^ 
 
 The obstetrical conjugate diameter, measured about f of 
 an inch below the tipper border of the symphysis, is only 
 4 inches. . ; 
 
 The transverse or bis-iliac diameter of the brim, 5 J inches. 
 
 Oblique diameter from the ilio-pectineal eminence to the 
 apposite sacrO-iliac articulation, .5 inches. 
 
 The circumference of the brim is very nearly .16 inches- I 
 
SEX, HERMAPHEODISM, ETC. 171 
 
 The diameters of the Inferior Strait or outlet of the 
 
 pelvis : — 
 
 Antero-Posterior, 3| inches. When the coccyx is pushed 
 back it may extend to 4 J inches. 
 
 Transverse (iiameter, 4J inches. 
 . Owing to the elasticity of the sciatic ligaments, the oblique 
 diameters are not of obstetrical importance, 
 I The circumference of the Inferior Strait is 1 3^ inches. 
 
 Below the brim the dimensions are increased considerably 
 by the concavity of the sacrum; thus a plane passing 
 through the lower .portion of the. symphysis pubis and across 
 the upper margins of the acetabula to the junction of the 
 tecond and third sacral vertebrae, gains f inches, in the con- 
 jugate, while the transverse diameter is barely | inch less 
 than the transverse diameter of the brim. The narrowing 
 of the outlet is most marked in a plane drawn so as to 
 Intersect the spines of the ischia and the extremity of 
 the sacrum ; at this level the transverse diameter between 
 the spines is but 4 inches, and the antero-posterior diameter 
 4^ inches. "; • ■" 
 
 Hermaphrodism. ■ — The determination of sex in cases 
 where the organs of generation are malformed is some- 
 times a matter of some difficulty, and occasionally 
 nothing short of actual dissection after death has dis- 
 odvered the true sex of the individual. ' A full discus- 
 sion of this subject is, beyond the scope of this manual. 
 The malformation is seldom . confined to the genitals 
 alone, but often extends to the conformation of the 
 body generally, and even to the distinctive mental facul- 
 ties, while the sexual desires are either wanting alto- 
 gether or sometimes point in the wrong direction. In 
 
172 MEDICAL JURISPRUDENCE. 
 
 4;his connection only the more important facts wili be 
 stated. : . 
 
 Hermaphrodism may be divided into false and true. 
 In* the first species, the genital OTgans and general 
 sexual conformation of one sex approach from imperfect 
 or abnormal development, those of the opposite sex. 
 In the second or true hermaphrodism, there actually 
 co-exists upon the body of the same individual more 
 or fewer of the genital organs and distinctive sexual 
 characters, both of the inale and female. Strictly, 
 perhaps, hermaphrodism should be defined as the 
 co-existence in a single individual of completely 
 developed ovaries and testicles, or one at least of each 
 gland, the genital gland being the only reliable test 
 of sex. But in this strict sense it is probable that 
 no true human hermaphrodite has ever existed, or 
 at least such a one as has been able to perform the 
 functions of either sex indep^dently and to effect 
 self-impregnation. 
 
 With proper care and attention it is always easy, 
 says Dr. Ogston, to discover the true sex in the dif- 
 ferent varieties of false hermaphrodism* It is chiefly 
 in regard to the so-called true hermaphrodite that 
 mistakes have arisen, even in the hands of competent 
 observers. .: 
 
 The table of Sir James Simpson as altered by Dr. 
 Ogston, is here given in order to facilitate the under- 
 standing of this subject : — 
 
SEX, HERMAPHRODISM, ETC. 
 
 173 
 
 I, Sparious. ' 
 
 II. Trne. 
 
 In the female, 
 Androgynae. 
 
 2. In the male, 
 Gynandri. 
 
 ( 1. Lateral. 
 
 2. Transverse. 
 
 3. Vertical or 
 douhle. 
 
 (1,). JFrpra enlarged clitoris. 
 
 (2.) From prolapsus uteri. 
 
 (1.) From extroversio vesiea. 
 
 (2.) JFrom adhesion of the penis to 
 the scrotum. 
 
 (3.) From hypospadia. 
 
 (1.) Testis on the right, and ovary 
 on the left side. 
 
 (2.) Testis on the left, and oyary 
 on the right side. 
 
 (1.) External sexual organs fe^ 
 , male, internal male. 
 
 (2.) External sexual organs male, 
 iutertial female. 
 
 (1.) Ovaries, imperfect uterus, ve- 
 sicul% seminales, and rudi- 
 mentary vasa deferentia. 
 
 (2.) Testes, vasa deferentia, vesi- 
 culae seminales, and imper- 
 fect uterus and its appen- , 
 
 (3.) Ovariesi and testes co-existing 
 on one or hoth sides. 
 
 1. In most cases where females have been mistaken 
 for males, the enlarged clitoris is the prominent feature ; 
 a consideration, however, of the anatomical distinctions 
 between the clitoris and the penis, which may be found 
 in any work on anatomy, is sufficient to distinguish 
 the two organs. 
 
 The prolapsed uterus could only be mistaken for a 
 penis by one ignorant of the anatomical distinctions 
 between the two organs. 
 
 2. Cases of spurious hermaphrodism in the male aris- 
 ing from the obtrusion of the bladder, the adhesion of 
 the inferior surface of the penis to the scrotum, and 
 from hypospadiac cleft of the penis, as a rule present 
 no difficulty to the careful examiner ; where, however, 
 the gland is imperforate, and the penis itself diminutive 
 in size, — resembling an enlarged clitoris, with the ure- 
 
174 MEDICAL JUEISPRDDEirCE, 
 
 thra opening in a fissure of some length further back 
 towards the perinseum, — there may be more dif&culty. 
 In such cases the scrotum is usually found split into 
 two lateral halves, resembling the labia majora ; in such 
 a case should the testes not have descended from the 
 abdomen the question would be ' even more difficult. 
 There are recorded instances of this sort where such a 
 hypospadian has married and cohabited with a husband 
 for a long term of years without the true sex .having 
 been discovered. In such cases the true criterion of sex 
 is, as we have already stated, the presence of the distinc- 
 tive genital glands, the testicle or the ovaiy. ; The deter- 
 • mination whether a body in what appears to be a labium 
 is a testicle or not is, however, not always easy ; it may 
 be impossible of determination without dissection. 
 
 It should be remembered in this connection, that a 
 very feminine appearance may result from non-desc6nt 
 of the testes or even of a testis, especially if atrophy-of 
 the organ has taken place. 
 
 The so-called true hermaphrodism may be considered 
 under the three divisions given in the table. 
 
 1. A peculiarity of the sexual organs in cases of 
 lateral hermaphrodism is that in the same individual 
 there is found on one side of the median line what is 
 or resembles a testicle and its appendages, and on the 
 other side an ovary and its appendages. In such cases 
 the ovary is more frequently found On the left side. In 
 these instances, also, along with the testicle on one side 
 and the ovary on the other, there generally coexists a 
 more or less perfectly formed uterus, while the external 
 parts of generation and of the body genert,lly differ in 
 their sexual characters, in some instances being, female, 
 
SEX, HERMAPHEODISM, ETC. 175 
 
 in others male, and in others of an indeterminate type. 
 In some cases of lateral hermaphrodism spermatozoa 
 have been' found in the seminal fluid, whUe in others a 
 periodic menstrual discharge has been recorded, — such 
 conditions indicating the prevailing sex. Dr. Tidy re- 
 uords a case where were not only spermatozoa dis- 
 covered in ' the secretion of the testicle, but regular 
 menstruation was said to have occurred from the age of 
 ten, and in which there were double sexual instincts. 
 : '2. In so-called transverse hermaphrodism, the exter- 
 nal organs may be male and the internal female, or the 
 reverse: By the terms external and internal are not 
 meant those placed superficially or more deeply in the 
 ibody. Those parts of the genitals which are covered 
 by the common integument or are lined by the mucous 
 ilnembrane, and thus communicating with the external 
 air, are classed as external, — including the vagina and 
 uterus. The testis, though more exposed from being 
 placed outside the pelvis, is termed an internal organ. 
 '■ In cases of this sort of true hermaphrodism nothing 
 short of dissection after death can determine the sex. 
 The existence in such cases of a body which might be 
 a testicle in the labium is considered by Dr. Ogston as 
 too slight evidence whereon to form a decision. 
 
 3. Cases of the third variety of hermaphrodism canr 
 not be verified during life, and their real nature can 
 only be determined by dissection after death. In cer- 
 tain rare cases, according to Dr. Tidy, ovaries are 
 associated with both male and female passages ; and in 
 other very rare cases, testicles are similarly associated ; 
 while in a third class both ovaries and testicles coexist 
 in the same connection. Two cases are recorded by 
 
17.6 MEDICAL JURISPRUDENCE. 
 
 him in which periodic menstruation and a seminal 
 secretion containing spermatozoa occurred. 
 
 Sezless Beiugs. — According to Dr. Tidy, individuak 
 are occasionally found presenting, precisely opposite char- 
 acters from those of hermaphrodites; namely, beings 
 that have the essential features of neither males nor 
 females. Several cases are recorded by him in which 
 the genital organs are said to be entirely wanting in 
 children born alive. 
 
 The following conclusions are arrived at by Dr. Tidy : 
 
 1. Given the presence of a testicle or testicles, where*- 
 ever placed, and of a single opening communicating 
 with a bladder and not with a uterus, — especially if 
 there be seminal emissions containing spermatozoa and 
 an absence of periodic hemorrhages, — the individual 
 in question is to be accounted as a male, and that 
 independently of anatomical malformations, such as the 
 presence of an imperforate penis, or its entire absence, or 
 the existence of the feminine configuration or instincts. 
 
 2. Given the presence of an ovary or ovaries, espec- 
 ially if there are periodic hemorrhages, the individual 
 in question is to be accounted as a female, and that iur 
 dependently of anatomical malformations, such as the 
 existence of a penis-like body, or of male configuration 
 and instincts. 
 
 3. Given the presence of glands that may be either 
 ovaries or testicles, and the precise nature of which 
 there is difiiculty in deciding; or given the absence 
 of both ovaries and testicles, together with,! in either 
 case, the absence both of seminal emissions and of 
 periodic hemorrhages, — then the presence of a uterus 
 and of a second opening below and distinct fromi the 
 
SEX, HERMAPHRODISM, ETC. 177 
 
 opening to the bladder, should be sought for. If a 
 uterus or a second opening of the nature described be 
 found, the individual is to be accounted as a female, 
 and that independently of anatomical malformations, or 
 of male configuration and instincts. But if, on the 
 contrary, there be no uterus and no second opening 
 below and distinct from the opening to the bladder, 
 then the male sex is strongly indicated. 
 
 4 When the anatomical conditions are so equally 
 balanced that neither sex seems to prevail, the exist- 
 ence of periodic hemorrhages is to be regarded as 
 strongly indicative of the sex being female ; while on 
 the other hand, the existence of emissions are strongly 
 indicative of the sex being male. In the latter case, 
 however, if spermatozoa can be detected in such indi- 
 vidual, the proof that the same is male is complete. 
 
 5. Sexual inclinations, habits and tastes, and general 
 configuration of the body, should in all cases be con- 
 sidered. If they support the conclusions based on 
 the principles above laid down, they may be regarded 
 as valuable confirmatory evidence ; but if, on the con- 
 trary, they fail to conform or even appear at variance 
 with such conclusions, they may then be entirely dis- 
 regarded. 
 
 Monstrosities. — According to Blackstone, it is a very 
 ancient rule of the law of England, that "a monster 
 which hath not the shape of mankind, but in any part 
 evidently bears the resemblance of the brute creation, 
 hath no inheritable blood and cannot be heir to any 
 land, albeit it be brought forth in marriage ; but although 
 it hath deformity in any part of its body, yet if it hath 
 human shape it may be heir." 
 12 
 
178 MEDICAL JURISPEUDENCE. 
 
 In a case of this nature, Dr. Tidy well says that 
 "the duty of the medical jurist would be best per- 
 formed by describing with the greatest detailed accu- 
 racy in what respects the individual in question differs 
 from the human, leaving the court to say whether it 
 be without the shape of mankind or not" 
 
 If the individual in question has the shape of man- 
 kind and is therefore capable of inheriting, the deter- 
 mination of its sex may be important with respect to 
 questions of inheritance, questions of divorce, business, 
 etc. This question has, however, already been con- 
 sidered. 
 
 The scope of this manual forbids our entering into 
 the subject of Teratology in detail ; for full information 
 upon this interesting subject, the student is referred to 
 professed treatises thereon. 
 
 In determining whether the monster has the shape 
 of mankind or not, it may be stated that congenital 
 deformities arising from a deficiency of structure, with 
 arrested or defective development of parts, may give 
 rise to acardiac monsters (monsters having no heart); 
 acephalous monsters (monsters without a head) ; mon- 
 sters anencephalic (having no brain, — the forehead, 
 cranial vault, and brain being entirely wanting); or 
 monsters with structural deformities of various kinds, 
 such as the absence of arms, nose, eyes, ears, etc. 
 
 Acardiac and acephalous monsters can, of course, have . 
 no existence independent of their mother, and are not, 
 therefore, likely to become the subject of medico- 
 legal inquiry. Anencephalic monsters may at times, 
 however, have a medulla oblongata and cerebellum and 
 may be born alive ; therie are recorded instances of 
 
SEX, HEEMAPHEODISM, ETC. 179 
 
 suob a child having lived from one and a half hours to 
 two months. 
 
 Children having deformities resulting from structural 
 deficiency, such as the absence of arms, nose, etc., but 
 having the vital organs perfect, as well as children hav- 
 ing congenital deformities arising from a redundancy of 
 parts, are occasionally born and live to adult age. No 
 medico-legal questions, however, will arise respecting 
 such persons, as they have all the rights of persons 
 without any structural defect. Occasionally double 
 monsters are born, where the children are more or less 
 distinct above and below, being united by a band of 
 greater or less width extending from the thorax and 
 abdomen of one child to the thorax and abdomen of the 
 other ; or where the union exists between the back and 
 pelvis or between the head and scalp. Another class 
 of double monsters is where the union is deep and inti- 
 mate and more or less complete, — as where the children 
 are single above and double below; or double above 
 and single below ; or where the bodies of the two chil- 
 dren are so connected that they form a single body with 
 a head at each end. 
 
 As to the medico-legal aspects of monstrosities, the 
 only cases likely to demand the attention of the medi- 
 cal jurist are those of doubtful sex or hermaphrodism 
 already considered, and those of monsters not possessing 
 the shape of mankind. As to the latter, it seems that 
 no such human monster that has lived to adult age 
 could be denied human shape ; and we quite agree with 
 Dr. Tidy in saying that "it would constitute an almost 
 unrecorded case where the jurist would be justified in 
 saying without reserve that a' child born alive had not 
 
180 MEDICAL JURISPRUDENCE. 
 
 the shape of mankind, — implying as the phrase does, 
 far more than mere deformity." 
 
 It is very clear that by the common law no degree 
 of monstrosity in a child will warrant the destruction 
 of its life either by a physician or friend. 
 
CHAPTER XV. 
 
 LEGITIMACY AND PATERNITY. 
 
 A LEGITIMATE child, according to Blackstone, is he 
 that is born in lawful wedlock or within a competent 
 time afterwards ; and a bastard is one that is not only 
 begotten but born out of lawful matrimony. According 
 to the statute in the State of Illinois, an illegitimate 
 child whose parents have intermarried, and whose father 
 has acknowledged him or her as his child, shall be con- 
 sidered legitimate. By the civil and canon laws the 
 intermarriage of the parents after the birth of a child, 
 legitimates such child. 
 
 It seems that a child born after the death of its 
 mother as, for example, by Csesarean section, is legiti- 
 mate although begotten before the intermarriage of the 
 parents. 
 
 Every child born in wedlock is to be regarded as 
 legitimate unless impossibility of access or impossibility 
 of intercourse with the husband can be proved by com- 
 petent witnesses other than the husband or wife. A 
 posthumous child will be legitimate unless non-access, 
 impotence, or sterility can be proved. According to 
 Lord Coke, " if a man hath a wife and dieth, and within 
 a very short time after the wife marrieth again, and 
 within nine months hath a child, so as it may be the 
 
182 MEDICAL JURISPRUDENCE. 
 
 child of one or the other, some have said in this case 
 the child may choose his father." 
 
 Medico-legal questions relating to disputed paternity 
 may arise as to posthumous children; as to children 
 born either shortly after marriage or after the prolonged 
 absence of the husband; or in, cases where a second 
 child is born a short time after the birth of another 
 child ; where a child is bom soon after a second mar- 
 riage following the death of the first husband or a 
 divorce from him in cases where the decree of nuUity 
 is not on the ground of impotence, which has already 
 been considered ; and lastly, in cases pf supposititious 
 children, where the woman during the life-time of her 
 husband pretends to have given birth to a child and is 
 suspected of substituting for the purpose of fraud the 
 child of some other person. These questions may be 
 considered under the following heads : — 
 
 1. Impotence and Sterility. 
 
 2. Duration of Pregnancy. 
 
 3. Similarity or Likeness. 
 4 Supposititious children. 
 
 1. Impotence and sterility. — Fruitfulness. results 
 when a spermatozoon from the seminal fluid of the male 
 nieets and becomes incorporated with an ovum dis- 
 charged from the ovary of the female. The essential 
 conditions of fruitfulness then, are the existence of an 
 ovum capable of impregnation and the presence of 
 active spermatozoa. Impregnation may result alto- 
 gether independently of sexual intercourse. 
 
 By impotence is meant inability for sexual inter- 
 course ; thus a male having no penis or a female no 
 vagina would respectively be impotent. The subject 
 
LEGITIMACY AND PATERNITY. 183 
 
 of impotence, so far as it relates to the subject of divorce, 
 has been considered in another chapter. 
 
 By sterility is meant an inability. to conceive and to 
 procreate ; a male whose semen contains no spermatozoa, 
 or a female without ovaries, would respectively be 
 sterile. "We have already seen in another chapter- that 
 mere sterility, whether in the man or woman, is not in 
 itself sufficient ground for avoiding, marriage unless it 
 is also accompanied by an irremediable incapacity for 
 sexual intercourse. 
 
 Impotence and sterility in the man may arise from 
 the male's not having arrived at the age of puberty. 
 By the English common law the age of consent to 
 marriage is fixed at fourteen in the male and twelve in 
 the female ; and it is generally held that by the com- 
 mon law a rape cannot be committed by a boy under 
 fourteen years of age^ Although puberty may be con- 
 sidered as commencing somewhere about the age of 
 fourteen in both sexes, exceptions, to this rule are not 
 uncommon; puberty is notunfrequently long deferred, 
 and again, there are recorded instances where boys Iiave 
 arrived at tlie age of puberty very early. Dr. Tidy 
 records one case where the boy arrived at puberty at the 
 age of four and a half years. 
 
 So far as respects the q^uestion of impotence and 
 sterility in cases other than criminal prosecutions for 
 rape, if unequivocal signs of puberty exist, the boy 
 should be regarded as virile, no matter how young ; and 
 if, on. the other hand, signs of puberty are absent, the 
 medical jurist has no ground for affirming the possession 
 of virile power, however great the age. 
 
 There is no age beyond which parties may not legally 
 
184 MEDICAL JUEISPKUDENCE. 
 
 marry ; and although old age usually lessens the virile 
 power, it cannot be regarded as negativing sexual fruit- 
 fulness or capacity. Old age does, however, unquestion- 
 ably render the occurrence of paternity less probable. 
 In such cases, however, the real question is not so much 
 the age of the man as whether his semen contains 
 spermatozoa. Dr. Tidy says that he has more than 
 once detected spermatozoa in the semen of men over 
 ninety, and Casper records a case where he found them 
 in a man aged ninety-six. 
 
 The subject of impotence and sterility arising from 
 accidental injuries or congenital defects or malforma- 
 tions of the sexual organs — such as hermaphrodism, 
 hypospadias, epispadias, etc. — have been considered in 
 another connection. In all these cases, so far as re- 
 spects the question of legitimacy and paternity, the 
 principal points for inquiry are, — 
 
 Firstly, whether there is a urethra capable of per- 
 mitting the passage of the seminal fluid, and whether it 
 is so placed that the opening may in copulation come 
 into contact with any part of the vagina. 
 
 Secondly, whether the individual has a testicle or 
 testicles. It is certain that fruitful intercourse may 
 result in the case of monorchids, that is, individuals 
 having only one testicle, or where only one testicle has 
 descended into the scrotum. As respects the very rare 
 cases of crypsorchids, that is, where neither testicle has 
 descended into the scrotum, it may be stated that they 
 are not necessarily impotent. As respects the question 
 whether they are sterile, recorded cases seem to estab- 
 lish the fact that a retained testicle does not, as a rule, 
 secrete prolific semen, and hence that they are generally 
 
LEGITIMACY AND PATERNITY. 185 
 
 sterile. Casper, however, and Professor Owen have 
 reeorded cases not only of the existence of sperma- 
 tozoa in the semen but of the possession of undoubted 
 virility. 
 
 The removal of both of the testicles by operation 
 certainly causes sterility ; but it seems to be settled 
 that, probably owing to the retention of semen in the 
 vesiculcB seminales, the individual may for a limited 
 period be capable of impregnating an ovum; and if 
 the secreting structure of the testicles is not entirely 
 removed, it seems clear that spermatozoa may be 
 formed. 
 
 Where the testicles are congenitally absent the per- 
 son will, according to Dr. Tidy, invariably be found to 
 be of a languid disposition, slenderly formed, beardless, 
 with a shrill voice, undeveloped genitals, and an absence 
 of sexual desires. Where the testicles have not de- 
 scended the development has been found, in some cases, 
 to be in all respects manly and complete, and in others 
 to be of a more or less womanly character. Where 
 the testicles have been removed by operation a scar 
 will always be found ; in these cases if the testicles are 
 removed in infancy the result will be much the same 
 as where they are congenitally absent. If the testicles 
 are removed after puberty, as a general rule the mascu- 
 line character is retained, although exceptional instances 
 to the contrary are recorded. 
 
 Impotence and sterility of the male may be caused 
 by a variety of diseases, such as cancerous, tubercu- 
 lous, or syphilitic diseases of the testicles or penis ; 
 an obstruction of the excretory ducts from double 
 epididymitis following gonorrhoea. The ejaculation of 
 
186 MEDICAL JUEISPRUDENCB, 
 
 semen may also be prevented by urethral stricture and 
 by other pathological conditions. Certain general dis- 
 eases, such as paraplegia, may also , cause sterility by 
 preventing sexual intercourse, especially so if accom- 
 panied with atrophy of the testicles. There are certain 
 recorded instances where mumps has caused sterility 
 in both sexes. Lithotomy has been known to cause 
 sterility in the male by interference with the ejacala- 
 tory ducts. Finally, any cause which decreases the 
 bodily vigor probably decreases sexual power; but 
 there are recorded instances in which coitus . in an 
 advanced state of phthisis or heart disease has been 
 followed by pregnancy, although the coitus took place 
 only a few hours before death. 
 
 Masturbation may be a cause both of sterility and 
 impotence. 
 
 Impotence and sterility may arise from the action of 
 certain poisons, notably alcohol, opium, tobacco, lead, and 
 gonorrhceal virus ; the last mechanically by producing 
 stricture of the urethra or of the seminal ducts. As to 
 the poisons above mentioned other than the gonoixhceal 
 virus, in the majority of cases it is perhaps doubtful 
 whether their effects have not been exaggerated. 
 
 Impotence and sterility in ^tvoman may arise from d 
 variety of causes. Impotence such as will warrant a 
 decree for a divorce is extremely rare ; this subject has, 
 however, been considered in another chapter. 
 
 Sterility may arise from extremes of age. The genera- 
 tive power in woman is generally supposed to commence 
 with the appearance, and end with the disappearance of 
 menstruation. The menses, or catamenia, from th© 
 arrival of puberty to the menopause or cessation of 
 
LEGITIMACY AND PATEENITY. 187 
 
 menstruation occur, as a rule, at regular intervals of 
 twenty-eight days from the beginning of one to the 
 commencement of the next monthly hemorrhage. The 
 fluid discharged consists chiefly of blood and coincides 
 in point of time with the discharge of the ovum from 
 the ripened Graafian follicles of the ovary ; the blood 
 discharged has been supposed to be deficient in fibrin 
 and is generally changed in color from admixture with 
 vaginal secretions. Epithelial scales from the vagina 
 and uterus will, as a rule, be found in such discharge. 
 This flow may last from a few hours to several days, 
 from three to four and a half days being the average 
 period. The amount discharged may vaiy from a few 
 drops to many ounces ; an average quantity being from 
 four to six ourices. Although the average interval, as 
 above stated, is twenty-eight days, the flow may be 
 anticipated or retarded by a variety of causes, and in 
 some instances the normal interval varies within con- 
 siderable limits. In cold countries the interval is said 
 to be longer than in warm countries. As a rule, 
 menstruation is said to begin in temperate climates 
 somewhere between the ages of fourteen and sixteen, — ■ 
 the usual earliest periods being twelve to thirteen, 
 and the latest periods nineteen to twenty-three years, 
 although exceptional instances of primary menstruation 
 have been recorded as early as one year and as late as 
 forty-seven ; primary menstruation, however, before the 
 age of nine and after twenty is exceedingly uncommon. 
 With female puberty come certain changes, — namely, 
 deposit of fat in the subcutaneous cellular tissue, caus- 
 ing first a slight swelling in the groins, extending over 
 the whole .body, more particularly the breasts ; growth 
 
188 MEDICAL JURISPRUDENCE. 
 
 of hair in the arm-pits and upon the genitals, while the 
 hair of the head often assumes a darker appearance; 
 the voice changes from its childish quality to the 
 characteristic voice of woman. 
 
 The catamenia, as a rule, cease between forty-two and 
 forty-eight, although there are numerous exceptions. 
 As a rule, those who develop early fade early; and 
 there are recorded cases where; after the change of life 
 seemed complete, menstruation reappeared and contin- 
 ued to a late period. The fruitful period in woman is 
 generally limited to the interval between the first and 
 last menstruation, but it is an established fact that 
 menstruation may occur without ovulation. There are 
 recorded cases of so-called menstruation from birth, but 
 the earliest recorded case of pregnancy was between 
 eight and nine years. 
 
 As to whether ovulation may occur without menstru- 
 ation, there is no doubt ; recorded cases of the concep- 
 tion of women who have never menstruated furnish 
 important evidence upon this point. There are also 
 recorded cases of women conceiving who menstruated 
 regularly before marriage and irregularly or not at all 
 during their child-bearing life ; and there are also cases 
 of conception after the -menopause. As to what time 
 during the monthly period the ovum is discharged from 
 the ovary, there is much doubt ; it may be regarded as 
 settled, however, that while pregnancy is more apt to 
 follow a few days after the cessation of the monthly flow, 
 or a day before its commencement, conception may take 
 place at any time during the interval. As to the age 
 beyond which conception is impossible, the limit doubt- 
 less varies with different women ; and while, as a rule, 
 
LEGITIMACY AND PATERNITY. 189 
 
 ability to conceive ceases with the menopause, there 
 are, as we have stated, recorded cases occurring after 
 that time. It is not possible, perhaps, for the medical 
 jurist to fix upon any age before or after which he will 
 be justified in stating that pregnancy is impossible. 
 Pregnancies up to fifty are not very uncommon; between 
 fifty and sixty, although there are some well authenti- 
 cated instances, the cases are very uncommon, while 
 there are recorded cases above the age of sixty, and 
 even as late as seventy; these cases, however, do not 
 seem entitled to much credit. 
 
 Impotence and sterility in women may arise from 
 congenital and other defects, .such as the absence of the 
 vulva and external genital organs; absence of the vagina; 
 absence of a uterus, which may or may not coexist with 
 an absence of the vagina ; or entire absence of ovaries, 
 which, however, could not be demonstrated during life. 
 
 Sterility may be caused by the non-performance of 
 their normal functions by the ovaries, or by some inter- 
 ference with the passage of the ovum from the ovary to 
 the uterus, arising from alteration in the coverings of 
 the ovary, in the Fallopian tubes, etc. ; it may arise from 
 alterations in the uterus or vagina which prevent the 
 impregnation of the ovum or access to it by the sper- 
 matozoa; or from the destructive action of unhealthy 
 fluids of the uterus or the vagina upon the spermatozoa. 
 Diseases and displacements of the uterus, contractions 
 of the OS uteri and the cervical canal, tumors in the 
 uterine cavity, etc., may also cause sterility. 
 
 As a general rule, women do not conceive during 
 lactation, but the exceptions to this rule are not in- 
 frequent. Promiscuous intercourse, as by prostitutes, 
 
190 MEDICAL JURISPRUDENCE. 
 
 from the inflammatory condition of the Pallopian tubes 
 thereby induced, frequently renders impregnation less 
 likely to occur. The habit of abortion at an early period 
 of pregnancy often practically amounts to sterility. -• 
 
 The full consideration of this subject, however, is 
 beyond the scope of this manual; the student is referred 
 for further particulars to professed treatises on obstetrics 
 and gynaecology. 
 
 A microscopical examination of the semen to ascer- 
 tain whether it contains spermatozoa, and if it does 
 contain them whether they are alive, is often an im- 
 portant aid in determining the question of sterility. 
 
 2. The duration of pregnancy, etc., has an important 
 bearing upon questions of legitimacy and paternity. 
 The signs of pregnancy, time of quickening, etc., have 
 already been considered in another connection. As to 
 its duration, it is impossible to fix definitely a period of 
 utero-gestation. Although some foreign codes of juris- 
 prudence have attempted to fix the time beyond which 
 utero-gestation cannot extend, the common law has more 
 properly left each case to be decided according to the 
 evidence introduced ; forty weeks, however, or two hun- 
 dred and eighty days, is commonly regarded as the 
 period of pregnancy. 
 
 Dr. Tidy, in the consideration of this subject, states 
 that there is a general consent among the best of ob- 
 stetricians as to the duration of pregnancy, the ex- 
 tremes being 266 days, or 38 weeks, to 280 days, or 40 
 weeks. 
 
 Duncan, from analysis of 46 cases, in which connec- 
 tion took place during a single day only, found the 
 average time to the date of parturition to be 275 
 
LEtilTIMACT AND PATERNITY. 191 
 
 days. Ahfeld, from analysis of 425 cases, obtained an 
 average of 271 days. Hecker, from 108 cases, found 
 the average to be 273.5 days. Veit, from 43 cases, 
 found an average of 276.4 days. Faye, from 63 cases, 
 found an average of 270.7 days. 
 
 While these averages show that the date of a particu- 
 lar confinement will probably occur at the time indi- 
 cated thereby, the fact that in Ahfeld's table there exists 
 between the longest and shortest gestation a difference 
 of 99 days, in Hecker's a difference of 63 days, and in 
 Veit's a difference of 36 days, shows that too much 
 reliance should not be placed upon such averages. The 
 bulk of confinements, however, vary within narrow 
 limits. According to Lusk, of 653 women, in 15.93 
 per cent delivery occurred in the 38th week ; in 27.56 
 per cent, in the 39th week ; in 26.19 per cent in the 
 40th week; in 10.01 per cent in the 41st week. Thus 
 in more than half the cases delivery occurred in the 
 39th and 40th weeks, and 80 per cent occurred between 
 the 38th and 41st weeks inclusive. Of the remainder, 
 14 per cent took place prior to the 38th week, and 
 according to Dr. Lusk, were probably influenced by 
 many operative accidental causes which favor prema- 
 turity. Of the 6 per cent reported as occurring later 
 than the 41st week, a considerable number he re- 
 gards as of questionable authenticity, as in his opinion 
 gestation protracted beyond the 285th day is certainly 
 of very rare occurrence. 
 
 The extent to which the normal period of utero- 
 gestation may be shortened, and a living child never- 
 theless be born, is one of great importance. In questions 
 of this sort, two points usually arise for consideration : 
 
192 MEDICAL JURISPRUDENCE. 
 
 first/ whether a child of the age stated or estimated is 
 viable, — that is, of such an age as to be capable of 
 showing some indications of live birth after it is com- 
 pletely external to the mother ; and secondly, whether, 
 if it is alive when born, it is probable that, at the age 
 stated or estimated, it can be reared. 
 
 Dr. Tidy draws the following practical conclusions 
 from the consideration of a large number of cases of 
 abnormally shortened utero-gestation : — 
 
 1. Allowing that from the first moment of impreg- 
 nation the ovum is truly alive, and further that mere 
 motion of limbs, or evidence of circulation without ac- 
 tive respiration, are sufficient to constitute live birth, r^ 
 nevertheless, there is no evidence to show that a foetus 
 born at an earlier period than between the fourth and 
 fifth months of uterine existence can in any sense be 
 said to be born alive, much less lead an independent 
 life apart from its mother. 
 
 2. That living children have been bom between the 
 fourth and fifth months of uterine life. As a rule, how* 
 ever, the only sign of life exhibited by children born 
 at this early period is a slight motion of the limbs, 
 although cases of somewhat more active vitality have 
 been recorded. There is, however, no well authenti- 
 cated case where a less than five months' child has 
 lived beyond twenty-four hours after its birth, and but 
 one where it has lived twenty-four hours. 
 
 3. That children born alive at the fifth or between 
 the fifth and sixth months of utero-gestation mostly die 
 after a few hours. Nevertheless, there is a limited 
 number of recorded cases where such children have 
 been reared, and have even reached adult age. 
 
LEGITIMACY AND PATERNITY. 193 
 
 V 4 That several well-authenticated cases exist where 
 children born between the sixth and seventh months, 
 and even at the sixth month, have reached adult age ; 
 but that in such cases more than ordinary care and at- 
 tention have been needed to maintain life, at least for 
 some time after birth. 
 
 Signs of Maturity in New-born Children. — Although 
 children born at full term vary in size, weight, etc., 
 there are certain signs of maturity which should be 
 considered in this connection. Among these signs are, — 
 
 1. A certain general hahitus familiar to experts. 
 
 2. The color of the skin of a mature child is paler 
 than in one less mature, while the down {lanugo) to a 
 great extent disappears with maturity. It is said that 
 certain white points found in many cases on the alee of 
 the nose, cheeks, and forehead, but especially on the 
 chin and under lip, — due to the. dilatation of the excre- 
 tory ducts of the sebaceous follicles, — are abundant in 
 proportion to the' immaturity of the fcetus, decreasing 
 in number as full term approaches ; at full term they 
 are only to be found, on the. tip of the nose. 
 
 3. At maturity there is more or less hair on the 
 head. 
 
 4 The immobility of the skull hones, — the anterior 
 fontanelle averaging f to 1 inch in length. 
 
 5. A certain height and weight. The average height 
 of new-born children of both sexes, born at fuU term, is 
 between 18 and 19 inches. Of 247 mature children of 
 both seXes, the average length is stated by Dr. Tidy to 
 have beeu 18^ inches. Average length of the males 
 (130) was l^ inches; of tlie females (117) 18f. The 
 maximum recorded length was 22 inches ; the minimum, 
 
 13 
 
194 MEDICAL JDRISPEUDBNCK' 
 
 16. The average weight of a mature infant at birth is 
 probably between 6 and 7 pounds. Dr. Tidy states that 
 the average weight of English cliildren at birth is 6 
 pounds, 8 ounces. The average weight of 247 mature 
 children of both sexes is stated by him to be 1^ 
 pounds; of 130 males, 7^; of 117 females, 6f. The 
 maximum recorded weight- of these children was 10 
 pounds, and the minimum, 4J pounds. It is said that 
 the weight and length of Indian children are less than 
 those of European children. 
 
 Casper quotes from Gunz the following table of 
 dimensions of the bones of a mature child : — 
 
 Inches. Lines, 
 
 Height of the frontal part of the frontal bone .... 2 3 
 
 Breadth of the same 1 10 
 
 Length of the pars orbitalis 1 
 
 Breadth of the same . 1 
 
 Parietal hone from anterior superior angle to inferior pos- 
 terior one 3 3 
 
 Ditto from anterior inferior angle to superior posterior one 3 3 
 
 Height oi pars occipitalis o{ OS occipUis 2 
 
 Breadth of the same 1 10 . 
 
 Height of squamous portion of temporal bone from upper 
 
 edge of auditory foramen 1 
 
 Height of malar bone 6 
 
 Breadth of the same 1 
 
 Height of nasal bone 5 
 
 Breadth of the same 3 
 
 Height of the superior maxillary bone from the protxssus 
 
 alveolaris to the apex of the processus nasalis ... 1 
 Length of the superior maxillaiy bone from the anterior 
 
 nasal spine to the apex of the processus zygomaticus . 1 1 
 
 Length of each half of the lower jaw 1 . 10 ; 
 
 Breadth of the lower jaw 7 
 
 Length of the seven cervical vertebr* 1 3 
 
 " " twelve dorsal " 3 9 
 
LEGITIMACY AND PATEENITY. 195 
 
 Inches. Lines. 
 
 Jjength of the five lumtar vertebrie 2 3 
 
 " " sacrum and coccyx 2 3 
 
 " " collar bone 1 7 
 
 " " shoulder blade 1 6 
 
 Breadth of the shoulder blade 1 2 
 
 Length of the humerus 3 
 
 " " ulna .' 2 10 
 
 " " radius 2 8 
 
 " " femur 3 6 
 
 " " patella 9 
 
 breadth of the patella 8 
 
 Length of the tibia 3 2 
 
 « " fibula 3 1 
 
 It is laid down as a general rule that still-born 
 children are heavier and longer than those horn alive ; 
 males than females, and single children and twins than 
 triplets. 
 
 6. The diameter of the head and measurements across 
 the shoulders and hips, according to Casper, afford val- 
 uable evidence of maturity. Of 207 children he found 
 the average transverse diameter of the head S^ inches ; 
 longitudinal diameter, 4|^ inches ; diagonal diameter, 
 4| inches. Tardieu makes the occipito-frontal diameter 
 from 4J to 4J inches, and the bipafietal from 3| to 3f. 
 
 According to Lusk, whose table is based upon that of 
 Tamier and Chantreuil, the diameters of the fcetal head 
 are as follows : — 
 
 Occipito-mental diameter 5} inches. 
 
 Occipito-frontal " 4^ 
 
 Sub-occipito-bregmatic 3f 
 
 Bi-parietal ■ 3| 
 
 Bi-temporal 3J 
 
 Bi-mastoid 3 
 
 Fronto-mental 3J 
 
 Cervioo-bregmatio 3f 
 
196 MEDICAL JDEISPRUDENCE. 
 
 According to Casper the average diameter across the 
 shoulders in 117 mature children was 4^1, and across 
 the hips, 3-:^^ inches. 
 
 7. Condition of the nails. — In mature childrei' the 
 nails are horny and reach' the tips of the fingers, al- 
 though not necessarily so in the case of the toes. 
 
 8. The cartilages, of the. ears and nose of a mature 
 child feel cartilaginous. 
 
 9. Condition of the genitals. — In mature male chil-; 
 dren the testicles will both be in the scrotum, which 
 will be corrugated. In about three or four percent of 
 cases, according to Dr. Tidy, one of the testicles will not 
 have descended at birth ; it is rare to find both testi- 
 cles undescended. In mature female children the labia 
 majora should cover the vagina and clitoris ; there are, 
 however, numerous exceptions to this rule. 
 
 10. Position of the Umbilicus. — The navel is usually 
 in the centre of the body of a mature child ; there are, 
 however, numerous exceptions to this rule. 
 
 11. Weight of the. placenta and length of the cord. — 
 The placenta at full term usually has a diameter from 
 8 to 10 inches, and weighs from 15 to 19 ounces. The 
 length of the cord at full term is stated by Tidy to vary 
 from 18 to 21 inches. 
 
 12. Ossification of bones, etc. — Where the child is 
 born dead the following sign is of value : In the 
 second halt of the tenth lunar month, the centre of 
 ossification of the inferior femoral epiphysis makes its 
 appearance ; this centre of ossification is to be demon- 
 strated by carefully making horizontal sections off from 
 the cartilaginous epiphysis until a colored point is ob- 
 served,, the greatest diameter of which osseus nucleus is 
 
LEGITIMACY AND PATERNITY. 197 
 
 to te measured. To the naked eye this nucleus appears 
 as a more or less circular blood-red spot in the midst of 
 iailk-white cartilage, in which vascular convolutions 
 may be distinctly recognized. 
 
 If there is no visible trace of this osseous nucleus, the 
 foetus cannot be more than from 36 to 37 weeks old ; 
 if it is of the. size of a hemp-seed (about half a line), it 
 corresponds to 37 or 38 weeks, if still-born ; when from 
 3-4 to 3 lines it indicates a uterine age of about 40 
 ■weeks ; if it measures more than 3 lines the child has 
 probably survived its birth. [ 
 
 . The following table quoted by Tidy from Tardieu, 
 shows the character of the fcetus at different ages of 
 intra-uterine development. 
 
198 
 
 MEDICAL JURISPRUDENCE. 
 
 Table showing the Character oftJie Foetus at differetit Ages of Intro- 
 Uterine Life. 
 
 Age. 
 
 GeDeral DevelopmeDt 
 of the Bodj. 
 
 State of the Bkin, etc. 
 
 Height. Weight. 
 
 D^ree to which 
 
 OsBiflcation has 
 
 adTanced. 
 
 Trom 1 month 
 to 1^ months. 
 
 From IJ to 2 
 months, 
 **From the 2d 
 to the 3d month, 
 
 From the 3d to 
 the 4th month. 
 
 From the 4th to 
 the 5th month. 
 
 From the 5th to 
 the 6th month, 
 
 From the 6th to 
 the 7th month. 
 
 From the 7th to 
 the 8th month. 
 
 3-1 inch. 
 ^2 inches. 
 2-4 " 
 
 4-6 " 
 
 6-8 " 
 10-12 " 
 12-14 " 
 
 14-16 " 
 
 From the 8th to 
 the 9th month. 
 
 At term 
 (mature). 
 
 16-18 " 
 
 18-20 • 
 
 15-46 gTB. 
 77-165 « 
 
 lJra.-4ioz. 
 
 6-8 oz. 
 
 8-12 oz. 
 
 15-32 oz. 
 
 2-3 pounds. 
 
 3-5 
 
 6-7 
 
 Skin quite trans- 
 parent, of a pur- 
 plish-red color, with 
 no trace of hair 
 on it. 
 
 Derelopmeut of 
 nails. Appearance of 
 matrix of nail. Sex 
 
 distinct, 
 
 B^ir-germs appear 
 on the forehead and 
 eyebrows. 
 
 Hairs appear on the 
 limbs. 
 
 Hairs on bands and 
 feet. Membranapu- 
 pillaris begins to dis- 
 appear. 
 
 Skin has lost its 
 transparency. Epi 
 dermis distinct. Color 
 pale pink. 
 
 Skin is covered mth 
 sebaceous materials. 
 { Vemix caseosa.) 
 The nails do not reach 
 tips of fingers. 
 
 Sebaceous cOTeriug 
 still thicker. Nails 
 overlap fingers. 
 Membrana pupilla- 
 ris has quite disap- 
 peared. Navel a little 
 below middle of en- 
 tire length of body. 
 
 ■ Centres of ossiflca^ 
 tion for clavicles and 
 lower jaw". Appear- 
 auce of dental papil- 
 Ine in the furrow of 
 the lower jaw. 
 
 Centre of ossifica- 
 tion in ischivm. 
 
 0?!siflcation of os 
 calds. 
 
 Osseous centres for 
 astragalus and os 
 pubis. 
 
 Three or four osse- 
 ous centres in ster- 
 num. 
 
 Ossification of low- 
 er vertebra of sa- 
 crum. 
 
 An osseous nucleu? 
 in the condyloid epi- 
 physis of femur. 
 The alveolar pro- 
 cesses of the lower 
 jaw are perfectly dis- 
 tinct. 
 
 The student will find an extended consideration of 
 the evidence of the development of the foetus in 2 
 " Tidy's Legal Medicine/' pages 59 to 64 inclusive. 
 
LEGITIMACY AND PATERNITY. 199 
 
 13. The extent to which the normal period of utero- 
 gestation may be lengthened, in practice must be 
 reckoned from the latest possible day of access of the 
 husband, which in most cases would be the date of his 
 death, departure abroad, or the like. That the period of 
 utero-gestation may be considerably prolonged beyond 
 the average period, there can be no doubt ; but, as has 
 already been stated, by the law in some countries a 
 definite period is fixed beyond which the child born is 
 regarded as illegitimate. Thus in Scotland a child born 
 six months after the marriage of the mother or within 
 ten months after the death of the father, is considered 
 legitimate. In France the limit is fixed at 300 days ; 
 the Prussian code, without absolutely declaring children 
 born in the 11th month illegitimate, attaches such con- 
 ditions to the proof of their legitimacy as to make it 
 almost unattainable. By the English common law the 
 C[uestion is always one of fact, depending upon the evi- 
 dence. 
 
 Obstetricians have furnished us with numerous in- 
 stances of utero-gestation extending beyond the 40th 
 ■treek, as calculated from the cessation of the catamenia. 
 Dr. -Ogston has tabulated 155 such cases, of which — 
 
 55 were protracted to the 41st week or to 287 days. 
 
 42 
 
 
 42d 
 
 ( (( 
 
 294 " 
 
 30 
 
 
 ■ 43d 
 
 ( (( 
 
 301 « 
 
 13 
 
 
 44th 
 
 ( H 
 
 308 '' 
 
 12 
 
 
 45th 
 
 t (( 
 
 315 " 
 
 3 
 
 
 47th 
 
 ( « 
 
 322-325 " 
 
 He also tabulates 55 cases dating from a single coitus, 
 as follows : — 
 
200 
 
 MEDICAL JURISPRUDENCE. 
 
 2 cases protracted to 281 days, or 40 weeks, 1 day. 
 2 
 
 283 
 
 
 40 
 
 
 3 
 
 284 
 
 
 40 
 
 
 4 
 
 286 
 
 
 40 
 
 
 6 
 
 287 
 
 
 41 
 
 
 
 288 
 
 
 41 
 
 
 1 
 
 289 
 
 
 41 
 
 
 2 
 
 2»1 
 
 
 41 
 
 
 4 
 
 293 
 
 
 41 
 
 
 6 
 
 or 8 were protracted into the 41st week^ 7 into the 42d, 
 while 3 had almost reached the 43d week From these 
 cases he arrives at the conclusion that utero-gestatioa 
 may in a few instances be extended to the 44th or evea 
 to the 46th week. 
 
 Upon the same subject Dr. Tidy concludes that there 
 is considerable evidence to show that 41, 42, and 43 
 weeks may elapse between coitus and labor; and that 
 although it is impossible to state that 44 weeks or even 
 longer periods of gestation may not occur, it must be 
 conceded that there are no well-recorded cases of such 
 protraction, except where the time has been determined 
 by the cessation of- the catamenia. 
 
 In cases of this sort, moral considerations, such as the 
 character of the parents, probability or possibility, of 
 access, are matters of great importance. 
 
 In cases where pregnancy is much prolonged beyond 
 the usual period, as well as in doubtful cases, the possi- 
 bility of the more or less complete' development of the 
 ovum in the ovary, in the Fallopian tube, in the walls of 
 the uterus, or in the peritoneal cavity, must not be lost 
 sight of In the peritoneal cavity the ovum may proceed 
 full development, become encysted, and remain dormant 
 for years ; but in the other cases mentioned, pregnancy 
 
LEGITIMACY AND PATERNITY. 201 
 
 will not be likely to proceed farther than the first half of 
 the usual term without causing the death either of the 
 foetus or of the mother. 
 
 In this connection, the possibility of super-fcetatiori, 
 or the impregnation of a second ovum in a woman al- 
 ready pregnant, should not be lost sight of. Many of the 
 supposed cases of super-foetation may doubtless be ex- 
 plained as being twin or triplet births, where a considera- 
 ble interval has elapsed before the birth of each child 
 after the first. A case of triplets is recorded where there 
 was an interval of fifteen days between the successive 
 births. It should also be remembered that there are in- 
 stances of foetuses remaining in utero for a considerable 
 time after their death, even when there is no other 
 foetus alive in the womb; and that at the fifth and 
 eighth month of pregnancy dead foetuses of not greater 
 development than from three to five months have been 
 born ; and that not unfrequently dead foetuses of dif- 
 ferent degrees of development have been retained until 
 the expiration of full term. Excluding, however, all 
 cases which are liable to be mistaken as cases of super- 
 fcetation, there are a few cases which are difficult of ex- 
 planation on any other hypothesis than that a second 
 impregnation must have taken place while a partially 
 developed foetus was in the womb. 
 
 In determining whether the case is one of super-foeta- 
 tion or not, the following points should be investigated : 
 the size and development of each child, and the inter- 
 val between the births. If the children are both mature, 
 and the interval between the births is two months, 
 super-foetation is probable, since it is altogether improb- 
 able that a seven months' child should possess the 
 
202 MEDICAL JUEISPRUDENCE. 
 
 appearances of maturity of a nine months' cliild. If the 
 interval varies between two and three months, and, the 
 first child is immature and the second mature, the case 
 is more likely one of twins, where one is bom prema- 
 turely and the other at full term. Where, however, 
 there is an interval of four months between the birthsi 
 and both children are capable of being reared, super- 
 foetation may be admitted, as it is highly improbable 
 that a five months' child should be capable of being 
 reared. 
 
 3. Similarity, or likeness. — Most authors upon medi- 
 cal jurisprudence regard likeness existing between the 
 child and its alleged father, as strong evidence of pater- 
 nity ; and even Lord Mansfield is reported to have said, 
 " I have always considered likeness as an argument of a 
 child being the son of a parent." The absence of hke-, 
 ness is certainly not evidence of non-relationship., and 
 there is great difficulty in drawing any definite conclu- 
 sion from mere likeness. It has been definitely held in 
 a case recently decided by the supreme court of Wia-- 
 consin {Manawcdt vs. The State, 64 Wis. 84), that in a 
 bastardy case the child may not be exhibited to the jury 
 as evidence of paternity. 
 
 In questions of this sort the possibility of atavism, 
 or- resemblance of a child to some ancestor prior to 
 its father or mother, should be remembered ; also that 
 in cases of a second marriage by the mother, a child of 
 the second marriage may resemble neither parent, but 
 the first husband. 
 
 In questions of paternity considerable importance ig 
 properly attached to the transmission of color; and 
 there are instances where the paternity of the father 
 
LEGITIMACY AND PATEENITT. 203 
 
 who was a black man, has been established by the color 
 of the child. The case of the Commissioners vs. Whis- 
 telo (3 Wheeler Crim. Cases, 194) is an interesting case 
 in this connection. 
 
 4. SupposititiouB children. — Cases of pretended de- 
 livery or alleged substitution of one child for another 
 should be examined by the medical jurist upon the prin- 
 ciples stated in a preceding chapter. Without the least 
 delay, careful examination of the person of the woman 
 should be made in order to ascertain whether there are 
 or are not signsof recent delivery. A demand should be 
 aiade to see the placenta, and the child should be ex- 
 amined with reference to ascertaining whether its ap- 
 pearance agrees with that of the alleged mother. Stains 
 upon the bedding and marks of blood may be fraudu- 
 lently made ; and there are instances of the substitution 
 of some viscus of an animal for the placenta. 
 
CHAPTEE XVI. 
 
 PERSONAL IDENTITY. 
 
 General ConsideratioiiB. — Questions of personal iden- 
 tity often become matters of inquiry in the course of 
 judicial proceedings. Such cases will usually turn upon 
 the evidence of ordinary witnesses without the aid of 
 the medical expert; not unfrequently, however, such 
 expert is able to furnish important aid in determining 
 such questions. 
 
 The question may arise in the case of a living person 
 or of a body which has been dead only a short time ; 
 with respect to bodies long dead or with respect to 
 complete skeletons or detached portions of the same. 
 In the case of a living person or of a body only re- 
 cently dead, the sex, occupation, complexion, general 
 type of face, race, hair, nails, stature, scars, injuries, 
 congenital malformations, as well as the clothes, etc., 
 upon the body, form important matters for investigai- 
 tion. In cases where the remains are mutilated or 
 only a portion of the body is discovered, the question 
 usually presents more difficulty. The case of Th 
 Commonwealth vs. Br. Webster, for the murder of Dr. 
 Parkman, reported in 5 Gush. 295, 386, is an interesting 
 one in this connection. See also Bemis's report of 
 this case. In such cases the stature may often be 
 
PERSONAL IDENTITY. 205 
 
 approximately determined from the measurement of 
 certain bones and their known relation to the height 
 of the person. The correspondence or otherwise of the 
 several parts will sometimes enable one to determine 
 the question whether they are parts of the same body 
 or not. The method of mutilation is sometimes sug- 
 gestive. The cause of the death may in some in- 
 stances be determined by the examination of mutilated 
 remains. 
 
 The extent of the destruction of the soft parts, as 
 bearing upon the time of death, is often important to 
 be considered. • Clothes, buttons, jewelry, or other arti- 
 cles surrounding the body, if there are any, should be 
 Carefully examined and preserved. 
 
 i Bodies long dead, skeletons and detached bones. — 
 The length of time required in an ordinary grave to 
 reduce a body to a skeleton is supposed to be about 
 ten years; certain parts, such as the hair and nails, will 
 resist decomposition much longer, if not indefinitely. 
 The subject of decomposition of a body has, however, 
 been fully considered in another place. The position 
 and relation of the bodies to their surroundings may 
 be of aid in determining their character and identity. 
 In Christian burial it is customary to place the body at 
 full length in the ground, with the head towards the 
 west. Eemains of clothes, buttons, jewelry, etc., as 
 already stated, will often afford valuable aid in the 
 identification of a body. Where the whole skeleton is 
 Submitted for examination there can be no difficulty in 
 deciding whether the bones are human or not ; and 
 in ordinary cases there ought not to be much difficulty 
 in determining whether single bones preserved entire. 
 
206 MEDICAL JUKISPEUDENCE. 
 
 are or are not human. It would be presumptuous, 
 however, in most instances where the bones are not 
 considered human to undertake to determine to what 
 animal they belong. 
 
 By the aid of the microscope it is possible to determine 
 whether the smallest fragment found is or is not bone ; 
 but according to the present State of our knowledge 
 it is not possible thus to determine whether a particu- 
 lar fragment is part of a human bone or of soine other 
 animal. : 
 
 It sometimes becomes important to determine whether 
 bones are parts of the same skeleton or belong to more 
 than one body ; this can only be determined by com- 
 parison and placing each bone in the place where it 
 belongs, aided by a competent knowledge of human 
 anatomy. Where the bones are fractured or otherwise 
 injured, it is important to determine whether the injury 
 was caused during the exhumation or during life j and 
 if during life, whether or not it was of recent occurrence. 
 If new bone is found around the broken ends this is 
 proof that the fracture occurred some time before death. 
 Diseased conditions of a bone may be discovered, and 
 in such case should carefully be distinguished from 
 decay and violence. All personal deformities should 
 be carefully noticed. The presence of fcetal bones about 
 the skeleton of a female, suggests but does not prove 
 pregnancy. 
 
 The age may sometimes be approximately deter- 
 mined by inspection of the bones, a subject, however, 
 which will be further considered in the next section. 
 
 Age. — The determination of age during life is usually 
 a matter of considerable diflSculty. In the case of 
 
PERSONAL IDENTITY. '207 
 
 children it may usually be determined approximately 
 by observing tbe teeth, height, weight, and general 
 development; in cases of hereditary syphilis and 
 other diseased conditions, the development may be 
 retarded. 
 
 During the middle period of life there is very great 
 difficulty, if not an impossibility in determining the 
 age ; as the person becomes older this difficulty dimin- 
 ishes somewhat. In females of advancing age the 
 mammse either waste or enlarge considerably; in old 
 people the arteries often become cord-like and tortuous, 
 and the aretes senilis appears in the eye. The figure 
 stoops as the intervertebral substance is absorbed, and 
 the muscular power lessens; the teeth decay or come 
 out, and the person puts on the characteristic appear- 
 ance of senility, which being familiar to every, one 
 needs no further description. In determining age from 
 the skeleton, important evidence is often derived from 
 the points of ossification and the extent to which os- 
 seous union has progressed. The following details 
 under this head are taken from Dr. Tidy's work on 
 Legal Medicine : — 
 
 ^0" 
 
 1 year : Points of Ossification, — lower extremities of hu- 
 merus and ulna ; heads of the femur and humerus ; upper 
 cartilage of tibia. 
 
 1| years: Anterior foutanelles should be closed. 
 
 2 years : Points of Ossification, — lower cartilages of radius, 
 tibia, and fibula. 
 
 2^ years: Points of Ossification, — greater tuberosity of 
 the head of the humerus ; patella ; lower ends of the last 
 four metacarpal bones. 
 
 3 years : Points of Ossification, — the trochanters. 
 
208 MEDICAL JUEISPEtJDENCE. 
 
 4 years : Points of Ossification, — the second and third 
 cuneiform bones of the tarsus. 
 
 4 J years : Points of Ossification, — the small tuberosity of 
 the head of the humerus ; the upper cartilage of the fibula. 
 
 6 years : The descending ramus of the pubis meets the 
 ascending ramus of the ischium: 
 
 From 8 to 10 years : The upper cartilage of the radius 
 becomes ossified. 
 
 9 years : The ilium, ischium, and pubis meet in the 
 cotyloid cavity (acetabulum) to form the pelvis. 
 
 10 years : Ossification begins in the cartilaginous end of 
 the olecranon. , 
 
 12 years : Points of Ossification, — the pisiform bones of 
 the carpus. 
 
 13 years: The three portions of the os innominata (ilium, 
 ischium, and pubis), though nearly united, can still be sepor 
 rated. The neck of the femur is ossified. 
 
 14 years, or about puberty : There are now added some 
 fourteen additional centres to the sacrum. 
 
 15 years : The coracoid process becomes united to the 
 scapula. 
 
 Between 15 and 16 years: The olecranon becomes united 
 to the ulna. 
 
 From 18 to 20 years : The epiphysis at the upper end of the 
 thigh bone is joined to the body of the bone, as well as those 
 belonging to the metacarpus, metatarsus, and phalanges. 
 
 20 years : The upper and lower epiphyses of the fibula, as 
 well as the lower epiphysis of the femur, are respectively 
 united to the bones. 
 
 25 years : The epiphysis of the sternal end of the clavicle, 
 and of the crista ilii are united to the bones. 
 
 If all the epiphyses be found united to their bones, 
 and the bones themselves are solid and well-marked as 
 
PERSONAL IDENTITY. 209 
 
 to muscles, processes, and foramina ; and further, if the 
 jaws show the wisdom teeth, — we may conclude the 
 individual to be of adult age. 
 
 The Vertebrae. — The epiphyses of the bodies of the 
 vertebrae are sometimes not consolidated until thirty 
 years of age. 
 
 The Cartilages of the Larynz in advanced life assume 
 more the appearance of osseous than of cartilaginous 
 structure. 
 
 The sternum. — The second and third pieces of the 
 sternum rarely join until the thirty-fifth or fortieth 
 year, while the union of the first and second pieces is 
 not usually complete until quite advanced life. 
 
 The Cartilages of the Ribs. — The cartilages of the 
 ribs generally ossify late in life. Dr. Humphrey regards 
 this ossification as rather a sign of disease than of age. 
 The first cartilage is more frequently ossified, and at an 
 earlier period of life, in men than in women. 
 
 The Skull. — In old age the diploe is more or less 
 absorbed, leaving the cranial bones thinner than they 
 were in middle life. The sutures become firmly ossi- 
 fied, and gradually less distinct. If the sutures of the 
 skull are indistinct, we may then fix the age as at least 
 between fifty and sixty. As a rule the parietal sutures 
 disappear about the age of puberty, although sometimes 
 (but rarely) they remain separate throughout life. 
 
 The Lower Jaw. — The alveolar cavities containing 
 the teeth are formed about the sixth month of intra- 
 uterine life, while the rudiments of the whole of the 
 temporary and of some of the permanent teeth (the 
 anterior molars, for instance) are usually found within 
 the gums in capsules at the time of birth. Again, the 
 
 14 
 
210 MEDICAL JURISPRUDENCE. 
 
 jaw of the infant is rounded and somewhat semi-circu- 
 lar, the ramus and body forming an obtuse angle. As 
 age advances towards middle life, the jaw loses its 
 roundness, and as the alveolar processes containing the 
 teeth become more and more perfect, exhibits a well- 
 marked angularity and squareness. With old age, the 
 teeth drop out or decay away, the jaw returning to its 
 infantile shape. After a time the whole alveolar body 
 may become absorbed, a sharp ridge replacing. the holes 
 for the teeth as they originally existed. 
 
 The Femur. — The neck of the femur hefore puherty is 
 directed obliquely, so as to form a gentle curve from 
 the axis of the shaft. In the adult male it forms an 
 obtuse angle with the shaft, being directed upwards, 
 inwards, and a little forwards. In the female it ap- 
 proaches more nearly to a right angle. Occasionally 
 in very old subjects, and more especially in those 
 greatly debilitated, its direction becomes horizontal, so 
 that the head sinks below the level of the trochanter, 
 and the length diminishes to such a degree that the 
 head becomes almost continuous with the shaft. 
 
 The subject of sex has already been considered in 
 another chapter. 
 
 Stature and Weight. — The average lengths of the 
 foetus at different periods of intra-uterine life, and of 
 children and adults at various ages, are variously stated 
 by different authors. 
 
 The following table is taken from M. Sue : — 
 
PERSONAI, IDENTITY. 
 
 211 
 
 Age. 
 
 Total Length. 
 
 Trunk. 
 
 Upper 
 Extremities. 
 
 Lower 
 Extremities. 
 
 Foetus of 1 
 
 6 weeks. ) 
 
 2} months. 
 
 16 lines. 
 
 1 inch. 
 
 5 lines. 
 
 4 lines. 
 
 2 in. 3 lines. 
 
 1 in. 8 lin. 
 
 9 lines. 
 
 7 lines. 
 
 3 ' 
 
 
 3 Inches. 
 
 2in. 1 " 
 
 IB lines. 
 
 11 lines. 
 
 4 ' 
 
 
 4 inches 4J lines. 
 
 2 in. 11 " 
 
 1 in. 9 lin. 
 
 1 in. 5i lines. 
 
 5 ' 
 
 
 6^ inches. 
 
 4 in. 4 " 
 
 2 in. 6 " 
 
 2 in. 2 ■' 
 
 6 ' 
 
 
 9 inches. 
 
 Sin. 8 " 
 
 3 in. 7 " 
 
 3 in. 4 " 
 
 7 ' 
 
 
 1 foot sotne lines. 
 
 6 in. 5J " 
 
 5 in. 10 " 
 
 5 in. 9 " 
 
 8 ' 
 
 
 14 inches 9 lines. 
 
 8 in. 3J " 
 
 6 in. 8 " 
 
 6 in. 6 
 
 9 
 
 
 18 inches. 
 
 10 inches. 
 
 8 inches. 
 
 8 inches. 
 
 lyear 
 
 
 22| inches. 
 
 13 in. 6 lin. 
 
 9 inches. 
 
 9 inches. 
 
 3 years. 
 
 2 ft. 9 in. some lin. 
 
 19 inches. 
 
 14 inches. 
 
 14 in. some lin. 
 
 10 « 
 
 3 feet 8i inches. 
 
 2 feet. 
 
 19 inches. 
 
 20 in. 6 lines. 
 
 14 " 
 
 4 feet 7 inclies. 
 
 2 feet 4 in. 
 
 24 in, 6 lin. 
 
 27 inches. 
 
 25 « 
 
 5 feet 4 inches. 
 
 2 feet 8 in. 
 
 30 inches. 
 
 32 inches. 
 
 Healthy children of healthy mothers, as a rule, di- 
 minish considerably in weight soon after birth, such 
 decrease amounting to about l-14th of the total weight 
 at birth. In about 60%, children begin to increase in 
 weight about the fourth day, and about the tenth day 
 the weight will be the same or slightly in excess of that 
 at birth. The increase in a child's weight thereafter 
 should be progressive ; much depends, however, upon 
 the hygienic conditions surrounding it and the nature 
 and amount of its food, etc. 
 
 The following table, taken from Tidy, gives the average 
 monthly weight of young children during the first year : 
 
 lbs. oz. 
 
 lbs. 
 
 At birth . 
 
 . . 6 
 
 8 
 
 7 months 
 
 . . 13 
 
 4 
 
 1 month . 
 
 . . 7 
 
 4 
 
 8 
 
 
 . . 14 
 
 4 
 
 2 months . 
 
 . . 8 
 
 4 
 
 9 
 
 
 . . 15 
 
 8 
 
 3 " . 
 
 . . 9 
 
 6 
 
 10 
 
 
 . . 16 
 
 8 
 
 4 « . 
 
 . . 10 
 
 8 
 
 11 
 
 
 . . 17 
 
 8 
 
 6 " . 
 
 . . 11 
 
 8 
 
 12 
 
 
 . . 18 
 
 8 
 
 6 •• . 
 
 . . 12 
 
 4 
 
 
 
 
 
212 
 
 MEDICAL JURISPRUDENCE. 
 
 The average weight of male adults at 20 is 143 
 pounda, and of females, 120 pounds. (See post, Insur- 
 ance.) As a rule, womeu increase in weight up to nearly 
 fifty; while males so increase only up to thirty-five; in 
 advancecl age both sexes weigh about fifteen times their 
 weight at birth. 
 
 The following table, from Barthes & Eilliet, is founded 
 on the measurements of thirty-seven well-nourished and 
 well-grown children : — 
 
 
 3} to 5 years. 
 
 6 to 10 years. 
 
 UtolSyesrs. 
 
 Height 
 
 Inches. 
 
 32.8-38 
 
 Inches, 
 
 38-50.8 
 
 Inches. ■ 
 60-52.8. 
 
 Lengtli of Sternum .... 
 
 4.4-5.2 
 
 4.8-6 
 
 5-7.2 
 
 Length of Dorsal Vertebras 
 
 5.6-8.8 
 
 7.2-10,4 
 
 9.2-11.6 
 
 Space between the Coracoid 
 processes 
 
 5.2-6.8 
 
 6-8 
 
 7.6-10.8 
 
 Bound the Thorax (under 
 Armpits) during inspiration 
 while seated 
 
 20.4-24.4 
 
 22.4-26.8 
 
 27.6-35.2 
 
 Round the Thorax (under Nip- 
 ples) during inspiration . . 
 
 22-25 
 
 22.4-26.8 
 
 27.2-32 
 
 The average height of the adult French male is said 
 to be 63 inches, and of the adult French woman, about 
 five feet. In England the average height of men born 
 under favorable circumstances, is said by Dr. Tidy to 
 be 5 feet, 9 3-5 inches, and of women, 5 feet, 2 inches. 
 The head is | part of the total height, and is divided 
 into two equal parts immediately below the eyes, the 
 nostrils being midway between the eyes and chin. The 
 pubis is the central point between the two extremities 
 
PERSONAL IDENTITY. 213 
 
 of the body. When the arms are raised vertically above 
 the head, the navel is the centre of the length ; if the 
 arm is divided into five parts, the hand occupies one 
 part and the fore-arm and arm two parts each ; multi- 
 ply, therefore, the length of the hand by five and we get 
 the length of the arm. The carpal and metacarpal bones 
 represent half the length of the hand ; the first pha- 
 lanx of the middle finger is J the length of the entire 
 hand, its last two phalanges being together equal to the 
 length of the first ; the last phalanx is halved by the 
 nail. The sole of the foot is J longer than the palm of 
 the hand, but the back of the foot or instep is as nearly 
 as possible the same length. 
 
 According to Dr. Sieveking, the weight should be in 
 the following proportion to the height : — 
 
 
 Model Heights 
 
 wild Weights. 
 
 The Height heing ^ 
 
 • The Weight should be 
 
 5 feet 
 
 linoh 
 
 8 stone 4 lbs. 
 
 5 " 
 
 2 
 
 tt 
 
 9 
 
 " 
 
 5 " 
 
 3 
 
 It 
 
 9 
 
 tt ^ tt 
 
 5 " 
 
 4 
 
 tt 
 
 9 
 
 " 13 " 
 
 5 " 
 
 5 
 
 tt 
 
 10 
 
 " 2 " 
 
 5 " 
 
 6 
 
 tt 
 
 10 
 
 5 " 
 
 5 " 
 
 7 
 
 tt 
 
 10 
 
 " 8 " 
 
 5 " 
 
 8 
 
 tt 
 
 11 
 
 (( I tt 
 
 5 " 
 
 9 
 
 tt 
 
 11 
 
 " 8 " 
 
 5 " 
 
 10 
 
 tt 
 
 12 
 
 tt H tt 
 
 5 " 
 
 11 
 
 tt 
 
 12 
 
 " 6 " 
 
 6 " 
 
 
 
 tt 
 
 12 
 
 " 10 " 
 
 As to this point, see 'post, Insukance. 
 
214 
 
 MEDICAL JUEISPBDDENCE. 
 
 As respects the dimensions of the skeleton at various 
 ages, the following tables by Dr. Humphrey are here 
 given: — 
 
 Measurements at different Ages in Inches. 
 
 Age. 
 
 1 
 
 ID 
 1 
 
 a 
 
 H 
 J3 
 
 1 
 
 1 
 
 ■a 
 1 
 
 1 
 
 i 
 
 1 
 
 Pelvis. 
 
 
 a S 
 <5. 
 
 At Birth .... 
 
 19 
 
 7.0 
 
 1.5.0 
 
 3.5 
 
 2.5 
 
 3.1 
 
 4.3 
 
 3.5 
 
 3.5 
 
 1.3 
 
 1.3 
 
 2 years (average) . 
 
 27 
 
 8.5 
 
 17.7 
 
 4.7 
 
 8.6 
 
 3.1 
 
 6.2 
 
 5,1 
 
 8.6 
 
 •l.'l 
 
 2.2 
 
 4 to 6 years (average) 
 
 US 
 
 11.8 
 
 18.0 
 
 6.6 
 
 4.8 
 
 4.1 
 
 9.1 
 
 7.1 
 
 6.1 
 
 2.5 
 
 S5 
 
 8 to 12 years (average) 
 
 43 
 
 12.8 
 
 18.8 
 
 8.3 
 
 B.O 
 
 5.1 
 
 11.4 
 
 9.4 
 
 6,4 
 
 3.1 
 
 3.1 
 
 no Temale . 
 
 55 
 
 17.0 
 
 19 
 
 10.3 
 
 7.0 
 
 5.8 
 
 14.8 
 
 11.0 
 
 7.8 
 
 4.0 
 
 36 
 
 >, Male . 
 
 54 
 
 lfi.5 
 
 19.0 
 
 10.5 
 
 7.5 
 
 6.6 
 
 16.0 
 
 11.5 
 
 
 
 
 S Average . 
 
 64 
 
 16.6 
 
 19.0 
 
 10.4 
 
 7.4 
 
 67 
 
 14.8 
 
 11.3 
 
 8.0 
 
 3.8 
 
 8.6 
 
 OS a (Female . 
 
 59 
 
 19.0 
 
 19 5 
 
 11.0 
 
 8.2 
 
 fi.5 
 
 160 
 
 12 8 
 
 8,0 
 
 6.0 
 
 4.8 
 
 T S j .Male . . 
 
 .59 
 
 17.5 
 
 204 
 
 110 
 
 8.5 
 
 6,3 
 
 15,0 
 
 13.0 
 
 8.0 
 
 3.9 
 
 .<i.8 
 
 rH g, ( Average . 
 
 60 
 
 18.5 
 
 19.8 
 
 11.0 
 
 8.4 
 
 6.4 
 
 16,8 
 
 13.3 
 
 8.0 
 
 4.7 
 
 4.6 
 
 Average Measurement at different Ages, reduced to a Scale o/'lOO. 
 
 Age. 
 
 
 
 
 lo- 
 
 1 
 § 
 
 s 
 
 9 
 
 i' 
 
 1, 
 
 22,60 
 
 18„50 
 
 1 
 18.60 
 
 Pelvis. 
 
 SO 
 
 u ^ 
 
 II 
 
 6,80 
 
 IJ 
 6.80 
 
 Birth .... 
 
 100.0 
 
 36.84 
 
 79.00 
 
 18,50 
 
 13.20 
 
 16 30 
 
 2 Years .... 
 
 100.0 
 
 31.40 
 
 66..66 
 
 17.40 
 
 13.33ill.48 
 
 22 94 
 
 18 88 
 
 13 3!H 
 
 8,U 
 
 8.14 
 
 4 to 6 years . . 
 
 100.0 
 
 33.71 
 
 51,42 
 
 18 86 
 
 13.7111.71 
 
 26.00 
 
 ?/).2S 
 
 14.57 
 
 7.14 
 
 714 
 
 8 to 12 years . . 
 
 100.0 
 
 29.76 
 
 43,72 
 
 I9,;w 
 
 14,09jll.86 
 
 26,51 
 
 21.86 
 
 14.66 
 
 7.21 
 
 7.21 
 
 15 years . . . 
 
 100.0 
 
 30.74 
 
 35.70 
 
 19.26 
 
 13. 70110.56 
 
 27.40 
 
 2148 
 
 1481 
 
 7.03 
 
 6.66 
 
 18 to 19 years . 
 
 100.0 
 
 30.83 33.00 
 
 19.00jl4.33|ll.ll 
 
 26.33 
 
 23,16 
 
 13 83 
 
 7.83 
 
 7.50 
 
 Adult .... 
 
 100.0 
 
 34.15 31.54 
 
 19.64 14 15 11.23 
 
 27 51 
 
 22.16 
 
 16,03 
 
 8.00 
 
 6.61 
 
 Orfila's tables differ considerably from those of Dr. 
 Humphrey ; they are as follows : — 
 
PERSONAL IDENTITY. 
 
 215 
 
 Table I. 
 
 [OrfUa's First Table.) Stature Calculated from length of Bones. 
 [The Measurements are given in InelieB and Fractions of an Inch.] 
 
 Length of Bone. 
 
 Stature. 
 
 Humerus (19 oba.) . . 
 Ulna 14 " . . 
 Femur 12 " 
 Tibia 11 " 
 
 Inches. 
 
 Maximum . 
 
 Minimum. 
 
 DiEference. 
 
 14.50 
 10.66 
 17.75 
 14.21 
 
 68.10 
 70-80 
 69-66 
 69.66 
 
 64.50 
 65.66 
 64.50 
 64.50 
 
 3.60 
 5.14 
 5.16 
 8 16 
 
 Table II. 
 {Orjila's Second Table.) Stature Calculated fiom length of Bones. 
 
 Length of Bone. 
 
 Stature. 
 
 Humerus (6 obs.) . . 
 Ulna 7 '• 
 Femur 7 " 
 Tibia 7 " 
 
 Inches. 
 
 Maximum. 
 
 MiDimum. 
 
 Difference. 
 
 13 00 
 10.66 
 18.10 
 15.00 
 
 73.25 
 73.25 
 72.00 
 70.50 
 
 69.75 
 65.00 
 67.00 
 65.00 
 
 3.50 
 8.25 
 5.00 
 5.50 
 
 The differences between these two tables show that 
 too much reliance should not be placed on calculations 
 based upon the relative length of bones. In such cal- 
 culations it may be added that it is usual to add from 1 
 inch to 1| inches for the soft parts. 
 
 Race. — Differences of race are chiefly manifested in the 
 skull, which Dr. Tidy divides into three classes : — 
 
216 MEDICAL JURISPRUDENCE. 
 
 1. The prognathous skull of the negro, in which there 
 is a forward prolongation of the jaw, with the foramen 
 magnum placed far back. ' 
 
 2. The pyramidal skull of the Esquimaux and of the 
 inhabitants of North and Central Asia, in which there is 
 a peculiar lateral projection of the zygoma, due to the 
 form of the malar bones, rendering the skull lozenge- 
 shaped in appearance. 
 
 3. The oval or elliptical skull of the Indo-European 
 or Caucasian, which he regards as essentially symmet- 
 rical, having no marked prominences and no undue 
 compressions. 
 
 The shape of the skull in some savage or half-civi- 
 lized races is modified by artificial pressure upon the 
 head during infancy ; but it is apprehended that ques- 
 tions relating to such skulls will rarely if ever be sub- 
 mitted to a medical jurist, and definite conclusions as to 
 race from the shape of the skull can rarely be formed, 
 
 The capacity of the skull, according to the better 
 opinion, seems to vary in different races ; but for details 
 upon this subject as well as measurements of human 
 skeletons in different races, the student must be referred 
 to more voluminous treatises. 
 
 - Definite conclusions as to race can rarely be drawn 
 from other anatomical peculiarities, if we except the 
 color of the skin of the negro and of other dark races, 
 and the various modifications of the hair. In the negro, 
 however, the feet are wide apart and flat, and the os 
 calcis has a remarkable backward projection. 
 
 Likeness. — This subject, so far as it relates to ques- 
 tions of legitimacy and paternity, has been already 
 considered. 
 
PERSONAL IDENTITY. 217 
 
 The determination of questions of identity of living 
 persons by likeness will usually depend upon the appli- 
 cation of the ordinary rules of evidence, in which the 
 medical jurist has no special iuterest. The famous 
 Tichborne case is an interesting case in this connection. 
 
 Congenital Peculiarities and Hereditary Diseases. — 
 Congenital peculiarities and hereditary diseases often fur- 
 nish strong evidence upon the issue of identity. Moles, 
 polydactylism, hypospadias, and epispadias are not un- 
 frequently transmitted through several generations. 
 
 Ncevi may often furnish evidence. of identity. He- 
 reditary diseases, such as syphilis, etc., may have some 
 hearing upon the question of identity, as may also other 
 congenital peculiarities and diseases, which will readily 
 suggest themselves to the medical jurist. 
 
 Cicatrices and Tattoo Marks. — Cicatrices and tattoo 
 marks are often important to be considered in this con- 
 nection. A scar may often be made more conspicuous 
 by briskly rubbing it with the hand, when the whiteness 
 of the scar, due to its deficient blood supply, will ren- 
 der it conspicuous in comparison with the sound skin. 
 As respects the necessity of a scar following a wound, 
 it may be said that a scar always results from a wound 
 involving loss of substance ; scars may not result from 
 shght punctures where the surface of the skin has only 
 been pierced, as by the prick of a lancet or the bite of 
 a leech. And again, where the scar arises from a clean 
 cut with a sharp instrument, especially if in the direc- 
 tion of the muscular fibres, it may be so slight and nar- 
 row as to escape notice even on a careful examination. 
 It should be remembered that a scar may affect the 
 epidermis only and not the cutis vera ; so that where 
 
218 MEDICAL JUEISPRUDBNCE. 
 
 putrefaction has set in and the skin has commenced 
 to peel, it would be impossible to say that no scar 
 existed during life. 
 
 As respects the period of cicatrization of a wound, it 
 may be stated that in the case of simple incised wounds in 
 tissues of average vitality, cicatrization may occur in from 
 14 to 20 days. The rapidity of the process is, however, 
 dependent upon many circumstances, such as the extent 
 of the wound (the more extensive, the less rapid will be 
 the cicatrization), its nature, whether contused or lacer- 
 ated (in which case cicatrization will be delayed), its 
 position (wounds of the lower extremities healing more 
 slowly than of the upper extremities), the age and health 
 of the person, and method of treatment. 
 
 A recent cicatrix is soft, tender, and pink, or at any 
 rate redder than the surrounding skin ; in the course of 
 one or two or more months, the cicatrix becomes less 
 tender, harder, and of a brownish-white color. As its 
 age increases, it becomes less and less sensitivCi hard and 
 thick, white and shining ; when a scar has assumed this 
 appearance it is impossible to determine the time when 
 the wound was inflicted, except that it may be safely 
 said that it did not result from a wound inflicted two, 
 three, or even four weeks previously. Where the cica- 
 trix is soft, red, and tender, the probabilities are that it 
 is not of long standing. 
 
 As to the inference which may be drawn from the 
 character of the cicatrix it may be stated, generally, that 
 the cicatrix of a straight incised wound, involving no 
 loss of tissue, is usually rectilinear ; the cicatrix of an 
 oblique wound is usually more or less semilunar. In- 
 cised wounds involving loss of substance, or contused 
 
PERSONAL IDENTITY. 219 
 
 or lacerated wounds, usually produce cicatrices irregu- 
 lar in outline, with the surface depressed and more or 
 less uneven and puckered; the cicatrix of a stab is 
 usually triangular; the cicatrix of a bullet-wound, 
 where the weapon was fired near the body, is large, deep, 
 and irregular, and.the probabilities are that tattoo marks, 
 due to particles of gunpowder being driven under the 
 skin, will be found in the surrounding tissue. Where 
 the weapon was fired from a distance the cicatrix is 
 usually a depressed disc, regular in shape and smaller 
 than the ball that caused it. The cicatrix of the wound 
 of exit, if there is one, will usually be larger and more 
 irregular than the wound of entrance. The cicatrix of 
 a burn will vary somewhat with the form of the heated 
 body applied, while the regularity and contraction of 
 the soar will depend upon the extent and depth of the 
 burn. 
 
 Cicatrices produced by caustics have usually regular 
 edges ; but this will vary, as in the case of burns, to an 
 unlimited degree ; much will depend on the caustic used 
 and the mode of its application. Scars from flogging 
 usually appear as faint white lines extending between 
 little circular pits marking the position of the knots of 
 the lash. Scars resulting from bleeding are white and 
 linear ; and where the operation has been properly per- 
 formed the scar is oblique with reference to the direc- 
 tion of the vein. Marks of cupping usually present 
 themselves as a series of small white symmetrical cica- 
 trices. The cicatrix of an issue is single, rounded, and 
 depressed ; that of a seton is double, each mark being 
 linear with a band of lymph connecting the two lines. 
 Blisters, as a rule, leave no scar ; occasionally, however, 
 
220 MEDICAL JURISPRUDENCE. 
 
 where suppuration results, scars do occur, the extent of 
 which depends on the amount of destruction of the 
 parts to which they are applied. The cicatrix of vac- 
 cination is an irregular, flat, slightly depressed, honey- 
 combed scar. Small-pox scars are deep and irregular, 
 occupying a place much below the level of the skin. 
 The cicatrix of a syphilitic abscess, on account of the 
 great loss of substance, is usually very deep. Scrofu- 
 lous ulcers cause irregular and deeply furrowed scars, 
 with hard, uneven edges. The character of the cica- 
 trices of different ulcers will depend much on theu" 
 locality and the character of the tissue involved. 
 
 The locality of a scar will often afford important 
 evidence as to its character. The cicatrix of a wound 
 in the case of an adult who has ceased growing will 
 be smaller than the wound causing it, and as its age 
 increases will diminish in size and become thicker and 
 whiter ; but in the case of a child, on the other hand, 
 a cicatrix will increase in size with the growth of the 
 body ; cases are recorded where the length and breadth 
 of a scar have thus become doubled. 
 
 As to whether a cicatrix can be obliterated either by 
 lapse of time or by artificial means, it appears to be 
 established that scars resulting from slight incised or 
 punctured wounds where the epidermis only has been 
 injured, or where if the cutis has been penetrated there 
 has been no loss of substance, may in time disappear ; 
 this is not, however, either necessarily nor invariably 
 the case. Marks of bleeding may become oblitei-ated 
 after the lapse of two or three years ; but on the other 
 hand, there are recorded cases where the scars were 
 distinct after periods of tw^enty-six, thirty, fifty, or even 
 
PERSONAL IDENTITY. 221 
 
 nearly sixty years. Where, however, a scar results 
 from a skin disease or from a wound involving loss of 
 substance, it is exceedingly doubtful whether the scar 
 can ever be obliterated, although changes may occur 
 resulting in its becoming less distinct. 
 
 Tattooing consists in first pricking the skin deeply, 
 and then rubbing into the punctures some coloring 
 substance. The process causes considerable inflamma- 
 tion, lasting commonly two weeks or more. In about 
 six weeks the cuticle scales off, and at the end of about 
 two months the skin assumes its normal character, 
 marked with the device pricked in by the operator. 
 Tattoo marks of irregular outline may be accidentally 
 caused by coloring matters, such as coal-dust, etc., find- 
 ing their way into a wound. Tattoo marks consisting 
 of scattered dots of bluish color are of constant occur- 
 rence in gun-shot wounds where the weapon has been 
 fired very near the persoa 
 
 As to the durability of tattoo marks it seems estab- 
 lished that they may entirely disappear in a small 
 proportion of cases ; ten years appears to be the mini- 
 mum period of such disappearance. 
 
 The permanence of tattoo marks depends upon, 
 first, the nature of the coloring-matter; and second, 
 the efficiency of the operation. 
 
 1. As to the coloring-matter, — vermilion, indigo, and 
 Prussian blue are the colors most disposed to fade. 
 Cinnabar and common ink are next in permanence ; 
 while cobalt and ultra-marine, and especially all car- 
 bonaceous material, such as India and China inks, soot, 
 coal-dust, and gunpowder, all of which produce a bluish 
 black tattoo, are by far the most permanent. The color- 
 
222 MEDICAL JUEISPEITDENCE. 
 
 ing-matter used in tattooing, even after its natural 
 obliteration, may frequently be distinguished in the 
 contiguous absorbent glands. 
 
 According to Dr. Tidy, the color produced by taking 
 nitrate of silver is absolutely indelible. 
 
 2. As to the efficiency of the operation, — if the surface 
 of the cutis merely be penetrated the marks are very 
 much more likely to fade than if the punctures are 
 carried into the substance of the skin. Tattoo marks 
 are more likely to disappear from a thin-skinned person 
 than from a thick-skinned one. If the operation is well 
 performed, a tattooed skin may after death be macerated 
 in water for an indefinite time without affecting such 
 marks. The separation of the cuticle by putrefaction 
 does not interfere with an efficient tattoo. 
 
 Tattoo marks can be obliterated by artificial means ; 
 but such means, resulting in suppuration and the de- 
 struction of the skin, will leave scars in the place of 
 the tattoo, as a general rule. 
 
 Marks of the Hands and Feet. — Evidence as to 
 footprints and hand-marks is usually given by ordi- 
 nary witnesses ; sometimes, however the opinion of the 
 medical jurist may be required upon this subject. It 
 appears to be settled as respects footprints that the 
 prevailing opinion, that the impression of the foot upon 
 the soil will always correspond with the foot making it, 
 is by no means correct ; but on the contrary such foot- 
 prints may be either larger or smaller than the foot 
 producing them, the exact relationship and size depend- 
 ing upon several causes. 
 
 1. The material in which the footprint occurs. Where 
 the impression occurs in sand or in any material com- 
 
PERSONAL IDENTITY. 223 
 
 posed of minute, freely moving particles, the footprint 
 is usually smaller than the foot ; and this, in the case 
 of sand, whether it is dry or moist. 
 
 On the other hand, if the impression is made in clay 
 or other material not composed of fine and free parti- 
 cles, the impression is invariably larger than the foot. 
 
 2. The impression will depend upon the shape of 
 the boot or shoe worn. If the boot or shoe worn is in 
 any respect peculiar as respects shape, or size, or nails 
 on its lower surface, and the impression corresponds 
 thereto, such evidence will be valuable ; but if the 
 correspondence is between the print and a boot not 
 worn at the time the impression was made, it is of little 
 value. 
 
 3. The size of the impression will depend upon the 
 rapidity of the progression and the level of the ground. 
 The impression produced by the foot of a person when 
 running is smaller than that of the same person walk- 
 ing ; and the impression of the same person standing 
 will be still larger. In a slow walk an impression of 
 the whole foot or the greater part thereof will probably be 
 made, while in running the mark of the heel will be less 
 distinct, and that of the front of the foot more distinct 
 than in walking. In going up-hill there may be only 
 slight evidence of the mark of the heel, while the mark 
 of the ball of the foot may be very distinct. In coming 
 down-hill the impression of the whole foot, but espe- 
 cially of the heel, will generally be well defined. 
 
 4 The character, shape, and size of the impression 
 will always depend to a great extent on peculiarities 
 of gait; such peculiarities should in each case be care- 
 fully studied. 
 
224 MEDICAL JUEISPEUDENCB. 
 
 5. Marks of blood on the floor of a room, if corres- 
 ponding stains be found on the sole of the boot worn by 
 the prisoner, may furnish important evidence. 
 
 Where blood-stains are found on the floor or other 
 portions of the room it is better to remove intact the 
 stained portion of board, plastering, etc. 
 
 6. The surroundings of all footprints should be care- 
 fully examined. In some cases it may be necessary to 
 take a cast of certain footprints, which may be done by 
 raising the temperature of the impressed ground to about 
 220° F. by holding over it a warming-pan filled with in- 
 candescent charcoal, and then dusting over it powdered 
 stearic acid, which wiU melt and soak in, taking the 
 exact form of the footprints. This, when allowed to 
 cool, may be detached and used as a mould for the pro- 
 duction of a plaster-of-Paris cast. 
 
 In a recent number of the "Annales d'Hygiene et 
 M^decine Legale " are given the results of a study by 
 Dr. Masson of the question whether certain marks were 
 made by one and the same foot, and so by one person 
 only. He is of the opinion that it is impossible that 
 two human footprints should closely resemble each other 
 unless made by the same foot. The toes, and especially 
 the great toe, leave marks which should be examined at- 
 tentively; these, and the outline of the digito-plantar 
 depression, the line which defines the plantar arch, are 
 the data for diagnosis. The conclusions drawn by Dr. 
 Masson are— r- 
 
 1. The dimension and shape of the footprints made 
 by the same foot vary with the attitude taken. 2. The 
 two extreme and characteristic types are represented by 
 impressions made by the foot in walking and standing. 
 
PEBSONAL IDEN^riTY. 225 
 
 3. The expert called to study the matter of footprints 
 should always take impressions of the foot of the ac- 
 cused, in the act of standing and of walking, and should 
 compare only those which correspond with the same at- 
 titude. 4. In connection with the measurements made 
 he should always consider the points which throw light 
 upon the individual characteristics of the foot. 
 
 The Teeth. — The condition of the teeth often affords 
 important evidence upon the question of identity. The 
 state of the teeth, and especially irregular dentition, 
 should be accurately noted ; and in important cases a 
 cast of the mouth should be taken by a dentist. Hu- 
 man beings have two periods of dentition. The ar- 
 rangement of the temporary and permanent teeth is 
 given in Table I. : — 
 
 Table I. 
 Arrangement of the Temporary and Permanent Teeth. 
 
 to O g O m 
 
 3 "3 *S "3 .3 
 .S 3 g 3 o 
 
 a o fi o a 
 
 Supper Jaw 2 14 12 = 
 J = 20 
 
 = ioi 
 
 Is i-'i 
 
 ,| gB i s i g« I 
 
 a II, o iq u p< a 
 
 (Upper Jaw 3 2 14 12 3 = 16i 
 Permanent Teeth ] > = 32 
 
 (Lower Jaw 3 2 14 12 3 = 16)- 
 
 The periods of the irruption of the teeth are given in 
 Table II.: — 
 
 15 
 
226 MEDICAL JUMSPEUDENCE. 
 
 Table II. 
 The Periods of the Irruption of the Teeth. 
 (a) Temporary Teeth. 
 
 (b) 
 
 6th or 7th month . . 
 
 . . two middle incisors. 
 
 9th " . . 
 
 . . two lateral incisors. 
 
 12th « . . 
 
 . . first molars. 
 
 18th " . . 
 
 . . canines. 
 
 24th •' . . 
 
 . . two last molars. 
 
 ) Permanent Teeth. 
 
 
 6th or 7th year . . . 
 
 . . the four anterior or first molars. 
 
 7th 
 
 
 . . two middle incisors. 
 
 8th 
 
 
 . . two lateral incisors. 
 
 9th 
 
 
 . . first bicuspids or prse-molars. 
 
 10th 
 
 
 . . second bicuspids or prse-molars. 
 
 11th to 12th 
 
 
 , . canines. 
 
 12th to 14th 
 
 
 . . second molars. 
 
 17th to 21st 
 
 I 
 
 . . last molars, or " wisdom teeth." 
 
 lu determining the age from the state of the teeth, it 
 should, however, be born in mind that there are cases 
 of very early dentition ; children have been born with 
 teeth, generally the central incisors ; other cases are 
 recorded where dentition was preternaturally late. Dr. 
 Tidy records the case of a woman 70 years of age cut- 
 ting a canine tooth, and there are cases where adults 
 have never cut their teeth. 
 
 The development of the teeth, especially the first set, 
 may be retarded by rickets ; sypliilis, on the other hand, 
 rather hastens the irruption of the teeth, and especially 
 the first set, and may cause peculiarities in the permanent 
 teeth. 
 
 Supernumerary teeth, and third dentition, even, have 
 been recorded. 
 
 Hairs and Fibres. — The microscopical exaihination of 
 hairs and fibres frequently affords important evidence of 
 
PERSONAL IDENTITY. 227 
 
 identity in criminal cases. Thus, the identity of hairs 
 found on mutilated portions of a skull, clutched in the 
 hands of a deceased person, on the clothes of the ac- 
 cused, or imbedded in blood on a weapon, etc., with the 
 hair of the deceased, or the accused, may form an im- 
 portant link in the chain of evidence to convict a person 
 accused of crime. 
 
 In cases of bestiality, hairs of the animal will almost 
 always be found adhering to the clothes of the person 
 accused. The examination of the hair about the female 
 genitals, in cases of alleged rape, may reveal the exist- 
 ence of spermatozoa. 
 
 Where the question is as to the nature of the hair, 
 it should be first washed in water, thoroughly dried, 
 then soaked in turpentine for some time, and afterwards 
 mounted in Canada balsam ; it should then be examined 
 with a medium power of the microscope, the power 
 used depending somewhat upon the nature of the fibre. 
 In every examination of fibres, the comparison should 
 he a direct one between the fibre in question and other 
 fibres, the nature of which is positively known. It 
 will be found convenient to keep a series of hairs of 
 different animals and of different fibres permanently 
 mounted for purposes of comparison. The observer 
 should make himself familiar virith the appearance of 
 all ordinary fibres, such as cotton, linen, silk, wool, 
 hemp, etc., and the effect produced upon them by vari- 
 ous reagents. It would be an interesting matter to 
 go more fully into the examination of this subject, but 
 want of space forbids ; the reader is referred to professed 
 treatises on microscopy. 
 
 As respects human hair, its structure and devel- 
 
228 MEDICAL JtmiSPKUDENCE. 
 
 opment will be found treated at length in professed 
 treatises upon anatomy, histology, and physiology. In 
 this connection it may be stated that hairs are appen- 
 dages of the skin, each hair being imbedded in a de- 
 pression of the skin called a "foUicle," fixed at the 
 bottom thereof by dilatation of the hair itself called 
 the "bulb." The portion above the bulb and within the 
 follicle is called the " root," and the portion projecting 
 beyond the surface, the "shaft." The outer or cortical 
 part of the hair is shown, when treated with sulphuric 
 acid, to be composed of spindle-shaped, flattened, angu- 
 lar cells containing pigment granules giving the color of 
 the hair; under the microscope it appears to be tubular, 
 although it is not in fact so. The inner medullary por- 
 tion consists of granular, nucleated cells, angular or 
 rounded in form,, arranged linearly, containing air, which 
 causes them to appear black by transmitted, and white 
 by reflected light. The whole hair is surrounded by a 
 cuticular coat of flat epithelial scales ; the varieties of 
 arrangement of this cuticular layer are, in great meas- 
 ure, the cause of the different appearances of the hair 
 in different animals. 
 
 The following table, altered by. Tidy from Dr. Pfaff s 
 work, gives the diameters of hairs from different parts 
 of the body, and from different animals, in fractions of 
 an English inch : — 
 
 Fractions of Inch. 
 
 Do-wn (lanugo) from a suckling -^^^ to -j^ 
 
 Down " from a young girl's arm . . . j^-g 
 
 Down " from the upper lip of a woman . -^-g 
 
 Down of beard (iulus) ^^ 
 
 Hair from a woman's head (capilli) .... -jj^ 
 
 Hair from female puLes -^ 
 
PERSONAL IDENTITY. 229 
 
 • , . ■ Fractions of Inch, 
 
 Hair from a man's head (capilli) ^^ 
 
 Hair from axilla y^ 
 
 Hair &om m^e pubes -^ 
 
 Hair from the eyelashes of a man . . . . . -^ 
 
 ., Eyebrows -j^ 
 
 Hair from nostrils (mbriss(B) .,. -g^ 
 
 , Hair from moustache (mystjiie) ^ir *" ihi 
 
 Hair from the ears (tragi) -g\j 
 
 H4ir from the arm of a man ToW ^° 'sij 
 
 Hair from a man's hand ^-^ 
 
 ■'Kg's bristle y^j- 
 
 Hair of fallow deer , . j^^ 
 
 Hair of horse y|^ 
 
 Hair of goat -^ 
 
 Hair of fox ^^ 
 
 Hair of cow ^^ 
 
 Hair of spaniel dog tt^t 
 
 Hair of rabbit t At- 
 
 ; The characteristic appearance of the haira of. different 
 animals will be found in various works upon microscopy, 
 and also in "Woodman and Tidy's Forensic Medicine." 
 iiThe question whether a particular specimen of hair 
 is human or not is ordinarily not difficult of answer. 
 In questions as to the nature, or identity of. hair, the 
 answer should always be based upon, pomparison with 
 authentic specimens. Microscopic examinations will 
 frequently enable one to say whether the hair has been 
 lately out, shaved, or violently torn from the body. 
 Infant's hair which has never been cut will be found 
 to taper gradually to a point ; after the hair has been 
 cut the ends never regain this taper condition, but re- 
 main more or less rounded, and not ^infrequently split, 
 terminating in two or more branches. For some days 
 
230 MEDICAL JURISPEUDENCE. 
 
 after cutting the hair retains a certain smoothness of 
 section. Hairs pulled out by force generally appear 
 crushed and somewhat frayed; the sheath will, as a 
 rule in such cases, be torn away with the bulb. The 
 condition of the hair, however, lost after fevers and 
 other acute diseases, closely resembles, as regards the 
 condition of the bulb, a sheath thus torn out violently. 
 The condition of the hair may also be modified by 
 certain skin and other diseases. 
 
 The color of the hair may be changed in a variety of 
 ways. Light or red hair may be darkened by the use of 
 dyes containing lead, silver, or bismuth; the material 
 in such cases may be detected by chemical analysis. 
 Dark hair may be made light by the application of 
 chlorine water, which, however, is apt to make the hair 
 brittle and rotten. A golden tint may be produced by 
 the use of peroxide of hydrogen. 
 
 Where the color has been changed artificially, it will 
 usually be marked by want of uniformity ; and if the 
 roots of the hair be examined, the new growth will be 
 seen to be of a different color. The general color of the 
 hair will not correspond with the color of the hair on 
 the pubes or trunk. Certain diseases will, at times, effect 
 a great change in the color of the hair ; and there are 
 authenticated instances of its sudden change without an 
 apparent cause, and of its becoming suddenly bleached 
 by grief or fright, although the last-mentioned cases do 
 not appear to be so well authenticated. 
 
 It seems to be settled that both hair and nails may 
 grow for a time after death, owing to the molecular Ufa 
 of the epidermis and the hair-follicles continuing for a 
 time after somatic deatL 
 
PERSONAL IDENTITY. 
 
 231 
 
 Limits of Sight and Hearing. — Questions of identity 
 sometimes require the consideration of the limits of 
 sight and hearing. The determination of such questions 
 may be modified by defects of vision, such as hyperme- 
 tropia, or long sight; myopia, or near sight; presbyopia, 
 aged sight ; astigmatism (due to the axes of curvature of 
 the cornea being unequal), color-blindness, and the like. 
 A limit is set to vision, even as respects lofty objects, 
 by the shape of the earth. The following table shows 
 the distance in miles of the farthest visible point that 
 can be seen from the top of a given height, taking into 
 account the effects of refraction : — 
 
 Height 
 
 BiEtance 
 
 Height 
 
 Distance 
 
 Height 
 
 Distance 
 
 in Feet. 
 
 in Miles. 
 
 in Feet. 
 
 in Miles. 
 
 in Feet. 
 
 in Miles. 
 
 5 
 
 2.96 
 
 150 
 
 16.2 
 
 3,000 
 
 72.0 
 
 10 
 
 4.18 
 
 200 
 
 18.7 
 
 4,000 
 
 83.0 
 
 15 
 
 5.12 
 
 250 
 
 20.9 
 
 5,000 
 
 94.0 
 
 20 
 
 5.91 
 
 300 
 
 22.9 
 
 6,000 
 
 102.0 
 
 25 
 
 6.61 
 
 400 
 
 26.4 
 
 7,000 
 
 110.0 
 
 30 
 
 7.25 
 
 500 
 
 29.5 
 
 8,000 
 
 118.0 
 
 40 
 
 8.37 
 
 700 
 
 30.5 
 
 9,000 
 
 125.0 
 
 50 
 
 9.35 
 
 1,000 
 
 41.8 
 
 10,000 
 
 132.0 
 
 60 
 
 10.25 
 
 1,500 
 
 51.0 
 
 15,000 
 
 162.0 
 
 70 
 
 11.1 
 
 2,000 
 
 59.0 
 
 20,000 
 
 187.0 
 
 100 
 
 13.2 
 
 2,500 
 
 66.0 
 
 
 
 From this it follows that a man of ordinary stature 
 can be seen on a clear day on level ground at a distance 
 of 3i mUes. 
 
 As respects hypermetropia, myopia, etc., the reader is 
 referred for information to professed treatises on the 
 eye. 
 
 Color-blindness, or Daltonism, in which red and green 
 or other colors cannot be distinguished, has doubtless 
 
232 MEDICAL JUEISPRUDENCE. 
 
 been the cause of many railway accidents. .According 
 to statistics furnished by Dr.. De. Fontenay, from the 
 examination of 9,659, persons from 8. years i of age up- 
 wards, 6,945 being, above, 16 and 2,714 below that age, 
 ,217, or 2,25 per cent, were color-blind. Of 4,492 adult 
 males, 165, or 3.7 per cent, were- color-blind; among 
 these, 1,001 belonging to the upper classes showed a 
 per cent of 3.09 ; while in 3,491 artisans, laborers, etc., 
 the per cent was 3.87. Statistics show that the per.cent 
 of color-blindness varies greatly, with the employment, 
 age, and sex. Of 6,945 adults above the age of 16, con- 
 sisting of 4,492 males and 2,453 females,. 176, or 2,56 
 per cent, were , color-blind. .Among, the. females, how- 
 ever, there were only 11 cases of color-blindness, or 
 0.45 per cent. Including all the females examined, 
 amounting to 3,819, there were 16 color-blind persons, 
 or 0.42 per cent; while of 5,840 males, adults and chil- 
 dren, there were 201 cases of color-^blindness, or 3.44 
 per cent, all the 16 color-blind females belonging to 
 the working classes. Among 2,714 children from 8 to 
 16 years of age, 41, or 1.51 per cent, were color-blind, — 
 namely, 1,348 boys with 36 colorrblind, or, 2 J7 per cent; 
 and 1,366 girls with 5 color-blind, or 0.37 per cent. Ex- 
 cluding two cases of violet-blindness, there were 56 cases 
 of red-blindness, 24 of green-blindness, and 135 of in- 
 complete color-blindness.- In , all the cases both eyes 
 were examined separately and found to be affected. 
 
 As to the effects of age on acuteness of vision. Dr. De 
 Gu^ret finds that — - 
 
 The acuteness of vision at 50 years has diminished ^ 
 
 " " 60 ' " "I 
 
 " 70 " " I 
 
 " " 80 " " J 
 
PERSONAL IDENTITY. 233 
 
 Moonlight, Daylight, Starlight, etc. — The light of the 
 moon, as is well known, varies very much ; but it is 
 stated by Dr. Tidy that the best known person cannot 
 be recognized by the clearest moonlight at a greater dis- 
 tance than from 16 to 17 yards. While this may be 
 true as respects recognition of the countenance, it would 
 seem that if there were anything characteristic about the 
 form, dress, gait, etc., 'recognition might be had at a 
 greater distance. 
 
 By starlight only, it is stated by the same author that 
 the best known person, cannot be identified further off 
 than from 10 to 13 feet. 
 
 Dr. Montgomery states a case where a lady was ena- 
 bled by the light afforded by a flash of lightning to see 
 distinctly and afterwards identify a man robbing her 
 trunk on a dark night in the cabin of a vessel. 
 
 As to the light afforded by the flash of firearms, 
 experiments seem to negative the possibility of recogni- 
 tion by such a light; other experiments by other ob- 
 servers seem to show the possibility of such recognition. 
 Very much would depend upon the nature of the arm, 
 ammunition, the relative position of the parties, quan- 
 tity of smoke, direction of the wind, etc. Under favor- 
 able circumstances, — that is, with a bright flash at a 
 short distance on a dark night, and in the absence of 
 artificial light, and where the wind is such that the 
 smoke does not intervene, — it would seem that in the 
 majority of instances recognition is possible. 
 
 The recognition of individuals dependa upon various 
 points. Where the person is comparatively near, feat- 
 ures, color and arrangement of the hair, prognathism, 
 color of the eyes, etc., are the principal means of iden- 
 
234 MEDICAL JURISPRUDENCE. 
 
 tification. Beyond a certain distance, stature, gait, gen- 
 eral peculiarities, etc., are the principal means of identi- 
 fication. De Gu^ret from experiment concludes that the 
 best known persons, even those possessing well-marked 
 personal peculiarities, can he recognized only with diffi- 
 culty, in broad daylight, at a distance of 100 metres, 
 which is a little more than 109 yards. Beyond 150 
 metres, or 164 yards, he believes recognition to he im- 
 possible. Less known and less remarkable people can 
 be recognized in broad daylight only within a distance 
 of 60 to 100 meters (65 to 109 yards). In the case of 
 people who have no personal peculiarities and are 
 almost strangers, he regards 25 to 30 metres (27 to 33 
 yards) as about the limit of recognition. Very much 
 would depend, however, as it seems to us, upon the 
 observer; for it is a well-known fact that persons 
 accustomed to using their eyes at long distances can 
 recognize persons at a comparatively great distance. 
 
 As to the size of the smallest object -which may be 
 seen by the unassisted sight, there is considerable differ- 
 ence of opinion. Carpenter states that the smallest 
 square magnitude, black or white, that can be seen on 
 the ground of the reverse color, is about j-J^ or ^-^^ of 
 an inch; while particles that powerfully reflect light, 
 such as gold dust, of y-jg-j of an inch, can be seen by the 
 naked eye by common daylight. Dr. Vincent De Gu^ret 
 states that objects, to be seen at all, must have a diameter 
 of 6 2V0 °^ ^^ inch. 
 
 Lines may be more easily seen than points; thus, 
 according to Dr. Tidy, opaque threads of fa^ °^ ^^ 
 inch can be seen by most people by the naked eye 
 when held towards the light. Our own experience is 
 
PERSONAL IDENTITY. 235 
 
 that lines ruled on glass very much smaller than any of 
 .the above may be distinctly seen under favorable cir- 
 «umstances by the naked eye; In our judgment it would 
 not be a difficult matter to see a line 1 mikron (j-^^yj 
 of an inch) in breadth ; and Prof. William A. Eogers 
 states that he and Professor Pickering and the assistants 
 at Harvard College Observatory have with the naked 
 eye seen lines ruled on glass which' could not have been 
 more than the yf^'STS °^ ^^ ^°*^^ ^^ diameter. 
 
 Passing from microscopic objects. Dr. Tidy states that 
 at a distance of one foot a person with normal sight can 
 scarcely see an ohjeet less than ^ of an inch ; and that 
 at greater distances the size must increase proportion- 
 ately. Our own experience does not agree with this 
 statement. In order to test the matter, the writer sub- 
 mitted the following-described test to 19 different per- 
 sons of ages ranging from 17 to 50 and upwards. The 
 test consisted of a piece of black paper approximately 
 one millimetre, or ^^ of an inch square, pasted upon a 
 white background ; of another similar white square upon 
 a black background, and of a black line approximately 
 one miUimetre, or ^V °f ^^ ^^^^ broad, upon a white 
 background. The cards were hung in a good light, 
 not artificial, and approached from such a distance that 
 they were invisible ; and the distances at which they 
 became visible and at which the shape of the squares 
 could first be defined were respectively noted. 
 
 The mean distance at which the black square upon 
 the white background became visible was 26 feet, 
 4 inches ; the mean distance at which it could be de- 
 fined was 5 feet, 10 inches. The mean distance at 
 which the white square upon the black background 
 
236 MEDICAL JURISPRUDENCE. 
 
 could be seen was 22 feet, 11 inches ; the^ mean dis- 
 tance at which it could be defined was 5 feet,. 7 inches. 
 The mean distance at which the black line upon a 
 white background could be seen was 75 feet. . The last 
 test was made by only 14 persons ; aU the, rest were 
 made by 19. 
 
 Limits of Hearing. — The velocity of sound in air 
 at 32° F. or zero C, is about 1,090 feet per second. 
 This velocity may be considered as increasing about 
 two feet for each degree of Centigrade. _ At lower tem- 
 peratures the velocity is less, and at higher temperr 
 atures, greater. In water the velocity of sound is 4 
 times, and in iron 17 times greater than in air. The 
 intensity of the sound in free air diminishes as the 
 square of the distance from the source of sound. At 
 great elevations the loudness of the sound is consider- 
 ably diminished. 
 
 With the normal sense of hearing, Savart fixes the 
 limits of hearing as between 8 complete vibrations per 
 second, and 24,000, while Helmholtz fixes the i limit 
 as between 16 and 38,000, or 11 octaves. This limit 
 varies, however, in different people ; and practically; no 
 doubt, will be found to be considerably less than the 
 figures above stated. The distance at which any pan- 
 ticular sound may be heard in free air varies with the 
 circumstances and with the observer, and perhaps can- 
 not in the present state of our knowledge be definitely 
 stated. Incredible as it may seem, the writer has usu- 
 ally been able to hear the sound of the impact of a 
 rifle-ball against a target consisting of cloth stretched 
 upon a frame, over which (the cloth) is pasted paper, at 
 a distance of 800 yards.; 
 
PERSONAL IDENTITY. 
 
 237 
 
 Limits of the Sense of Smell. — The limits of the 
 sense of smell wUl not often come in question in a 
 medico-legal examination; stiU, the experiments re- 
 corded below, made by Profs. Edward L. Nichols and 
 E. H. S. Bailey, of the University of Kansas, are of 
 such interest as to be worthy of presentation to our 
 readers. The following substances were made use of: 
 oil of cloves, nitrite of amyl, extract of garlic, bromine, 
 cyanide of potassium, prussic acid, oil of lemon, and oil 
 of wintergreen. A series of solutions of each was pre- 
 pared, such that each member was of half the strength 
 of the preceding one. These series were extended by 
 successive dilutions till it was impossible to detect the 
 substances by smell. The order of the bottles contain- 
 ing these solutions was completely disarranged, and the 
 test consisted in the attempt to classify them properly 
 by the unaided sense of smell. The iirst series of tests 
 was made by 34 observers, r-^ 17 male and 17 female ; 
 the results ;of which are indicated in Table I. 
 
 TABLE L 
 
 Amount Detected. 
 
 
 Oil of 
 . Oloves.. 
 
 Nitrite of 
 Amyl. 
 
 Extract of 
 aarlic. 
 
 BromiDe. 
 
 Cyanide of 
 Potassium. 
 
 Average ) 
 of 17 [ 
 males. ) 
 
 1 part in 
 88,218 of 
 water. 
 
 1 in 783,870 
 
 1 in 57,927 
 
 1 in 49,254 
 
 1 in 109,140 
 
 Average ) 
 
 of 17 [ 
 
 females. ) 
 
 1 part in 
 50,667 of 
 water. 
 
 1 in 311,330 
 
 1 in 43,900 
 
 1 in 16,244 
 
 1 in 9,002 
 
238 
 
 MEDICAL JURISPRUDENCE. 
 
 In Table II. the same method of investigation- was 
 followed with the following results : — 
 
 TABLE IL 
 Amount Detected. 
 
 
 Prussic Acid. 
 
 Oil of Lemon. 
 
 OUofWintergreen. 
 
 Average of 27 ) 
 males. ) 
 
 I part in 112,000 
 of water. 
 
 1 part in 280,000 
 of water. 
 
 1 part in 606,000 
 of water. 
 
 Average of 21 1 
 females. ) 
 
 1 part in 18,000 
 of water. 
 
 1 part in 116,000 
 of water. 
 
 1 part in 311,000 
 of water. 
 
 Some striking individual peculiarities were devel- 
 oped in the course of these experiments. Three of 
 the male observers could detect one part of prussic acid 
 in about 2,000,000 parts of water; two of these pei^ 
 sons were engaged in occupations favoring the culti- 
 vation of this sense. Careful chemical tests failed to 
 show the presence of prussic acid in several of the more 
 dilute solutions in which it could be detected by the 
 sense of smell. It was found that some of both sexes 
 could not detect prussic acid even in solutions of almost 
 overpowering strength. There were also several in- 
 stances of the same peculiarity as respects bromine. 
 As will be seen from the tables, the averages show 
 that the sense of smell is in general much more deli- 
 cate in the case of male than of female observers. ■ 
 
 Stains. — The identification of a variety of stains, 
 such as seminal stains, blood-stains, etc.; is often a mat- 
 ter of great importance in criminal trials, and may 
 conveniently be considered in this place. The subject 
 
PERSONAL IDENTITY. 239 
 
 of seminal stains has been, perhaps, sufficiently con- 
 sidered in another chapter. The subject of blood-stains 
 will be considered in this place. 
 
 In examining stains suspected to be blood, their 
 number, size, shape, location on the apartment, gar- 
 ment, or instrument submitted for examination, should 
 be accurately recorded. Spots of blood will, as a rule, 
 have well-defined and somewhat raised edges ; their 
 color will depend on their age and thickness, the mois- 
 ture and temperature to which the blood has been sub- 
 jected, and the nature of the material upon which it 
 has fallen. There are three sorts of tests by which its 
 nature may be determined, namely, the microscopic, 
 chemical, and spectroscopic tests. 
 
 1. Microscopic Examination of Blood-stains. — The 
 examination of a spot alleged to have been made by blood 
 should, in our judgment, be first made with a medium 
 power of from 400 to 500 diameters, for the purpose of 
 ascertaining its general characteristics. All measure- 
 ments of blood-corpuscles for medico-legal purposes, 
 should be made with as high a power as will give per- 
 fect definition. The author is in the habit of using a 
 power of about 1,500 diameters, and is of the opinion 
 that a power of at least 1,000 diameters should be used 
 for such purpose. The technique of such examination 
 cannot be entered upon in detail in this manual. For 
 extended details the reader is referred to Woodman 
 and Tidy's " Legal Medicine," Tidy's " Medical Jurispru- 
 dence," and the learned and interesting discussions of 
 the subject by Dr. J. J. Woodard and Dr. J. G. Richard- 
 son, which may be found in the London "Monthly 
 Microscopical Journal," vols. 12, 13, and 16. 
 
240 MEDICAL JURISPRUDENCE. 
 
 The general manner of examination may be briefly 
 stated to be, — that a very small portion of the stained 
 fabric or material should be cut off; or if the stain ia 
 found on a hard sui'face> such as glass or steel, a minute 
 fragment should be removed with a sharp instrument, 
 and broken into fine pieces with a sharp knife upon a 
 glass slide, and such material wet with a few drops of | 
 of 1 per cent solution of common salt in distilled water, 
 covered with, a thin cover-glass and examined with a 
 microscope. , For- the purpose of making comparativB 
 measurements of fresh blood, the method most usually 
 employed is — having first impeded the return circula- 
 tion of the finger by a thread or rubber band — to prick 
 the finger, remove a small drop to the surface of a slide 
 or cover-glass, and spread the same in a thin film over 
 such surface by the use of a needle or the edge of 
 another slide, allow it to dry, and then immediately 
 examine it with, the highest power at the disposal of 
 the observer. If the preparation is intended to be per- 
 manent, it may be cemented to the slide in the usual 
 way. If properly prepared it will keep indefinitely. 
 
 Corpuscles thus prepared were thought by the late 
 Dr. Joseph Gr. Eichardson to flatten, out a little in dry- 
 ing, so as to give an average diameter slightly in ex- 
 cess of that of fresh blood ; but the difference in the 
 case of the human blood-corpuscle is, according to his 
 experiments, only that between ^^^ and the -g^-g of 
 an inch. 
 
 The blood-eorpuscles of man and of alt mammals 
 except the camel tribe are circular, flattened, transpar- 
 ent, non-nucleated cells, presenting concave sides. In 
 the camel tribe the corpuscles are oval, but contain no 
 
\4-^ Vv PERSONAL IDENTITY. 241 
 
 i ' \K 
 
 nuclei. Vln birds, reptiles, and fish, the corpuscles are 
 also oval, and are distinctly nucleated. The shape of 
 the corpuscles found in examining any suspected stain 
 may therefore afford conclusive evidence as to the gen- 
 eral nature of the staiu; that is to say, if oval and 
 nucleated, it can be positively affirmed that it is not the 
 blood of a mammal ; if circular, it may be as definitely 
 affirmed that it is not the blood ^ a bird, reptile, or fish. 
 It should be remembered, however, in this connection, 
 that oval corpuscles as well as ordinary circular cor- 
 puscles may be rendered globular by treatment with 
 water. 
 
 In the examination of blood-corpuscles, when not 
 dried upon the slide as above described, a so-called 
 normal solution, such as the common salt solution 
 already mentioned, or one of the other solutions which 
 may be found described in the larger treatises upon this 
 subject, should always be used. 
 
 In the hands of a competent observer there is very 
 little probability that any other bodies will be mistaken 
 for blood-corpuscles; starch-cells, sporules of certain 
 fungi, and the discs found in certain coniferous woods 
 have been considered as the most likely to be so 
 mistaken. 
 
 The question as to whether blood under examination 
 can be identified positively as human blood, or as the 
 blood of any particular animal, has been very much 
 discussed. According to the experience of the writer 
 from the examination of 650 corpuscles taken from his 
 own finger, examined at different times, but under as 
 nearly identical conditions as possible, it appears that if 
 the average of a sufficient number of blood-corpuscles 
 
 16 
 
242 MEDICAL JURISPRUDENCE. 
 
 is taken, namely, not less than 100, sucli average will 
 be found to be sensibly constant, or at least will vary 
 within very narrow limits, not much, if any, greater than 
 the sum of the personal and instrumental errors. 
 
 Whether, however, another and competent observer 
 w^ould have arrived at the same average from the meas- 
 urement of the same corpuscles is open to some ques- 
 tion. The experience of the author in micrometry leads 
 him to believe that very much of the discrepancy found 
 by different observers to exist between the sizes of 
 blood-corpuscles of the same sort of animals is due to 
 several causes, namely : that the average is taken from 
 the measurement of too small a number of corpuscles ; 
 that the eye-piece micrometers were standardized from 
 stage micrometers whose errora were not known, and 
 from too small a number of observations ; that too low 
 a power was used in making such examinations, as well 
 as the use of a defective method of measurement; and 
 finally, although perhaps this is not the least source 
 of error, to that personal error which necessarily exists 
 in every refined measurement. 
 
 In order to test the relative accuracy of micrometrio 
 measurements with different apparatus in the hands of 
 different competent observers, the author recently ruled 
 on a glass slide 15 spaces of approximately .004 and 
 .008 of an inch, and procured the same to be measured 
 by six well-known microscopists, who were instructed 
 to take the mean of at least five measurements of each 
 space and report the same to the author. The result 
 showed, using standard micrometers by the same maker, 
 that the measurements of the same space by different 
 observers varied from zero to .00011 of an inch. 
 
PERSONAL IDENTITY. 243 
 
 Whether a similar discrepancy will be found to ex- 
 ist in the measurement of spaces of approximately the 
 diameter of a human blood-corpuscle, with a high power, 
 is in process of investigation. If a similar discrepancy 
 shall be found to exist it will go far towards explain- 
 ing the differences in the size of corpuscles found by 
 different observers. Had a single measurement only 
 been made instead of taking the mean of five, the above 
 discrepancy would, no doubt, have been much greater. 
 This subject seems to demand more attention and more 
 careful examination than it has hitherto received. 
 
 According to the present state of our knowledge it 
 appears to be settled that the blood-corpuscles, even in 
 the fresh state, of man, dog, rabbit, guinea-pig, muskrat, 
 monkey, elephant, lion, whale, seal, otter, kangaroo, 
 capybara, wombat, and porpoise, cannot be distinguished 
 from each other by micrometric measurement. With 
 respect to the corpuscles of other animals presenting a 
 greater difference than exists between the corpuscles of 
 the above-mentioned animals and those of man, it seems 
 to the writer, in the light of the investigations above 
 recorded, that it would be extremely perilous to un- 
 dertake, by mere micrometric measurements alone, to 
 distinguish the blood of man from that of another 
 mammal. 
 
 It is possible that further investigation and more 
 extended knowledge of the relation between these dif- 
 ferent corpuscles, and of the sources of error in micro- 
 metric measurements, may enable a careful observer to 
 distinguish human blood-corpuscles from those of some 
 other mammals ; but at present it seems somewhat pre- 
 sumptuous. 
 
244 MEDICAL JUEISPBUDENCE. 
 
 For full details respecting such micrometric measure- 
 ments as have been made, the reader is referred, in ad- 
 dition to the works above cited, to an extended series 
 of measurements published in an article by Dr. Moses 
 C. White, in the first volume of the " Eeference Hand- 
 book of the Medical Sciences," page 587. 
 
 It should also be borne in mind in this connection 
 that not only the number but the size of human red 
 blood-corpuscles is changed to an uncertain extent in 
 some diseases, which tends to make more uncertain any 
 conclusions as to the identity of blood derived from the 
 measurement of blood-corpuscles. 
 
 2. Chemical Tests for Blood. — The consideration of 
 the physiology, pathology, and chemistry of the blood is 
 beyond the scope of this treatise. For details upon 
 these interesting subjects the student is referred to pro- 
 fessed treatises upon Physiology and Pathology, and 
 especially to Dr. Charles's "Physiological and Patho- 
 logical Chemistry." 
 
 The color of the blood is due to the presence of 
 a very complex crystalline substance variously called 
 Hsemoglobin, haemato-globulin, haematocrystallin, cruorin, 
 and erythrocruorin. This coloring-matter exists in the 
 blood under two forms : the oxidized form, .which is of 
 a scarlet color ; and the deoxidized form, which is more 
 or less purple. Oxidized haemoglobin, oxyhaemoglobin, 
 or scarlet cruorin, is found in arterial blood ; and the 
 reduced haemoglobin, or purple cruorin, is found in 
 venous blood combined with more or less oxidized 
 haemoglobin. The blood found in a dead body, pro- 
 vided access of air to the blood is prevented, derives 
 its color from reduced haemoglobin and gives the spec- 
 
PERSONAL IDENTITY. 245 
 
 trum of reduced hsemoglobin only; exceptions to this 
 post-mortem condition of the blood exist, however, after 
 poisoning by hydrocyanic acid, after death by cold and 
 starvation (in which the reducing powers of the tis- 
 sue are much diminished), and especially in carbonic- 
 oxide poisoning, where the blood exhibits the particu- 
 lar spectrum of carbonic-oxide haemoglobin hereinafter 
 described. 
 
 Hsemoglobin can be separated from the corpuscles 
 by any means tending to their dissolution, — as, the 
 addition of water to the blood ; the passage through it 
 first of a current of oxygen and then of carbonic acid ; 
 freezing and subsequent thawing, repeated several 
 times ; electrical discharges ; agitation of the blood with 
 ether ; and the addition to the blood of certain salts or 
 of crystallized bile. By any of these processes the 
 blood is rendered transparent or laky. 
 
 Hsemoglobin crystals are obtained with difficulty 
 from human blood, but more readily from that of the 
 guinea-pig, dog, or rat. For the technique of their sepa- 
 ration, see Dr. Charles's " Physiological and Pathological 
 Chemistry," page 199. 
 
 Hsemoglobin is remarkable for its indiffusibility ; it 
 is insoluble in absolute alcohol, ether, chloroform, or 
 benzole ; it is readily soluble in water and in weak 
 alcohol, and also in alkaline solutions, but is decom- 
 posed both by acids and alkalies, when the body now 
 called hsematin (also a very complex structure), together 
 with an albuminous principle, is formed. It should be 
 noted, however, that hsematin is not formed by the 
 action of hydrocyanic acid upon haemoglobin. Nearly 
 all the iron of the blood is contained in the hsematin. 
 
246 MEDICAL JURISPRUDENCE. 
 
 Hasmatin is a bluish-black amorphous body, forming 
 a reddish-brown powder, which, when burnt, leaves 
 behind pure oxide of iron. It is insoluble in water, 
 alcohol, ether, and chloroform, but readily soluble in 
 alkalies or alkaline carbonates ; it is with difficulty 
 soluble in acetic or the mineral acids, and hydrochloric 
 acid appears to be the only one of these that dissolves 
 it without its iron separating. Solutions of haematin 
 are dichroic, being reddish-brown in a thick layer, and 
 olive-green in a thin layer. Like haemoglobin, hsematin 
 exists in an oxidized and a reduced condition, freshly 
 reduced hsematin passing back rapidly into the ordi- 
 nary form. Haemoglobin, where the blood has been 
 kept for a long time, becomes changed into haematin ; 
 and haematin, whether produced by age or by chemical 
 actions, like haemoglobin, in its two states of oxidation 
 has separate spectra. 
 
 The time required to change haemoglobin into me- 
 thaemoglobin, or haematin, varies according to circum- 
 stances ; it is said to be rapid in towns, but slow in the 
 country, and to be especially rapid where the stain is 
 exposed to an atmosphere in which coal-gas is burnt, 
 any weak acid tending greatly to accelerate it. The 
 change is rapid also where the stained fabric has been 
 worn next to the skin. As a rule, it may be said that 
 if the color of the blood-stain be a bright red, it is proof 
 that the stain is recent ; but if it be brown, it is not 
 proof that it is old. 
 
 The fact that heemoglobin is very soluble and hsematm 
 very insoluble, is of great medico-legal importance. 
 After an article once stained with blood has been 
 washed in water — provided sufficient time has elapsed 
 
PERSONAL IDENTITY. 247 
 
 for the hsemoglobin to be converted into haematin — 
 enough will in all probability remain to serve for its 
 identification; but where the stain is perfectly fresh, 
 and the fabric is washed in cold water before the hsemo- 
 globin has had time to be converted into hsematin, the 
 whole of the blood may be so effectually removed by 
 efficient washing that no trace will remain ; hot water, 
 however, will not effect the removal of a fresh blood- 
 stain like cold water, owing to its further action on the 
 coloring-matter of the blood. Where, therefore, in a 
 criminal case, it appears that an article has been washed 
 in cold water, evidence of the absence of blood-stains 
 is of little value ; but if it has been washed in hot 
 water the probability is that the presence of the blood, 
 if it existed on the fabric, can be satisfactorily demon- 
 strated. The age of the stain is no impediment to the 
 spectroscopic test hereinafter described. Dr. Sorby has 
 been able to discover the spectrum of hsematin after 
 forty-four years, while Dr. Tidy states that he has 
 obtained excellent spectra from stains which he had 
 good reason to believe were over one hundred years 
 old. 
 
 The further consideration of the spectroscopic exami- 
 nation of the blood will be found post. , 
 
 Hsemin (Teichmaun's blood-crystals) has not been 
 found pre-formed in animal bodies ; it is a bluish-black 
 or dark-brown metallic-looking, very staple crystalline 
 powder. It is almost insoluble in dilute acetic acid, 
 water, alcohol, ether, and chloroform ; but is soluble in 
 hydrochloric and sulphuric acids and in solutions of 
 •the alkalies and alkaline carbonates, but is decomposed 
 in its solution. Hsemin crystallizes in numerous forms 
 
248 MEDICAL JURISPKUDENCB. 
 
 belonging to the rhomtic system, ■which are most gener- 
 ally small, brown, or almost black rhombic prisms or 
 tables. 
 
 Teichmann's test for hsemin crystals, as modified by 
 Buchner and Simon, is substantially as follows : The 
 stained portion of the fabric or material is to be cut 
 away from the rest, macerated if recent, and if old, 
 boiled with an excess of glacial acetic acid till the acid 
 is colored, when it is to be evaporated to dryness on a 
 watch-glass or slide. When now examined with a 
 power of about four hundred diameters, the character- 
 istic crystals of hsemin should be found if the stain is 
 blood, existing in the form of rhomboidal, tabular, or 
 needle-shaped crystals, lying across one another in star* 
 shaped masses, varying in color from a faint yellowish- 
 red to a deep blood-red. As the presence of the saline 
 matter of the blood is requisite to the success of this 
 process, and as this may have been previously all washed 
 away, a very small particle of common salt may be 
 added to the acetic acid before the maceration or boil- 
 ing, in order to insure the appearance of the crystals ; 
 some advise the omission of the salt as being unneces- 
 sary and as liable to encumber the field with crystals 
 of chjoride of sodium ; these, however, can be easily 
 dissolved out by water, leaving the haemin crystals un- 
 touched. To preserve the crystals, they may be sealed 
 lip in acetic acid, or the surplus acid may be removed 
 and replaced by Tarrant's solution. 
 
 An alkaline solution of hsemin is dichroic, — brown 
 by transmitted, and olive-green by reflected light. 
 
 Teichmann's test has been shown to be liable to 
 considerable uncertainty, for the reason that spots of 
 
PERSONAL IDENTITY. 249 
 
 human blood, or even the fluid itself in appreciable 
 quantity, may faU to yield any haemin crystals what- 
 ever, or only such as are of so indefinite a character as 
 to be utterly worthless for diagnosis. Similar failures 
 have been found to follow attempts at bringing out the 
 polychroism of the blood, even in the hands of com- 
 petent observers. 
 
 , , In testing a suspected stain, where there is sufficient 
 material, the action of cold water upon the stain should 
 be particularly noted ; if the stain is recent and upon a 
 material incapable of chemical combination with any of 
 the constituents of the blood, it will be rapidly dis- 
 solved by the water, the solution becoming of a rich 
 red or brownish-red color ; if the stain is not fresh but 
 still comparatively recent, it is less rapidly dissolved 
 by the water and yields a solution of a dirty-brown 
 color ; if the stain is very old, it will be insoluble in 
 water, the hseraoglobin being completely changed into 
 hsematin. 
 
 The chemical testa for blood all have reference to 
 the action of reagents upon its coloring-matter. If the 
 stain be upon a fabric, cut a portion out and treat with 
 cold distilled water ; if upon a porous body, such as 
 wood, brick, etc., the stained part should be scraped off 
 for some depth, reduced to a fine powder, and digested 
 for a considerable time in cold distilled water. In 
 either case the liquid should be filtered, and both the 
 matter on the filtered paper and the filtrate preserved 
 for examination. If the stain is upon iron or steel, it 
 may be peeled or scraped off; the scrapings wiU con- 
 sist of a mixture of blood and iron. Digest them for 
 several hours in cold distilled water rendered sUghtly 
 
250 MEDICAL JUEISPRTIDENCE. 
 
 alkaline by ammouia, and should this fail to effect the 
 solution, a trace of citric acid may be used instead. 
 This solution should be filtered ; the iron, except a trace 
 of citrate where citric acid has been used, will be left 
 on the paper. The blood solution thus obtained may 
 be tested as foUows : — 
 
 a. Heat a small quantity in a test-tube to about 
 149° F ; with a blood solution three results will follow: 
 1. The red color is destroyed. 2. The solution is coagu- 
 lated. 3. A thick brown precipitate is produced, de- 
 pending in amount on the strength of the solution. 
 
 6. If this brown precipitate is present in quantity, 
 it should be collected upon a filter-paper, dried, and 
 heated with a weak ammonia solution, by which, if 
 blood, it will be soluble. The solution, if sufficiently 
 strong, will appear dark-green by reflected, and red by 
 transmitted light. 
 
 c. Where the stain has not been removed from a 
 steel blade, a tincture of galls added to the blood will 
 produce a red precipitate. 
 
 d. If the red solution be blood, upon the addition of 
 a very weak solution of ammonia the color will either 
 remain unchanged, or if changed will be slightly inten- 
 sified or reddened. 
 
 e. A solution of chlorine will effect no change on the 
 coloring-matter of the blood, if the chlorine solution be 
 but moderately strong. 
 
 /. Strong nitric acid wiU cause the blood solution to 
 become of a dirty-brown color. If the coagulated mass 
 is sufficient in quantity, heat with strong nitric acid, 
 when a clear yellow solution will be obtained. 
 
 g. If a solution of sodic hydrate, ten grains to one 
 
PERSONAL IDENTITY. 251 
 
 .ounce, be added to blood, a dark olive discoloration 
 results, which on treatment with excess of acetic acid 
 changes to red. 
 
 Guaiacum Test. — Wet the blood-stain with freshly 
 prepared tincture of guaiacum, and then add a small 
 quantity of an ethereal solution of hydroxyl; if the 
 stain is blood, a characteristic blue tint will be pro- 
 duced. If the material stained is of such a color as to 
 obscure the reaction, add the several reagents and after- 
 wards press the fabric between two pads of white 
 blotting-paper, when the blue color will be absorbed by 
 the paper. In this test the blue color results from the 
 oxidation of the guaiacum resin. It should be remem- 
 bered, however, that guaiacum is turned blue by a great 
 number of substances, such as gluten, milk, the fresh 
 juice of a variety of roots (such as horse-radish, col- 
 chicum, carrot, etc.) ; also by nitric acid, chlorine, the 
 chlorides of iron and mercury, copper and gold; the 
 alkaline hypochlorites, and a mixture of hydrocyanic 
 acid and sulphate of copper ; also by pus, saliva, and 
 mucus mixed with creosote or carbolic acid. 
 
 It will be observed that to all the foregoing tests 
 of the existence of blood, except the miscroscopic ex- 
 amination for blood-corpuscles, there are serious if not 
 fatal objections. Moreover, a larger quantity of the col- 
 oring matter of the stains is usually required for the sat- 
 isfactory performance of these tests than is usually foiind 
 to be present on the stains submitted for examination. 
 
 3. Spectrum Analysis. — By this test in the hands of a 
 competent observer, the existence of blood in very small 
 quantities may in many instances be determined with 
 great certainty. 
 
252 MEDICAL JURISPRtTDENCE. 
 
 The four most important spectra produced by blood 
 are the following : — 
 
 1. In the spectrum of ozyhaemoglobin the blue end 
 is darkened ; two absorption bands are visible in the 
 yellower half of the green, the band nearest the violet 
 end being about twice the breadth of the other band. 
 
 2. In the spectrum of deoxidized haemoglobin the 
 blue end is darkened but somewhat less than in the 
 case of oxyhaemoglobin ; a single broad absorption band 
 is visible in the green. 
 
 3. In the spectrum of blood after short exposure to 
 air (methaemoglobin or hsematin) the blue end is dark- 
 ened ; the two bands of oxidized haemoglobin are much 
 weakened, and a third band is visible in the red. 
 
 4. In the spectrum of reduced or deoxidized hsematia, 
 the blue end is darkened ; and two well-defined bands 
 are visible in the green, somewhat nearer the violet 
 than those of haemoglobin ; the band nearest the red 
 end is the narrower, but is intensely black, and has 
 exceedingly well-defined edges. The band nearer the 
 violet is nearly double the width of the other band, but 
 the edges are less distinct ; this band may possibly not 
 be seen in very weak solutions. 
 
 In the examination of a comparatively recent blood- 
 stain on a white fabric, where there is not a lack of 
 material, cut out a small piece of the stained fabric 
 and soak for a few minutes in a few drops of cold dis- 
 tilled water on a watch-glass; then squeeze out the 
 colored fluid and set the solution by, so that the insol- 
 uble matters may be deposited. Fill several experi- 
 mental glass cells, made of barometer-tubing, with the 
 solution. 
 
PERSONAL IDENTITY. 253 
 
 1. Examine the aqueous solution with the micro- 
 spectroscope, when, if the blood be tolerably fresh, the 
 spectrum of oxyhsemoglobin above described will be 
 apparent ; if such a spectrum is found it is certain that 
 the stain is tolerably recent. 
 
 2. Add to the solution in the cell, first, a trace of 
 ammonia, and then a minute fragment of the double 
 tartrate of potash and soda (Eochelle salt) ; so far no 
 change will appear. Now stir in a small piece of the 
 sulphate of iron and ammonia, with as little as possible 
 exposure of the solution to air, and cover the cell with a 
 cover-glass. The two absorption bands of oxyhsemoglo- 
 bin will now be replaced by a single intermediate band, 
 fainter kit broader than those previously existing, which 
 is the spectrum of reduced haemoglobin. The haemo- 
 globin thus reduced may be oxidized by exposure to the 
 air with vigorous stirring, and again deoxidized by fur- 
 ther addition of the iron salt. The reduction of the 
 haemoglobin may be effected spontaneously by merely 
 covering the solution over with a cover-glass and keep- 
 ing it for some time in the sealed cell. This deoxidation 
 and reoxidation of the haemoglobin constitutes a very 
 characteristic reaction, and serves to distinguish blood 
 from all other substances. 
 
 3. Stir into the solution in a cell a minute fragment 
 of citric acid, which will convert the haemoglobin into 
 haematin, when the bands of the oxyhemoglobin will 
 disappear; and if the solution be tolerably strong a 
 faint band will appear in the red. If an excess of am- 
 monia be now added the band in the red will disappear, 
 the original bands either not reappearing or, at most, to a 
 very slight extent. If now to the solution in the cell 
 
254 MEDICAL JURISPRUDENCE. 
 
 a very small particle of the double sulphate of iron and 
 ammonia be added, and the solution immediately covered 
 with a cover-glass, in a variable time, say about fifteen 
 minutes, the well-marked spectrum of reduced hasmatin 
 will appear, — the band at the red end being the first to 
 appear. If this solution of reduced hsematin be exposed 
 to the air and vigorously stirred, the oxidized haematin 
 band may often be restored ; and also, provided the con- 
 version of the haemoglobin in the first instance was 
 incomplete, the bands of oxyhsemoglobin. 
 
 The late Dr. Joseph G. Eichardson, of Philadelphia, 
 who has given great attention to this subject, recom- 
 mends the following method of examination where the 
 quantity of material is very small. He says : — 
 
 " Procure a glass slide with a circular excavation in the 
 middle, called by dealers a ' concave centre,' and rooisten it 
 around the edges of the cavity with a email drop of diluted 
 glycerine. Thoroughly clean a thin glass cover, about one 
 eighth of an inch larger than the excavation, lay it on white 
 paper, and upon it place the tiniest visible fragment of a 
 freshly dried blood-clot (this fragment will weigh from TisiTss 
 to ^-j^Tj^y of a grain). Then with a cataract needle deposit 
 on the centre of the cover, near your blood-spot, a drop of 
 glycerine about the size of this period (.), and with a dry 
 needle gently push the blood to the brink of your micro- 
 scopic pond, so that it may be just moistened by the fluid. 
 Finally invert your slide upon the thin glass cover in such a 
 mauner that the glyoerined edges of the cavity in the former 
 may adhere to the margins of the latter, and turning the 
 slide face upwards, transfer it to the stage of the microscope. 
 
 " By this method, it is obvious, we obtain an extremely 
 minute quantity of a strong solution of haBmoglobin, whose 
 
PERSONAL IDENTITY. 255 
 
 point of greatest density (generally in the centre of the clot) 
 is readily found under a \ inch objective, and tested by the 
 adjustment of the spectroscopic eye-piece. After a little 
 practice it will be found quite possible to modify the bands 
 by the addition of sulphuret-of-sodium solution, as advised 
 by Preyer. 
 
 " In order to compare the delicacy of my plan with that 
 of }ILr. Sorby, a spot of blood •^ of an inch square may be 
 made on a piece of white muslin, the threads of which 
 average 100 to the inch. When the stain is dry, ravel out 
 one of the colored threads, and cut off and test a fragment 
 as long as the diameter of the filament, which will of course 
 be a particle of stained fabric measuring yj^ of the mini- 
 mum-sized piece directed by Mr. Sorby. When the drop of 
 blood is old a larger amount of material becomes requisite, 
 and you may be obliged to moisten it with aqua ammonice, or 
 with solution of tartrate of ammonium and protosulphate of 
 iron ; but in the criminal case referred to, five months after 
 the murder I was able from a scrapi of stained muslin -^^ of 
 an inch square to obtain well-marked absorption bands, easily 
 discriminated from those produced by a solution of alkanet- 
 root with alum and those caused by an infusion of cochineal 
 with the same salt." 
 
 In the examination of old blood-stains and of blood- 
 stains on colored fabrics, Dr. Tidy recommends the fol- 
 lowing procedure : If the blood-stain be old, either citric 
 acid or ammonia (preferably the latter) should be used 
 for dissolving the coloring-matter. If the fabric be col- 
 ored, that reagent should be employed which possesses 
 the least action on the dye. If the stain, as sometimes 
 happens, be found insoluble in both ammonia and citric 
 acid, it should first of all be acted upon by ammonia, and 
 
256 MEDICAL JURISPEUDENCE. 
 
 a moderate heat afterwards applied. The solutions ob- 
 tained are then to be examined in the manner first above 
 described. 
 
 The presence of mordants frequently necessitates some 
 alteration of the procedure, the blood being very likely 
 to become incorporated with the mordant, especially 
 where the fabric has been wet ; in such case filtration or 
 allowing the subsidence of the deposit is equivalent to 
 removing the blood coloring-matter. The same details 
 must be carried out as above described and the turbidity 
 of the liquid overcome, not by removing the precipitate 
 but by increasing the intensity of the transmitted light 
 
 In the examination of stained fabrics that have been 
 'washed with water after staining, the blood will fre- 
 quently be found spread over a considerable surface. 
 In such case a large piece of material should be digested 
 with a proportionately large quantity of ammonia or of 
 citric acid, and the solution concentrated by evaporation 
 at a gentle heat, and examined with a micro-spectroscope 
 in the manner already described. In the examination 
 of the water used for washing stained garments or fab- 
 rics, it should first be concentrated ; if in such concen- 
 tration any deposit is formed, this should be carefully 
 collected, treated with ammonia, and heat applied if 
 it be insoluble while cold. 
 
 Where the stained fabric has been washed with soap 
 and water, the haemoglobin, by the action of the alkali, 
 will be found converted into hsematin; in such case 
 there wUl probably be little difficulty in detecting 
 blood on the fabric by ordinary means. Where it is 
 necessary to examine the soap-water itself, it should be 
 agitated with a large bulk of ether and the mixture 
 
PERSONAL IDENTITY. 257 
 
 allowed to stand until the ether has well separated. 
 The ether should then be removed with a pipette and 
 the residue again shaken up with fresh ether, and this 
 should be repeated until the aqueous solution is per- 
 fectly clear ; the solution remaining is to be concen- 
 trated and tested for blood in the usual manner. 
 
 Blood-stains on leather, or upon any substance con- 
 taining tannic acid, require special management on 
 account of the precipitation of the coloring-matter. In 
 such case the serum frequently soaks into the leather, 
 leaving the blood-corpuscles on the surface. Dr. Tidy 
 directs that in such case a fine slice be shaved off from 
 the stained portion of the leather, so that there may be 
 as much blood and as little leather as possible on the 
 shaving. Bend this shaving so that the stained side 
 only be brought into contact with water placed in one 
 of the glass cells already described. In this manner he 
 says that a solution of the blood coloring-matter may 
 probably be obtained. Dr. Sorby suggests, however, 
 that if the leather has been washed after the blood has 
 dried upon it, it wUl probably be impossible to obtain 
 the blood-spectra by this method. The following pro- 
 cedure in such case is said to work satisfactorily: — 
 
 Digest the stained leather in a mixture, by measure, 
 of one part of hydrochloric acid and fifty of water, for 
 twenty-four hours, which will effect a solution of the 
 mixed compound of the blood coloring-matter and tannic 
 acid ; the acid liquid is then to be poured off, but not 
 filtered. The solution may then appear almost color- 
 less, or of a slight yellow tint. To it add an excess of 
 ammonia, when the color will become either a pale pur- 
 ple or a neutral tint, the tint-shade being considerably 
 
 17 
 
258 MEDICAL JUJlISPEIJPJEjNCB. 
 
 intensified by the addition of the, ferrous salt and double 
 tartrate, which are now to be added. .The solution is 
 then to be examined in an experimental' cell under a 
 light sufficiently intense (such as. the lime-light or .direct 
 sunlight) to penetrate the turbid, solution, when the 
 spectrum of. deoxidized haematin will: become visible, 
 If the liquid be too turbid, to allow a. direct, ray from 
 the sun to be reflected througk ip, the cell should he 
 placed for a few minutes in a horizontal position so that 
 a little of. the deposit may subside; remembering, how- 
 ever, that the removal of the deposit destroys ,the inten- 
 sity of the spectrum, — the greater part of the haematin 
 existing as a compound insoluble in dilute acid, 
 
 In the examination of blood-stains on earth, digest the 
 stained earth for some hours in a considerable quantity 
 of ammonia; pour off and concentrate the solution, and 
 examine the turbid solution with an: intense light,, such 
 as the lime-light or idirect sunlight, AiSipular, process 
 should be adopted in the case of stained fabrics soiled 
 with earthy matters* 1 
 
 In conducting, micro-speotroscopic examinations, the 
 following general advice is given by Dr. Tidy: — 
 
 1. If the fabric on which the blood-stains. occur be colored, 
 the spectrum produced by the coloring-matter, extracted 
 from unstained portions of the fabric, should in the first 
 instance be examined. A little blood may be placed on an 
 unstained portion, and when dry eSamined with a spectro- 
 scope, the object being to determine at the outset the spec- 
 trum of the dye itself, and any possible interference likely 
 to result on the blood'-spectra. 
 
 2. The observer should on no account decide that an 
 observed spectrum from a suspected stain is due .-to. blood 
 
PERSONAL IDENTITY. 259 
 
 unless it exactly coinoides with, tha bands prodiieed by a 
 known solution of blood erf equal strength, treated in the 
 same inann&r. 
 
 3. The spectra should in all cases be examined, both by 
 daylight and by artificial light. , Direct, concentrated sun- 
 light,, pr the lime-light, should be tried \yheneyer the solution 
 ja tJjick and turbid. 
 
 4 Never be content with observing a single spectrum of 
 blood. Kemember, further, that it is often impossible to 
 obtain the unaltered blood-spectrum ; hence, never be sat- 
 isfied tha!t a stain is not blood until you. have failed to 
 obtain all the spectra produced by the action of appropriate 
 teagents.' 
 
 5. If the liquid under examination is too strong, so much 
 light will be cut off that the absorption-bands may be 6b- 
 Soui'ed; if the solution is too weak the bands will become 
 so faint that they are likely to be overlooked. Solutions of 
 several different stueugths should, if possible, be examined. 
 
 6i. Use excessively minute .quftntities of the several re- 
 agents. 
 
 7. Adjust tlie width of. the, slit of the spectroscope during 
 the examination. Absorption bands are best defined when 
 the sUt is very narrow. 
 
 8. In the present state of our knowledge, the micro- 
 spectroscope affords no information whatsoever whether the 
 blood comes from man or beast, or from what class of 
 animals it is derived. 
 
 As -to whether, other substances give spectra sim^ar to 
 those of .blood, Sorby says, of the spectrum of oxyhsemo- 
 globin : "I do not kuovir of .anyjbhing that gives exactly 
 the same, but there are some things wMcb give bands 
 so (far similar as to show the importaace of studying the. 
 effect of different reagents." 
 
260 MEDICAL JURISPRUDENCE. 
 
 A form of chlorophyll, from the petals of the red 
 variety of cineraria, gives two absorption bands which, 
 though dissimilar in relative width, are nearly similar 
 in position to those of oxyhaemoglobia "With ammonia, 
 however, the absorption bands of blood remain un- 
 changed, while those of cineraria are completely altered. 
 The reds of cochineal, lac-dye, alkanet, madder, and mwn- 
 jeet, dissolved in each case in alum, while somewhat 
 similar in their absorption bands to blood, are not, when 
 examined side by side with blood, likely to be mistaken 
 for it by the practised observer; all are changed by 
 ammonia, and all are bleached by potassic sulphite, 
 which has no action on blood. 
 
 Of all the tests for blood given in this connection, 
 the discovery of red blood-corpuscles by the microscope 
 and the micro-spectroscopic examination above described 
 alone seem to be without fallacy. In, the present state 
 of our JcTWwledge, hoivever, it is impossible to determine 
 whether a given specimen of Hood is or is not human. 
 
 Menstmal Blood. — In the case of blood-stains found 
 on the clothes of a female, the question may arise 
 whether or not the blood is menstrual. It has been 
 stated that menstrual blood contains no fibrin, is acid, 
 owing to its admixture with vaginal mucus, and that it 
 is invaribly associated with the pavement epithelium 
 derived from the vaginal waUs. Such pavement epi- 
 thelium, if existing, could readily be demonstrated by 
 microscopical examination; and this last peculiarity 
 might justify an inference as to the source of the blood; 
 but the observer would rarely, if ever, be justified in 
 stating a positive opinion as to the source of the blood 
 from a mere microscopical examination. 
 
CHAPTER XVII. 
 
 LIFE INSUKANCE. 
 
 Expectation of Life, Presumption of Death, etc. — A 
 discussion of the rules of law upon this interesting and 
 important subject would swell the size of this book 
 beyond its prescribed limits. We can, therefore, in 
 this connection, only refer to those topics which are of 
 special interest to the medical examiner, leaving the 
 legal discussion of the subject where it more properly 
 belongs, to professed treatises on the Law of Insurance. 
 
 Life Insurance is a contract by which, in considera- 
 tion of the payment by the insured to the insurers of 
 a certain sum of money called a premium, either in 
 quarterly, semi-annual, or yearly instalments or in a 
 gross sum, the insurers agree upon the death of the 
 assured, or upon his arrival at a certain age, or upon his 
 death before that time, to pay either to him, his execu- 
 tors, administrators, or assigns, a certain sum of money. 
 The insurance is sometimes effected for a limited num- 
 ber of years, payment of the sum assured to be made 
 only upon the death of the insured within that period. 
 Insurance is also effected by some companies against 
 partial or total disability by accident. 
 
 The writing evidencing this contract is called a policy. 
 The policy is based upon an application in writing made 
 
262 MEDICAL JUEISPBUDENCE. 
 
 by the assured, in which full information should be 
 given upon all questions affecting the risk, such as age, 
 occupation, habits, condition of health, disease, family 
 history, etc. The applicant for insurance is also re- 
 quired to submit to examination by a physician, or 
 physicians, as to his physical condition. The answers 
 to the questions propouiided by the agent or examiner, 
 as well as the statements made by him in his applica- 
 tion for insurance, are warranted by the applicant to 
 be true, and form the ■ basis of his contract with the 
 company. 
 
 Life insurance as a business is based upon the expec- 
 tation of Ufe. Various mortality tables have been from 
 time to time computedj^ — from the first by the astrono- 
 mer Edmund Halley, from a series of life-registers 
 during the years 1687-91, to the. present century. The 
 Actuaries', or Combined Experience Table was pub* 
 lished by Actuary Jenkin Jones in 1843, and was 
 based upon the recorded experience of seventeen life 
 companies in England, and was deduced from 62,537 
 assurances, under the superintendence of a committee 
 of actuaries. It is as follows : 
 
■.S. LIFE' INSURANCE. 
 
 263 
 
 COMBINED EXPERIENCE TABLE. 
 
 Age. 
 
 Expectation 
 of Lire. 
 
 Age. 
 
 Ezpect&tioa 
 of Life. 
 
 Age. 
 
 Expectation 
 of^ife. 
 
 •10 
 
 48.36 
 
 40 
 
 27.28 
 
 70 
 
 8.54 
 
 11 
 
 47.68 
 
 41 
 
 26.56 
 
 71 
 
 8.10 
 
 12 
 
 47.01 
 
 42 
 
 ' 25.84 
 
 72 . 
 
 7.67 
 
 13 
 
 403 
 
 43 
 
 25.12 
 
 73 
 
 7.26 
 
 14 
 
 45.64 
 
 ;44 
 
 24.40 
 
 '74 
 
 6.86 
 
 i 15 
 
 , 44.96 
 
 1.45 
 
 23.69 
 
 75 
 
 6.48 
 
 16 
 
 44.27 
 
 46 
 
 22.97 
 
 76 
 
 6.11 
 
 17 
 
 43.58 
 
 .47- 
 
 1 22.27 
 
 '77 
 
 5.76 ■ 
 
 18 
 
 42^8 
 
 48 
 
 21.56 
 
 78 
 
 5.42 
 
 19 
 
 42.19 
 
 49 
 
 20.87 
 
 79 
 
 6:.09 
 
 20 
 
 41.49 . 
 
 50 
 
 20.18 
 
 -80 
 
 , 4.78 ■ 
 
 21 
 
 40.79 
 
 51 
 
 , 19.50 
 
 81 
 
 4.48 
 
 22 
 
 40.09 
 
 52 
 
 1882 
 
 82 
 
 4.18 
 
 23 
 
 39.39 
 
 53 
 
 18.16 
 
 83 
 
 3.90 , 
 
 24 
 
 38.68 
 
 54 
 
 17.50 
 
 84 
 
 3.63 ' 
 
 -25 
 
 37.98 
 
 -55 
 
 16.85 
 
 85 : 
 
 3.36 
 
 26 
 
 37.27 
 
 56 
 
 16.22 
 
 86 
 
 3.10 
 
 27 
 
 36:5?' 
 
 -—57 - 
 
 16.59 ■ 
 
 '87 
 
 2:84 
 
 28 
 
 35.86 
 
 58 
 
 14-97 
 
 88 
 
 2.59. 
 
 29 
 
 35.15 
 
 59 
 
 14.37 
 
 89 
 
 2.35 
 
 30 
 
 34.43 
 
 60 
 
 13.77 
 
 90 
 
 2.11 
 
 31 
 
 33.72 
 
 61 
 
 13.18 
 
 91 
 
 1.89 
 
 ' 82 
 
 83.01 
 
 62 
 
 ■ 12;61 
 
 92 
 
 1.67' 
 
 83 
 
 82.30 
 
 63 
 
 12.05 
 
 98 
 
 147 
 
 34 ' 
 
 31.58 ■ 
 
 64 
 
 11.61 
 
 94 
 
 1.28 
 
 85 
 
 30.87 
 
 65 
 
 10.97 
 
 95 
 
 1.12 
 
 36 
 
 80.15 
 
 66 
 
 10.46 
 
 96 
 
 0.99 
 
 37 
 
 29.44 
 
 67 
 
 9.96 
 
 97 
 
 0.89 
 
 88 
 
 28.72 
 
 68 
 
 9.47 
 
 98 
 
 0.75 
 
 39 
 
 28.00 
 
 69 
 
 9.00 
 
 99 
 
 0.50 
 
264 
 
 MEDICAL JTJEISPRUDENCB. 
 
 The American Experience Table of Mortality is as 
 follows : — 
 
 Age. 
 
 Espeotation 
 ofLi&. 
 
 Age. 
 
 Expectation 
 oilAte. 
 
 Age. 
 
 Dxpectation 
 of Life. 
 
 10 
 
 
 38 
 
 29.62 
 
 57 
 
 16.05 
 
 20 
 
 42.20 
 
 39 
 
 28.90 
 
 68 
 
 16.39 
 
 21 
 
 41.63 
 
 40 
 
 28.18 
 
 59 
 
 14.74 
 
 22 
 
 40.85 
 
 41 
 
 27.45 
 
 60 
 
 14.09 
 
 23 
 
 40.17 
 
 42 
 
 26.72 
 
 61 
 
 13.47 
 
 21 
 
 39.49 
 
 43 
 
 25.99 
 
 62 
 
 12.86 
 
 25 
 
 38 81 
 
 44 
 
 25.27 
 
 63 
 
 12.26 
 
 26 
 
 38.11 
 
 45 
 
 24.54 
 
 64 
 
 11.68 
 
 27 
 
 37.43 
 
 40 
 
 23.80 
 
 65 
 
 11.10 
 
 28 
 
 36.73 
 
 47 
 
 23.08 
 
 66 
 
 10.64 
 
 29 
 
 36.03 
 
 48 
 
 22.36 
 
 67 
 
 10.00 
 
 30 
 
 35.33 
 
 49 
 
 21.68 
 
 68 
 
 9.48 
 
 SI 
 
 34.62 
 
 fiO 
 
 20.91 
 
 69 
 
 8.98 
 
 32 
 
 33.92 
 
 51 
 
 20.20 
 
 70 
 
 8.48 
 
 33 
 
 33.21 
 
 62 
 
 19.49 
 
 71 
 
 8.00 
 
 84 
 
 32.50 
 
 53 
 
 18.79 
 
 72 
 
 7.64 
 
 85 
 
 81.78 
 
 54 
 
 18.09 
 
 73 
 
 7.10 
 
 36 
 
 31.07 
 
 55 
 
 17.40 
 
 74 
 
 6.68 
 
 37 
 
 30.35 
 
 66 
 
 16.72 
 
 75 
 
 6.28 
 
 The expectation of life, that is, the number of years 
 on an average that a healthy person at a certain age 
 ■will live, excluding all persons under 25 and over 75 
 years of age, is represented by the formula of Willich; 
 as follows : — 
 
 x = f(80 — a). 
 
 In which x represents the expectation of life and a 
 the age of the person. 
 
 Medical Esamination. — The medical examination of 
 an applicant for an insurance should be made by a man 
 of skill and experience, and in by no means as superfi- 
 cial and perfunctory a manner as is usually the case. 
 
LIFE INSURANCE. 265 
 
 The scope of the examination will necessarily vary 
 somewhat according to the requirements of the different 
 companies, — some companies requiring an investigation 
 by the physician of the family history and a personal 
 medical history, as well as an investigation of the appli- 
 cant's personal condition. Assuming that it is the duty 
 of the examiner to make the more extended examination 
 above described, he should ascertain — 
 
 1. The family history of the assured, taking care that it 
 is stated clearly and fully, with no ambiguity of terms, 
 and no uncertainty or concealment. General and in- 
 definite statements by the assured regarding deaths 
 should be explained. Symptoms as effects of disease 
 should not be allowed to be stated in the place of the 
 diseases on which they depend. Particular inquiry 
 should be made regarding the following points in the 
 family record : Have there been two cases of apoplexy, 
 paralysis, heart disease or brain affection,^ or one of 
 each pathologically akin? Have there been two cases 
 of Bright's disease or cancer ? Have any two members 
 been insane ? Have the questions, relative to the final 
 illness of the members of the family who have died 
 been answered particularly as to duration and previous 
 health ? 
 
 2. The Applicant's personal medical History. — The 
 inquiry here should be directed to the point whether his 
 present and past condition warrants the belief that the 
 applicant will reach advanced age, aside from the acci- 
 dents and contingencies common to all. 
 
 ' For many of the rules here given for medical examiners, the author 
 is indebted to the printed rules prescribed by the Mutual Benefit Life 
 Insurance Company of New Jersey, to its medical examiners. 
 
266 MEDICAL JURISPEUDENCE. 
 
 B; The Applicant's personal Condition. — Is he sound 
 in body and mind? His habits as regards indulgence 
 in spirituous or malt liquors, opium, or tobacco, or in any 
 other stimulant or narcotici should be carefully investi- 
 gated, and the organs likely to be .injured by such indul- 
 gence carefully examined. The temperature should be 
 taken, and if thereibe heat of skin, it should be observed 
 before he is undressed. The physique and complexion 
 are important- facts in determining the character of the 
 riskjia flat chest; pigeonrbreast, protuberant abdomen, 
 local muscular atrophy,- disproportionate height and 
 weight, excessive height, stooping gait, curved spine, are 
 all serious evidences of impairment. Exact and not 
 approximate measurement should in every case be mada 
 The proper average relation between the height and 
 weight of an individual,: according to the tables pub-, 
 lished'by the Mutual Benefit life Insurance Company 
 of New Jersey and by the Mutual life Insurance Com- 
 pany of New York (the latter of which was compiled 
 by. Dr. Minturn Post and Dr. Isaac Kipp.from American 
 lives)r is as follows : — 
 
 Height. 
 
 5 feet 
 
 5 " 1 inch 
 
 5 " 2 •' 
 
 5 " 3 " 
 
 5 " 4 " 
 
 5 " 5 " 
 
 5 " 6 " 
 
 5 " 7 " 
 
 5 " 8 " 
 
 5 " 9 " 
 
 6 " 10 " 
 5 " 11 " 
 
 M. B. of N. J. 
 Weight. 
 
 120 pounds 
 
 124 " 
 
 M. L. of N. Y. 
 Weigbt. 
 
 pounds. 
 
 120 " 
 
 128 
 
 (( 
 
 125 
 
 »* 
 
 132 
 
 tt 
 
 130 
 
 tt 
 
 136 
 
 it 
 
 135 
 
 tt 
 
 140 
 
 it 
 
 140 
 
 tt 
 
 144 
 
 tt 
 
 143 
 
 tt 
 
 150 
 
 ft 
 
 145 
 
 if 
 
 156 
 
 tl 
 
 148 
 
 It 
 
 162 
 
 tt 
 
 155 
 
 tt 
 
 168 
 
 tt 
 
 160 
 
 *' 
 
 174 
 
 H 
 
 165 
 
 (( 
 
 180 
 
 tt 
 
 170 
 
 It 
 
LITE INSURANCE. 267 
 
 A Variation of 20 pounds at.5.feet and of 40 pounds 
 at 6 feet, and in the same proportion at intermediate 
 heights, will not be considered excessive. 
 
 The medical examiner should examine in turn — 
 
 1. The Nervous and Muscular Systems. 
 
 2. The Respiratory System. — ■ Too much attention 
 cannot be given to this ^head. Healthy respiration should 
 be quiety easy, in the- ratio of 1 to 4 or 5 beats of the 
 pulse and not exceeding 20 per minute in adults. The 
 chest should expand freely in all directions, — 'the muscles 
 of the neck and arm taking no visible part in the act of 
 breathing ; the respiratoiy murmur should be neither 
 harsh nor -noisy ; drawing a full breath and holding it for 
 a few seconds should <!ause no distress; an adult should 
 be able to count aloud rather slowly from 20 to 30 with- 
 out drawing fresh breath ; if the blood be^ weU aerated, 
 the lips, ears, and tips of the fingers should present no 
 appearance of : a purple or livid hue. In conducting the 
 examination of the respiratory and circulatory systems 
 the clothes should be removed from the chest, and as 
 much care should be exercised in making the examina- 
 tion as if the physician intended to prescribe for the 
 applicant as a patient. 
 
 3. The Circulatory System. — The condition of the 
 heart should be particularly examined. The pulse 
 should be regular and not jerking, and neither too com- 
 pressible hot too hard ; its beat should be about 4 or 5 
 to each respitation, and in the case of the adult, sitting, 
 should not be below 65 or 70, nor above 80 per minute, 
 although there are very exceptional cases of very slow 
 or v^ry rapid- pulse with good health. Change of posture 
 should not make any greater difference than about 10 
 
268 MEDICAL JURISPRUDENCE. 
 
 beats per minute. The pulse of the female is shgttly 
 more rapid, as a rule, than that of the male sex, — the 
 average number of beats per minute of a healthy female 
 being 75, while that of a male is 70. In infancy the 
 average number of beats per minute is from 120 to 100 ; 
 childhood, 100 to 90 ; youth, 90 to 75 ; middle age, 75 
 to 65 ; old age, 70 to 60 ; decrepit age, 75 to 80. 
 
 The beats of the heart should be clear and unattended 
 with any murmur, blowing or rubbing sounds ; the first 
 sound should be louder, longer, and lower pitched ; the 
 apex beat of the heart should be in the fifth interr 
 costal space, f of an inch within and about 1^ inches 
 below the left nipple, and the impulse while plainly 
 perceptible should neither be jerking nor too widely 
 diffused. 
 
 Diseases of the heart have practically only two termi- 
 nations : (1) sudden death, which is the common end- 
 ing of fatty and brown degeneration, dilatation and 
 atrophy, aortic regurgitation, disease of the coronary 
 arteries, etc. ; and (2) dropsy, which is a common 
 ending to most forms of diseases of the heart and its 
 appendages. 
 
 4. The Digestive System. — Other things being equal 
 those who have good digestion will live the longest, bear 
 the most fatigue, and can best endure the risk of heat and 
 cold, and exposure. Chronic alcoholism makes a decided 
 impression upon this system. In making this exami- 
 nation the state of the tongue and mucous membrane 
 of the mouth, the appetite, regularity of the bowels, 
 presence or absence of symptoms of dyspepsia, size of the 
 liver, color of the skin and conjunctiv£e, etc., should be 
 principally noted. 
 
LIFE INSURANCE. 269 
 
 5. The Qenito-urinary System. — Although an exami- 
 nation of the urine is not required by all companies, it is 
 hy some, and by others where the amount insured exceeds 
 a certain sum. In our judgment no medical examina- 
 tion even approximates to completeness without an ex- 
 amination of the urine. The manner of conducting this 
 examination is not within the scope of this work. When 
 made, the examination should be microscopical as well 
 as chemical. 
 
 Even when the rules of the company do not require 
 it, certain symptoms may suggest its necessity. The 
 following are bad indications and suggest special in- 
 quiry : oedema of the eyelids, backs of the hand, dor- 
 sum of the feet, scrotum and vulva ; nocturnal micturi- 
 tion ; lumbar pains ; dysuria ; presence in the urine of 
 albumen, sugar, pus, blood, cancer-cells, epithelial and 
 other tube casts from the kidneys, etc. As regards the 
 genital organs, sexual incapacity in males is an early 
 symptom of many neuroses ; and in females, the uterus 
 and ovaries are favorite seats respectively of cancer and 
 of cystic disease. In the male, stricture of the urethra, 
 followed as it often is by grave seguelce, is to be regarded 
 as an element of danger. 
 
 In making a medical examination for the purposes 
 of insurance much must of necessity be left to the 
 judgment of the examiner; and to undertake to give 
 detailed directions would in most instances be entirely 
 unnecessary ; only a few general hints have been here 
 attempted. The examiner, besides the mere personal 
 examination of the applicant, should always bear in 
 mind the influence of habits, place of residence, occu- 
 pation, climate, etc., on the duration of life. 
 
270 MEDICAL JUEISPRtJDENCE. 
 
 The influence of pregnancy and child-bearing is. im- 
 portant in the case of women. While very few women 
 die while actually in a state of pregnancy, it must not 
 be assumed that pregnancy is a shield for any longer 
 period than that of actual gestation. Again; a consider- 
 able number of women die during: confinement; of 
 10,382 women confined for the first time, 168 orione in 
 every 62 died ; while of 26,394 multiparae, 213 or one in 
 every 124 died. There can be no doubt that much of 
 this mortality was due to ignorance and carelessness ; but 
 so long as ignorance and carelessness are possible, they 
 must be taken into account in determining the nature 
 of the risk when application is made for insurance. 
 
 Presumption of Death. ^ Where by a policy of insur- 
 ance the sum insured is payable at death, the burden of 
 proving the death of course rests with the administra? 
 tors, executors, or those benefited by the death. Death, 
 being proved, is to be regarded as due to natuial' causes 
 unless the contrary is shown. By the common law, after 
 the lapse of seven years without intelligence concerning 
 the person the presumption of life ceases, and the burden 
 of proof is devolved on the other party : Upon an issue 
 of the life or death of a party, however, the jury may 
 find the fact of death from the lapse of a shorter period 
 than seven years, if other circumstances concur,^ as, if 
 the party sailed on a voyage which should have long 
 since been accomplished and the vessel has not been 
 heard from ; but the presumption of the common law, 
 independent of the finding of the jury, does not attach 
 to mere lapse of time short of seven years, unless letters 
 of administration have been granted on his estate within 
 that period, which is in such case a conclusive proof of 
 
LIFE INSUKANCE. 271 
 
 his death. Although the presumption, of l^fe ceases at 
 the expiration of seven years iipu). the periqd, at ■which 
 the person is last heard from, in thejabsence of proof it 
 will not be presumed that the death occurred at any 
 particular time prior to the lapse, of the seven years. 
 In order to warrant such a presumption there ipust be 
 evidence other .than tihe mere absence of j the party ^i^ithr 
 out being heard from. 
 
 It is said to be the practice.ofjpsurance companies 
 in the case of the absence, unheard-pf of the assured for 
 a considerable time under circumstances leading to 
 the beUef of ,bis death, to pay the policy after ,the lapse 
 of a year or two, in the absence of, any suspicious 
 eireumstances. 
 
 t^resumption of Survivorship. — Most treatises upon 
 aiedical jurisprudence contain more or less discussion 
 upon . this subject, nearly all c(f which has no applica- 
 tion whatever to the administration of justice in conrts 
 where the . common law prevails. .Where the succession 
 to an estate is concerned, the question which of two, 
 persons is to be presumed the survivor where both per- 
 ished in the same calamity,, but where the circumstances 
 of their death is unknown, is by. the common law a 
 inatter to be determined by the evidence, no positive 
 rule being laid down upon the .subject. These . ques- 
 tions are not to be.; decided by mere pj:es,umption, but 
 are to be tried as they arise,, like .other questions of fact. 
 Courts of probate, equity, and law, alike refuse to pre- 
 sume simultaneous death or survivorship in the absence 
 of evidence. This question has been considered in the 
 Eoman law and in several other codes; for the full 
 statement of the rules of the Eoman law upon this 
 
272 MEDICAL JURISPRUDENCE. 
 
 subject, and of those codes which have in this respect 
 followed the Eoman law, see 1 " Greenleaf on Evidence," 
 sec. 29 et seq. ; and 1 " Tidy's Legal Medicine," page 383 
 et seq. 
 
 Insanity and Suicide. — The subject of insurable in- 
 terest and the legal effect of certain conditions to be 
 found in most life policies, the effect of concealment of 
 facts material to the risk, etc., while matters of great 
 interest and importance, do not properly come within 
 the scope of a work on Legal Medicine, but are more 
 properly considered in legal treatises upon Insurance. 
 
 Most policies contain pro^fisions relating to the effect 
 of suicide, providing for the most part that the policy 
 shall be void if the insured commit suicide or shall die 
 by his own hand, whether sane or insane. Much hti- 
 gation has arisen as to the effect of such clauses, but 
 the questions discussed in the recorded cases are ques- 
 tions of law rather than of medicine, and do not come 
 within the scope of this work. If a person is found 
 dead, questions may occur under some policies which 
 will require the aid of the medical jurist in determining 
 whether the death was natural, accidental, suicidal, or 
 homicidal. The burden of proof that the death was 
 not natural would seem to rest with the insurers, and 
 the mode and cause of death, when the question arises, 
 is to be determined upon principles discussed in other 
 chapters. It may be stated in passing, that it is well 
 settled that suicide is not proof of insanity. See post, 
 chapter upon Insanity. 
 
CHAPTEE XVIIL 
 
 FEIGNED, FACTITIOUS, AND LATENT DISEASES. 
 
 Definitions. — A feigned disease, strictly so called, is 
 one whicli is altogether fictitious. 
 
 A factitious disease is one which is wholly produced 
 by the patient, or at least with his connivance. 
 
 A latent disease is a real disease which presents little 
 or no outward manifestation during life, and is only de- 
 tected on inspection after death. 
 
 To this classification some writers add exaggerated 
 diseases, or those which, existing in some degree or 
 form, are pretended by the party to exist in a greater 
 degree or a different form ; and aggravated diseases, or 
 those which originate in the first instance without the 
 person's concurrence, and are intentionally increased 
 by artificial means. 
 
 1. Feigned diseases are simulated from a variety of 
 motives, such as avoidance of military and naval service, 
 the obtaining of a pension, escape from imprisonment 
 or other punishment, obtaining alms from the charita- 
 ble, obtaining damages in courts of law for simulated 
 injuries alleged to have been received in railway acci- 
 dents, and from many other motives too numerous to 
 mention. 
 
 18 
 
274 MEDICAL JURISPRUDENCE. 
 
 Simulated insanity will be considered in another con- 
 nection. Feigned poisoning will be considered under 
 Toxicology. Pretended delivery has already been re- 
 ferred, to. 
 
 The diseases best adapted for the purpose of simula- 
 tion are those of a chronic kind, in which the symptoms 
 are purely subjective and produce no apparent disturb- 
 ance of the system, and consequently call for less seK- 
 denial on the part of the simulator ; and owing to their 
 existence resting mainly on the veracity of the patient, 
 are less easily proved to be simulated. Although cases 
 of simulation are more often met with in the army and 
 navy, they are not unfrequently encountered in hospital, 
 dispensary, and private practice. 
 
 The consideration of this subject must necessarily 
 consist principally in the narration of particular cases, 
 many of which are to be found in the larger treatises on 
 Medical Jurisprudence. A few only will be stated in 
 this connection. 
 
 Dr. Ogston relates the case of a beggar in Aberdeen, 
 who simulated elephantiasis very successfully. The pre- 
 tended swelling was confined to one leg below the knee, 
 and was produced by padding; to. favor the deceit, part 
 of the leg was covered with gold-beater's-skin, and 
 exposed by drawing down his stocking two or three 
 inches. 
 
 Epilepsy is a disease frequently simulated by beggars ; 
 and next to that, according to Ogston, the loss of an 
 arm. To give color to a feigned attack of epilepsy, a 
 ligature around the neck has been applied to induce 
 reddening of the face ; soap in the mouth to imitate 
 froth about the lips, and the gums have been pricked 
 
FEIGNED DISEASES, ETC. 275 
 
 to give the tongue the appearance of having been bitten. 
 It would be impossible, in such cases, for the impostor 
 to imitate the iixing or twitching of the eyeballs, the 
 insensibility of the pupils, the peculiar perturbation of 
 the heart, rigidity of the muscles, and the insensibility 
 of the skin and mucus outlets; while the prodromata 
 and the sequelae of the attack, if ascertainable, would 
 assist further in determining the nature of the suspected 
 simulation. 
 
 Eeal epilepsy often offers considerable variety in its 
 character, — one attack being a mere momentary loss of 
 consciousness (le petit mal), while another may consist of 
 the most violent convulsions (le grand mal). Impostors 
 usually simulate the severer type, with the peculiar cry, 
 falling down, struggling, lividity, frothing at the mouth, 
 etc. ; but they often omit to feign any of the sequelae of 
 true epilepsy. Many such cases have been unmasked 
 by threats, or by quietly bringing some sharp or hot 
 siibstance into contact with some part of the body. 
 Galmeil is said to have detected a simulator, who fell 
 in a pretended fit on a heap of straw in the street, by 
 ordering the straw to be set on fire. 
 
 The true epileptic usually falls forward, and thus 
 frequently injures his nose, forehead, chin, or cheeks. 
 As he falls he is deadly pale, not red ; tonic convulsions 
 immediately begin, the trunk muscles being nearly 
 always affected as well as the others; the muscular 
 rigidity is not to be overcome, or only with great diffi- 
 culty : once overcome, the muscles remain flaccid until 
 some time after, or until another fit sets in ; the face 
 only reddens after a time, and then the veins of the 
 neck swell, etc. Then clonic convulsions set in; the 
 
276 MEDICAL JURISPRUDENCE. 
 
 pupils are usually dilated and refuse to contract under 
 the stimulus of a strong light ; the sense of smell is also 
 abolished, and. strong aqua ammonise may be held to the 
 nose with impunity. The attack is succeeded in severe 
 cases by torpor, drowsiness, and confusion of mind, 
 which last for some hours, and the patient is left very 
 weak. Impostors usually, as in insanity, overact their 
 part; their contortions are too violent, and they mix up 
 all the stages of the complaint, usually disregarding the 
 sequelae. 
 
 Deafness and dumbness are very frequently simulated, 
 as well as neuralgiai spinal irritation, muscular debihty, 
 spasms, paralysis, contraction of joints, and rheumatism, 
 — all of which demand no great self-denial, and but 
 little cunning on the part of the simulator. In dumb- 
 ness, impostors seldom attempt more than ceasing to 
 speak, and in paralysis, ceasing to move about ; in both 
 cases the sudden development and confirmed state of 
 the alleged disease from the outset should excite suspi- 
 cion. Dr. Ogston relates the case of a prisoner in the 
 Aberdeen jail who pretended sudden and total deafness, 
 and whose imposition was detected by dropping at his 
 back a huge bunch of keys from a high window, without 
 his being at all startled or taking any notice of it ; while 
 the same thing, done in a case of congenital deaf-mutism, 
 caused the prisoner to start in alarm and look around 
 in all directions except that from which the sound or 
 impulse had come. 
 
 True deaf-dumbness occurs only in congenital cases. 
 The Abb^ Sicard is said to have detected one impostor 
 by noticing that his spelling of written words was pho- 
 netic. Feigned deafness may sometimes be detected by 
 
FEIGNED DISEASES, ETC. . 277 
 
 • 
 
 the exercise of a little pious fraud. Dr. Taylor records 
 one case where a pauper, feigning deafness, was detected 
 by the production of a case of surgical instruments 
 during the conversation of the two surgeons regarding 
 the immediate performance of an operation upon him. 
 Some startling statements may be whispered, the coun- 
 tenance, pulse, etc., of the supposed simulator being 
 watched meanwhile. 
 
 Haemoptysis has frequently been mimicked by first 
 swallowing the blood of animals and ejecting it in the 
 presence of witnesses. 
 
 Scurvy has been imitated by irritating and pricking 
 the gums. 
 
 The unhealthy hue or yellowness of the skin in 
 chronic dyspepsia, jaundice, and hepatitis, has been 
 simulated by the use of emetics and purgatives, by the 
 use of skin dyes, or by the natural or acquired facility 
 of ejecting the contents of the stomach at pleasure. 
 
 The appearance of amaurosis has been imitated by 
 the application to the eye of belladonna, hyoscyamus, 
 or atropine to insure the dilatation and insensibility of 
 the pupils. A thorough knowledge of ophthalmic medi- 
 cine and surgery and some acquaintance with optics are 
 necessary in order to detect some clever impostors. An 
 ophthalmoscopic examination will here prove of great as- 
 sistance ; the use of atropine for the purpose of paralyz- 
 ing the accommodation will often be necessary, when it 
 wiU be frequently found that the pretender of myopia or 
 near-sight cannot see the test types with concave lenses 
 which would suit a real sufferer, and the reverse, 
 i'eigned double vision may usually be detected by col- 
 ored glasses and the use of prisms. The simulation of 
 
278 MEDICAL JURISPRUDENCE. 
 
 • 
 complete blindness is the most difficult of exposure. 
 Pretended blindness of one eye may often be detected 
 by a prism, placed base upwards or downwards before 
 the sound eye, the double vision produced furnishing 
 the req^uired proof. 
 
 Contraction and rigidity of the large and small joints 
 are often affected by soldiers and beggars ; and some 
 color is occasionally given to the imposture by keep- 
 ing the limb at rest by bandages till some stiffness 
 and wasting of the muscles ensue; a feigned dieases 
 may thus occasionally be converted into a factitious 
 one. 
 
 Simulated nervous diseases, such as hemiplegia, para- 
 plegia, catalepsy, etc., may frequently be detected by 
 the intelligent use of electricity ; in such cases the tem- 
 perature, change of nutrition, reflex movements, pecu- 
 liar eruptions, etc., if they exist, may throw light on 
 the solution of the question. 
 
 As most impostors have little or no knowledge of 
 many of the diseases which they simulate, the simula- 
 tion can often be detected by the patient's enumerating 
 incompatible, improbable, or impossible symptoms. 
 
 An accurate knowledge of the symptoms, course, and 
 pathology of disease, with watchfulness and attention to 
 the surrounding circumstances, and a few simple tests 
 such as will suggest themselves to the intelligent practi- 
 tioner, will in most cases disclose the fraud. The 
 resources of medical art have of late years been so in- 
 creased by the thermometer, microscope, ophthalmo- 
 scope, stethoscope, laryngoscope, electrical apparatus, 
 sphygmograph, etc., that the exposure of fraud is now 
 much easier than it once was. 
 
FEIGNED DISEASES, ETC. 279 
 
 Many amusing instances of the exposure of attempted 
 simulations are to be found in the books. Thus, Pard 
 mentions a beggar who had introduced a long piece of 
 bullock's gut into his rectum in order to imitate 'pro- 
 la'pms ani; from the bowel which was filled with a 
 mixture of blood and milk, he had learned to press out 
 drops at pleasure. A kick from the foot of the in- 
 spector made the gut tumble out and disclosed the 
 imposture. 
 
 For further cases the reader is referred to the larger 
 treatises of Taylor, Ogston, and other writers. 
 
 2. Factitious Diseases. — Scrofulous and other sores, 
 stiffening and contraction of the joints, fistula in ano, 
 (ypMhalmia, cutaneous eruptions, and many other ail- 
 ments are included in this category. Sores have been 
 produced in the neck simulating scrofulous ulcers, by 
 the use of escharotics, and the deceit strengthened by 
 the application of the juice of euphorbium to favor the 
 swelling and redness of the eyelids, nose, and lips. 
 
 Inflation of the scrotum to simulate hydrocele, or of 
 the areolar tissue elsewhere to resemble oedema, would 
 only deceive a novice. (Edema has been produced by 
 ligatures. There are recorded instances of pretenders 
 having so overdone their parts in this respect as to pro- 
 duce gangrene of the arm or leg. 
 
 Diarrhoea and dysentery have been simulated by 
 taking strong cathartics. 
 
 Ophthalmia may be produced artificially by the appli- 
 cation of various irritants to the eye. 
 
 Various cutaneous affections have been successfully 
 imitated by the use of a variety of irritants applied to 
 the skin. 
 
280 MEDICAL JTJBISPKUDENCE. 
 
 Tinea capitis has been imitated by the application of 
 nitric acid to the scalp, previously protected by some 
 fatty substance. 
 
 This list might be very much lengthened, but enough 
 has probably been said upon this subject. 
 
 In the ezaminatioii of cases of both suspected ficti- 
 tious and factitious diseases, the inspector should be 
 well acquainted with the disease simulated and with 
 the means which may be resorted to for producing the 
 appearance of morbid actions or discharges. The his- 
 tory of the person will often throw light upon the ques- 
 tion ; the suspected impostor should be encouraged to 
 give full accounts of the origin, progress, duration, and 
 symptoms of his disease; to do this correctly wHl in 
 the majority of cases require more knowledge than is 
 possessed by a non-medical man. 
 
 Anaesthetics will sometimes assist in unmasking a 
 fraud ; in cases of doubt, however, it is more charitable 
 to assume for the time being that the patient's state- 
 ments are true than to run the risk of mal-treating or 
 neglecting a case of real disease. The possibility of 
 latent disease in a person supposed to be an impostor, 
 should also be borne in mind. 
 
 See an interesting case narrated by Dr. Ogston, on page 
 340 of his excellent work on Medical Jurisprudence. 
 
 3. Latent Diseases. — It is a fact well known to physi- 
 cians that many disorders, even those of which the 
 presence is commonly indicated by well-marked symp- 
 toms, may in particular cases present, throughout the 
 whole or a greater part of their course, a material 
 deficiency or total absence of their usual external char- 
 acters or symptoms ; and on this account they are 
 
FEIGNED DISEASES, ETC. 281 
 
 frequently confounded with other diseases, or entirely 
 escape observation. As stated by Sir Kobert Christi- 
 son, nothing is more common in the practice of medical 
 jurisprudence than for the expert to find his opinion 
 and conduct embarrassed by sudden death arising in 
 the like circumstances, by the discovery of appearances 
 in the dead body adequate, apparently, to account for 
 death, yet unconnected with any traces of the existence 
 of corresponding disease during life. 
 
 In the list of latent diseases. Sir Eobert Christison 
 enumerates (with perhaps some latitude in the use of 
 the term latent) apoplexy, cerebral meningitis, cerebral 
 inflammation, pleuritis, pneumonia, pneumothorax, pul- 
 monary tubercle, diseases of the great vessels within 
 the chest, such as aneurism, and affections of the abdo- 
 men and spine. 
 
 Dr. Ogston remarks that the term "latent disease" 
 applies with most force to such diseases as cerebral 
 meningitis, softening of the cerebral lobes of the brain, 
 and abscess in its substance; instances of which he 
 says he has encountered in practice where no complaint 
 of illness was made until within a few hours, or days at 
 most, of the fatal event. 
 
 Some fatal diseases of the heart, aneurisms of the 
 large vessels, and apoplexy most nearly approach what 
 may be called strictly latent diseases. 
 
 A full consideration of this interesting subject would 
 occupy too much space; for further particulars the 
 student is referred to Dr. Ogston's work and to standard 
 treatises on the Practice of Medicine. 
 
CHAPTEE XIX. 
 
 MALPRACTICE. 
 
 Malpractice may be considered under two heads: 
 civil, and criminal. 
 
 1. Civil Malpractice. — The gist of an action for civil 
 malpractice is negligence. The rules of law governing 
 this important subject are well stated by Judge Cooley 
 in his work on Torts. We cannot do better than quote 
 his language: — 
 
 " As the promise is not different in the case of the physi- 
 cian and surgeon from what it is in the case of the attorney, 
 BoHcitor, and proctor, one general rule may be given which 
 will apply to all. 
 
 " The English authorities are, perhaps, somewhat more 
 indulgent to the faults and mistakes of professional men 
 than are those of this country. Thus, Lord Campbell, with 
 the full concurrence of his associates in the House of Lords, 
 declared that in order to maintain an action against one's 
 legal adviser, it was necessary, ' most undoubtedly, that the 
 professional adviser should be guilty of some misconduct, 
 some fraudulent proceeding, or should be chargeable with 
 gross negligence or with gross ignorance. It is only upon 
 one or the other of these grounds that the client can main- 
 tain an action against the professional adviser.' 
 
 " On the other hand the rule is laid down in Pennsylvania 
 that the professional man must bring to the practice of 
 
MALPRACTICE. 283 
 
 his profession a degree of skill and diligence such as those 
 ' thoroughly educated in his profession ordinarily employ.' 
 This is a severe rule, and fixes a standard of professional 
 skill and attainments which, in the newer portions of the 
 country, would be quite out of the question. In New Hamp- 
 shire the undertaking of the practitioner has been stated in 
 the following language : ' By our law a person who offers his 
 services to the community generally, or to any individual, 
 for employment in any professional capacity as a person of 
 skill, contracts with his employer : 1. That he possesses 
 that reasonable degree of learning, skill, and experience which 
 is ordinarily possessed by the professors of the same art or 
 science, and which is ordinarily regarded by the community 
 and by those conversant with that employment as necessary 
 and sufficient to qualify him to engage in such business. 
 2. That he will use reasonable and ordinary care and dil- 
 igence in the exertion of his skill and the application of his 
 knowledge to accomplish the purpose for which he is em- 
 ployed. He does not undertake for extraoi'dinary care or 
 extraordinary diligence, any more than he does for uncom- 
 mon skill. 3. In stipulating to exert his skill and apply his 
 diligence and care, the medical and other professional men 
 contract to use their best judgment.' This is believed to be 
 an accurate statement of the implied promise. The practi- 
 tioner must possess at least the average degree of learning 
 and skill in his profession in that part of the country in 
 which his services are offered to the public ; and if he exer- 
 cises that learning and skill with reasonable care and fidel- 
 ity, he discharges his legal duty." 
 
 A physician possessing a reasonable degree of learning 
 and skill, and exercising according to his best judgment 
 reasonable and ordinary care and diligence, is not liable 
 for a mere error of judgment in advising a particular 
 
284 MEDICAL JURISPRUDENCE. 
 
 remedy about whicli there is a difference of opinion. 
 To hold a physician liable for every error of judgment 
 made in the ordinary course of practice would be to 
 debar him from the exercise of his profession, and to 
 deprive the public of the benefit of valuable service. 
 The la'w does not require infallibility. A medical man 
 cannot, as a rule, be held guilty of negligence for not 
 employing any particular remedy, since, as a rule, there 
 is never any one specific remedy in the use of which all 
 authorities are agreed. If it could be shown, however, 
 that all authorities agreed that a particular drug should 
 be used in a particular case, as, for example, a certain 
 antidote in a case of poisoning, the failure to employ 
 such specific would probably constitute actionable 
 negligence. 
 
 A physician may decline a case, but having once 
 undertaken it, he must continue his services, even if 
 gratuitous, untU a reasonable time has been given the 
 patient to procure another physician ; where his services 
 are not gratuitous, he has no right to desert a patient 
 without reasonable cause before the end of the illness 
 he has undertaken to treat. 
 
 As respects voluntary services, Judge Cooley lays 
 down the rule thus : " Where friends and acquaintances 
 are accustomed to give, and do give, to each other vol- 
 untary services without expectation of reward, either 
 because other assistance cannot be procured, or because 
 the means of parties needing help will not enable them 
 to engage such as may be within reach, the law will not 
 imply an undertaking for skill, even when the services 
 are such as professional men alone are usually expected 
 to render. And where there is no undertaking for skill, 
 
MALPRACTICE. 285 
 
 the waut of it can create no liability. So the • street 
 opinion' of an attorney, given in answer to a casual 
 inquiry by one to whom he holds no professional rela- 
 tion, cannot, however erroneous, render him liable. 
 But when one holds himself out to the public as hav- 
 ing professional skill, and offers his services to those 
 who accept them on that supposition, he is responsible 
 for want of the skill he pretends to, even when his 
 services are rendered gratuitously." Under such cir- 
 cumstances, the one who undertakes the treatment of a 
 patient, either voluntarily or upon request, is only liable 
 for gross negligence; but if by forcing himself into a 
 case he excludes a competent physician, he is liable for 
 slight negligence, or for lack of the skill and diligence 
 of the specialist. In general it may be said that the 
 hability of one rendering medical services is measured 
 by the amount of skill he undertakes to exercise ; and, 
 as we have seen, the matter of compensation is 
 immaterial. 
 
 A physician must always use his best judgment; 
 and while he is not responsible for mere errors of 
 judgment or mere mistakes in matters of reasonable 
 doubt and uncertainty, if the error of judgment is so 
 gross as to be inconsistent with the use of the degree 
 of skQl required by the law he will be liable to an 
 action. Where errors of judgment result from the want 
 of ordinary care and skill, responsibility attaches, how- 
 ever carefully the judgment is exercised. In exercis- 
 ing his best judgment th.e physician is only required 
 to anticipate the nature and probable consequences of 
 his treatment. It has been held that he cannot be 
 held responsible for the disastrous effect resulting from 
 
286 MEDICAL JURISPRUDENCE. 
 
 administering chloroform as an anaesthetic to a patient 
 of a peculiar temperament where such peculiarity was 
 unknown to him ; but in view of the many fatal cases 
 resvilting from the use of chloroform, and the fact of 
 the uncertainty of its action in this respect, and the 
 further fact that there are other efficient anaesthetics, 
 which are safe as compared with chlorofonn, we cannot 
 see how at the present time a physician or surgeon can 
 justify himself in the use of chloroform under ordinary 
 circumstances. We do not now refer to the careful ad- 
 ministration of chloroform in obstetric cases, nor where 
 the patients are children; there may be some other excep- 
 tional cases where its use will be justified. Its adminis- 
 tration without a previous careful physical examination 
 of the patient, or its administration by a dentist with- 
 out the assistance of a competent physician, and to a 
 patient in an upright position, seems clearly culpable. 
 Common prudence would also require that neither it nor 
 any other anaesthetic should be administered without 
 the aid of a competent assistant. 
 
 A physician cannot lawfully try experiments upon 
 his patients to their injury. 
 
 One who professes to adhere to a particular school 
 of practice must come up to its average standard, and 
 must be judged by its tests and in the light of the 
 present day. 
 
 As to the mode of treatment in a given case, when it 
 conforms to the settled practice of the particular school 
 to which the physician belongs he is relieved from all 
 responsibility ; in such case, evidence of the practice of 
 physicians of other schools is inadmissible. Where, 
 however, the case will admit of but one mode of treat- 
 
MALPRACTICE. 287 
 
 ment, the use of a different mode would be evidence tend- 
 ing to show a want of skUl. The proper and only mode, 
 however, of showing want of skill on the part of the de- 
 fendant is by proving that he did not exercise it in the 
 particular case. It can neither be established nor dis- 
 proved by showing the defendant's general professional 
 reputation; it is improper, therefore, to ask a witness 
 what the reputation of the physician is in the commu- 
 nity and among the profession as being an ordinarily 
 learned and skilful physician. The treatment of each 
 individual case is the criterion for ascertaining the phy- 
 sician's liability. It has been held, also, that the gen- 
 eral opinion of the practitioner with whom the physician 
 studied his profession, or of the professors of the school 
 at which he graduated, are inadmissible. 
 
 A sign, or other proof that one actually practises 
 medicine or surgery, is prima facie evidence of his pro- 
 fessional character. The possession of a medical diploma, 
 issued by a college having authority to grant degrees in 
 medicine, is prima facie evidence of ordinary skill. 
 
 The mere fact that the defendant refused consultation 
 with other men of his science is no assumption upon his 
 part that he is possessed of more than ordinary skill ; 
 and his declination in this respect does not vary the 
 application of any of the rules above stated. 
 
 As to the proof of the alleged malpractice, it has 
 been held that the limb upon which the alleged mal- 
 practice occurred cannot be exhibited to the jury after 
 the lapse of several years. 
 
 It is the duty of the patient to co-operate with the 
 physician in his endeavors to effect a cure. If the in- 
 jury complained of is due to the contributory negligence 
 
288 MEDICAL JURISPRUDENCE. 
 
 of the plaintiff, no recoveiy can be had ; if the want of 
 co-operation of the plaintiff merely aggravates the effect 
 of malpractice on the part of the physician, it will 
 not debar a recovery, but wUl mitigate the damages. 
 Negligence of the nurse concurring with that of the 
 physician has been held to be imputable to the patient. 
 This, however, would depend upon the question whether 
 such nurse was the agent of the patient or physician. 
 If the acts of negligence can be so separated as to show 
 that the injury was due solely to the fault of the phy- 
 sician, and the fault of the nurse was only remotely 
 connected therewith, an action will lie against the 
 physician. 
 
 A physician is responsible for the results of his 
 negligence or unskilfulness notwithstanding the case is 
 given over by him to another ; of course, however, he 
 wUl not be responsible for the subsequent negligence of 
 the physician to whom the case is transferred. 
 
 If a family doctor, or the surgeon of a company or 
 society, on leaving home recommends in case of need 
 some other physician, who is not, however, in any sense 
 in his employment, it does not make him in any way 
 liable for injuries arising from the latter's want of skUl. 
 
 In an action brought by a father against two medical 
 men to recover damages for advising him to suck a 
 tracheotomy-tube of his child, who had just been oper- 
 ated upon for diphtheria, without first duly warning him 
 of the risk he ran, whereby he himself became infected 
 with the disease, it was held that there was no cause of 
 action. 
 
 The capacity of the patient injured to judge of the 
 probable results is an important element in cases of 
 
MALPRACTICE. 289 
 
 malpractice; hence, if the patient is insane he cannot 
 be chargeable with contributory negligence ; but wliere 
 a patient relies upon his own judgment, and not that of 
 the surgeon, as to the propriety of the operation, it is 
 held that the surgeon is not liable for injurious conse- 
 quences resulting therefrom, — premising, of course, that 
 due care and skill are exercised in performing such 
 operation. 
 
 If a person is attacked by a fatal disease and there is 
 no escape from it save by a dangerous surgical operation, 
 then if he gives his free and intelligent consent to the 
 operation and it is skilfully performed, the surgeon can- 
 not be blamed even though the patient perishes under 
 the knife. If a woman in labor is in such a condition 
 that her life can be saved only by the sacrifice of that 
 of the child, then it is not only the right but the duty 
 of the attendant to save the mother at the expense of 
 the child. Of course in such a case counsel should 
 be had when possible before resorting to such extreme 
 measures. 
 
 The burden of showing that the use of instruments 
 to produce abortion was necessary to save the life of 
 the woman is on the defendant. 
 
 The rules of law above stated respecting the liability 
 of physicians for negligence and malpractice are equally 
 applicable to similar charges made against midwives, 
 nurses, medical students, chemists, pharmacists, and 
 against any other person who holds himself out as 
 possessing special knowledge or skill in any particular 
 department of learning or practice. 
 
 Denti3tB likewise are subject to the same rules as to 
 negligence as physicians and surgeons. A patient must 
 
 19 
 
290 MEDICAL JURISPRUDENCE. 
 
 exercise ordinary, care and prudence ; so that if one tells 
 a dentist to pull out a tooth, but does not say which 
 one should be pulled, and the wrong one is taken out, 
 the sufferer has no legal ground of complaint unless, 
 indeed, it is quite apparent which is the ofiending mem- 
 ber. The patient may have been a little careless and 
 negligent, still if the dentist has been so very neglect- 
 ful of his duty that no ordinary care on the part of the 
 patient would have prevented the mistake or injury 
 complained of, the injured party may recover damages. 
 The fact that one has taken chloroform will not affect 
 his rights or remedies against a dentist for any mistake 
 or negligence. 
 
 The fact that a dentist extracts teeth gratuitously 
 does not relieve him from liability for failure to perform 
 his work properly. 
 
 As in the case of physicians so in the case of the 
 dentist, it is a good answer to an action to recover 
 payment for his work and labor that the defendant 
 has been injured instead of benefited by the plain- 
 tiffs treatment, either because of his negligence or 
 want of skill. 
 
 Sex is no excuse for negligence, and there is no rule 
 of law that less care is required of a woman than of 
 a man. 
 
 If a physician should be so indiscreet as to make a 
 special contract to cure a person of a certain disease or 
 deformity or to bring about any other desirable result, 
 he will of course be liable for damages for a breach of 
 contract if he fails to perform his agreement. Common 
 prudence would therefore dictate great caution in this 
 respect, and a guarded prognosis in every case, lest the 
 
MALPRACTICE. 291 
 
 patient may pervert what is intended as a mere prog- 
 nosis into a positive engagement to cure. 
 
 Although where the statute of a State requires a State 
 license in order to authorize a physician to practise 
 medicine or surgery an unlicensed physician cannot 
 recover at law compensation for services rendered by 
 him, the fact that he is unlicensed does not affect his 
 liabOity to an action for malpractice. 
 
 Although it may not afford much consolation to the 
 defendant in a malpractice suit, the rule of law is that 
 an action for malpractice does not survive the death of 
 the defendant, and hence does not constitute a claim 
 against his estate. 
 
 Although it is not within the power of a State legis- 
 lature to discriminate in favor of any particular school 
 of medicine, yet such laws may be enacted as will 
 protect the ■ people from ignorant pretenders, and re- 
 quire learning and skill in the school of medicine 
 which the physician professes to practise. No school 
 of medicine is exempt from liability to an action for 
 malpractice. 
 
 If a patient voluntarily employs in one art a man 
 who openly exercises another, his folly has no claim to 
 indulgence. The old Mahomedan case cited by Puffen- 
 dorf with approbation is very much to the point : A 
 man who had a disorder in his eyes called on a farrier 
 for a remedy, who gave him one commonly used upon 
 his quadrupedal patients. The man lost his sight and 
 brought an action against the farrier for damages, but 
 the judge held that no action would lie, for if the com- 
 plainant had not himself been an ass he would never 
 have employed a horse-doctor. 
 
292 MEDICAL JURISPEUDENCB. 
 
 But on the contrary it has been held that an expert 
 in the diseases of man is necessarily an expert in the 
 diseases of animals, so as to make his opinion com- 
 petent evidence upon the question as to whether a 
 disease with which a mule was afflicted was of recent 
 origin or of long standing. 
 
 However much a regular physician may differ from the 
 method of treatment adopted by the profession of any 
 other school, such as homoeopathy or hydropathy, these 
 systems have acquired a certain recognition by the pub- 
 lic, and in some instances legal recognition by statute ; 
 and it is not to be expected that an adverse verdict will 
 be given merely because the medical attendant ^o 
 tempore practised according to these systems. It is a 
 well-known fact that the same drugs are to a very con- 
 siderable extent used by the best practitioners in the 
 two leading schools of practice ; and so far as concerns 
 the practice of surgery and obstetrics, the general prin- 
 ciples of practice must necessarily be the same in every 
 rational system. On the other hand, — as is well ob- 
 served by Drs. Woodman and Tidy in their manual of 
 " Forensic Medicine," — mesmerism, Cof&nism, Morri- 
 sonism, have never acquired such a status, and are not 
 likely to do so. 
 
 Certain other systems of charlatanism which at pres- 
 ent are occupying an undue share of the attention of 
 the more credulous portion of the community, such as 
 the so-called " faith healing " and " metaphysics," might 
 well be included in the same category. It would, as it 
 seems to us, be very dif&cult to frame a defence to a 
 charge of malpractice preferred against one professing 
 to heal certain ailments by either of the last two 
 
MALPRACTICE. 293 
 
 so-called systems. Suppose the case, for instance, of 
 the treatment of strangulated hernia, or a compound 
 fracture, dislocation, placenta prcevia, or hemorrhage 
 from a divided artery, by means of faith or so-called 
 metaphysics, or any other like inefficient means. It 
 would not be possible, in our judgment, to frame a de- 
 fence which would relieve a party practising such or 
 any other mere expectant treatment from liability for 
 malpractice. 
 
 As to the question of doses, however, even in so- 
 called orthodox medicine, very considerable latitude 
 within certain extremes must necessarily be allowed. 
 Common-sense and experience are the only safe criteria 
 in such case. As is well observed, however, by Drs. 
 Woodman and Tidy, "No experience and no theory 
 can be held to justify giving an infant of a month old 
 J grain doses of opium at frequent intervals as a dental 
 sedative, or \ grain doses of strychnia as a tonic." 
 
 Several rules may be found in treatises upon therapeu- 
 tics by which to determine the dose proper for patients 
 under adult age. 
 
 Dr. Young's rule is to add 12 to the age of the patient 
 and divide the age by the sum. Thus, a child one year 
 old would require ^^, and one 3 years old ^ = ^ of the 
 amount necessary for an adult. 
 
 By Dr. Cowling's rule the proportionate dose for any 
 age under adult life is represented by the number of 
 the following birthday divided by 24. Thus, for a child 
 one year old the dose would be 2^= 12 °^ ^^^^ ^°^ ^° 
 adult. 
 
 Professor Clarke's rule is based upon relative weights. 
 Assuming the average weight of an adult to be 150 lbs.. 
 
294 MEDICAL JTJEISPEUDENCE. 
 
 for whom an appropriate dose is unity, the dose of most 
 medicines must be increased or diminished in the pro- 
 portion of the weight of the patient to that number of 
 pounds. This proportion is represented by a fraction 
 whose numerator is the patient's weight and whose de- 
 nominator is 150. 
 
 Actions for malpractice are most frequently brought 
 where an unfavorable result has followed the reduction 
 of a fracture or dislocation, or some other surgical opera- 
 tion. It would be interesting to review the reported 
 cases wherein these particular acts of malpractice are 
 more fully discussed, and also to state the leading prin- 
 ciples of the practice of medicine and surgery bear- 
 ing upon such cases ; but the limits assigned to this 
 work forbid entering into such details. For further 
 details the student is referred to "Woodman and 
 Tidy's Forensic Medicine," and to the " Compilation 
 of Eeported Cases upon Civil Malpractice " by Dr. Mc- 
 Clelland, in which latter book will be found a large 
 number of reported cases of malpractice in the various 
 departments of medicine, surgery, obstetrics, etc. 
 
 2. Criminal Malpractice. — Mr. Bishop, in his work 
 on Criminal Law, vol. i., § 314 (7th ed.), lays down the 
 rule as to homicide from carelessness thus: — 
 
 " Every act of gross carelessness, even in the perform- 
 ance of what is lawful, and a fortiori of what is not 
 lawful, and every negligent omission of legal duty, 
 whereby death ensues, is indictable either as murder or 
 manslaughter. 
 
 " If a man take upon himself an office or duty re- 
 quiring skill or care, — if, by his ignorance, carelessness, 
 or negligence, he cause the death of another he wiU be 
 
MALPRACTICE. 295 
 
 guilty of manslaughter. ... If a person, whether a 
 medical man or not, profess to deal with the life or 
 health of another, he is bound to use competent skill 
 and sufficient attention ; and if he cause the death of 
 another through a gross want of either, he will be guilty 
 of manslaughter." 
 
 In vol. iL of his work on Criminal Law, § 664, Mr. 
 Bishop says : — 
 
 " The doctrine as to physician and patient is not quite 
 the same in England and the United States. And pos- 
 sibly it is not entirely harmonious among our States. 
 According to English adjudication, whenever one under- 
 takes to cure another of disease, or to perform on him 
 a surgical . operation, he renders himself thereby liable 
 to the criminal law if he does not carry to this duty 
 some degree of skiU, though what degree may not be 
 clear; consequently, if the patient dies through his 
 ill-treatment, he is indictable for manslaughter. 
 
 "Still, in an English case [says Mr. Bishop in the 
 same section], Willes, J., once put the doctrine in a 
 more reasonable way, thus : ' If a man knew that he was 
 using medicines heyond his knowledge, and was meddling 
 with things beyond his reach, that was culpable rash- 
 ness. Negligence might consist in using medicines 
 in the use of which care was required, and of the prop- 
 erties of which the person using them was ignorant. A 
 person who so took a leap in the dark in the adminis- 
 tration of medicine was guilty of gross negligence.' " 
 Mr. Bishop then very characteristically and somewhat 
 dogmatically observes : " Kow, in the facts of human 
 life, the less a man understands of anything occult, like 
 the unseen workings of medicine, the more confident he 
 
296 MEDICAL JUEISPRUDENCE. 
 
 is that his knowledge of the thing is perfect. There- 
 fore some of our American courts have laid down the 
 doctrine, not altogether inharmoniously with this utter- 
 ance of the learned English judge, in substance, that, 
 since it is lawful and commendable for one to cure an- 
 other, if he undertakes this office in good faith, and 
 adopts the treatment he deems best, he is not liable to 
 be adjudged a felon, though the treatment should be 
 erroneous, and in the eyes of those who assume to know 
 all about this subject, which in truth is understood by 
 no mortal, grossly wrong; and though he is a person 
 called by those who deem themselves wise, grossly igno- 
 rant of medicine and surgery." 2 Bish. Cr. Law, § 664, 
 citing Commonwealth vs. Thompson, 6 Mass. 134 ; and 
 Bice vs. State, 8 Mo. 561. 
 
 We have quoted thus lai^ely from Mr. Bishop's ex- 
 cellent book because we believe that in thus dogmatiz- 
 ing concerning the lack of knowledge of their profession 
 by those following the practice of medicine and sur- 
 gery, he has himself erred through insufficient knowl- 
 edge. "If a man ktiew that he was using medicines 
 beyond his knowledge, and was meddling with things 
 beyond his reach, that was [indeed] culpable rash- 
 ness." But it does not appear that Mr. Justice Willes, 
 in the case from which the above quotation was made, 
 which was from a charge to the jury at the Durham 
 Assizes, 1864, intended to say that this was the only 
 kind of culpable rashness. It seems, on the other hand, 
 that this was merely an illustration ; for he immediately 
 adds : " Negligence might consist in using medicines 
 in the use of which care was required," etc. See supra. 
 That it was merely an illustration is further apparent 
 
MALPRACTICE. 297 
 
 from the fact that immediately thereafter he adds 
 another illustration : " If a man were wounded, and 
 another applied to his wound sulphuric acid, or some- 
 thing which was of a dangerous nature and ought not 
 to be applied, and which led to fatal results, then the 
 person who applied this remedy would be answerable, 
 and not the person who inflicted the wound, because a 
 new cause had intervened." In the beginning of his 
 charge the learned judge very properly said : " Every 
 person who dealt with the health of others dealt with 
 their lives, and every person who so dealt was bound 
 to use reasonable care and not to be grossly negligent 
 . . . Another sort of gross negligence consisted in rash- 
 ness, where a person was not sufficiently skilled in 
 dealing with dangerous medicines which should be care- 
 fully used, of the properties of which he was ignorant, 
 or how to administer a proper dose. A person who 
 with ignorant rashness and without skill in his profes- 
 sion used such a dangerous medicine acted with gross 
 negligence." The drug given in this case, and which 
 caused death, was a tablespoonful of a tincture of col- 
 chicum-seeds, containing eighty grains of the seeds, — 
 eighteen grains, as is said in this case, being a fatal 
 dose. 
 
 In Nanny Simpson's Case, 1 Lewin, 172, 262, the pris- 
 oner was indicted for manslaughter in having caused 
 the death of a man by administering white vitriol as a 
 medicine. Bailey, J. : "I am clear that if a person not 
 having a medical education, and in a place where per- 
 sons of a medical education might be obtained, takes on 
 himself to administer medicine which may have a dan- 
 gerous effect, and such medicine destroys the life of the 
 
298 MEDICAI. jnEISPRUDENCE. 
 
 person to whom it is administered, it is manslaughter. 
 The party may not mean to cause death ; on the con- 
 trary, he may mean to produce beneficial effects ; but 
 he has no right to hazard medicine of a dangerous ten- 
 dency where medical assistance can be obtained. If 
 he does, he does it at his peril" See also TassytrumcCs 
 Case, 1 Lewin, 169, where the prisoner was convicted 
 of manslaughter in causing the death of an infant by 
 negligently selling laudanum for paregoric. 
 
 It may be conceded that the cases of Commonwealth 
 vs. Thompson, 6 Mass. 134 (decided in 1809); and Bice 
 vs. State, 8 Mo. 561 (decided in 1844), — in the former of 
 which the law of the case is contained in Chief Justice 
 Parsons's charge to the jury that tried the piisoner, and 
 the latter of which is apparently decided mainly upon 
 the authority of the former, — seem to lay down the rule 
 that in order to warrant a conviction for murder or 
 manslaughter, the defendant must have some knowledge 
 of the fatal tendency of the prescription. An attentive 
 perusal of these cases cannot fail, as it seems to us, to 
 convince the reader that there was a palpable failure of 
 justice in both cases. 
 
 In the case of Commonwealth vs. Thompson the 
 defendant gave to the patient suffering with a cold, 
 powdered lobelia, and persisted in giving it to him 
 for a period of eight days till he was so completely 
 exhausted that no relief could be afforded, and he died 
 of exhaustion. 
 
 In Bice vs. The State the defendant in the court below 
 was employed by the husband of a woman near the 
 end of the eighth month of pregnancy, to cure her of 
 " sciatica ; " and after having been informed of her con- 
 
MALPRACTICE. 299 
 
 dition and that other physicians had cautioned against 
 the use of vapor baths and emetics in her then condi- 
 tion, he commenced a course of treatment by steaming 
 and giving lobelia, and persisted in this treatment till 
 she had a premature delivery, a few days after which 
 she died. The evidence showed that she had been 
 married five years, and during that time had had three 
 children, always doing well after a confinement, and 
 was in better health when the defendant commenced 
 his practice on her than she had been for many years. 
 
 After a consideration of the reported cases it seems 
 to the writer that the cases of Commonwealth vs. Thomp- 
 son and Bice vs. The State are clearly wrong. In our 
 opinion the rule laid down in the late case of Com- 
 monwealth vs. Pierce, decided by the Supreme Court of 
 Massachusetts, is much more rational, and virtually 
 overrules the rule laid down in Commonwealth vs. 
 Thompson. In Commonwealth vs. Fierce it was held — 
 Holmes, J., delivered the unanimous opinion of the 
 Court — that to constitute manslaughter where there is 
 no evil intent, it is not necessary that the killing should 
 be the result of an unlawful act ; it is sufficient if it is 
 the result of reckless or foolhardy presumption judged 
 by the standard of what would be reckless in a man of 
 ordinary prudence under the same circumstances. 
 
 The defendant in this case, who publicly practised as 
 a physician, being called upon to attend a sick woman, 
 caused her with her consent to be kept in flannels satu- 
 rated with kerosene for three days, by reason of which 
 she died. There was evidence that he had made simi- 
 lar applications with favorable results in other cases, 
 but that in one the effect had been to blister and burn 
 
300 MEDICAL JUKISPRUDENCB. 
 
 the flesh, as in the present case. It was held that the 
 jury having found that the application was made as the 
 result of foolhardy presumption or gross negligence, a 
 conviction of manslaughter was proper. 
 
 The court in the case of Commonwealth vs. Pierce 
 has carefully limited the application of the rule there 
 laid down to cases where there was no sudden emer- 
 gency and where no exceptional circumstances were 
 shown ; and thus limited, the rule of the case seems 
 eminently reasonable and grounded on the soundest 
 views of public policy. 
 
CHAPTEE XX. 
 
 GENERAL TOXICOLOGY. 
 
 Toxicology treats of the history and properties of 
 poisons and their effect upon the living body. Although 
 this subject is commonly treated as a part of medical 
 jurisprudence, it has practically become a distinct sci- 
 ence ; and at least so far as concerns the chemical an- 
 alysis of the stomach or other viscus for the detection 
 of poison, he would indeed be a bold if not reckless 
 man who would undertake to conduct such analysis for 
 medico-legal purposes without special technical train- 
 ing greater than is possessed by the average medical 
 practitioner. 
 
 The growth of the science and the number and im- 
 portance of the facts connected therewith are so great 
 as to demand more time and attention in order to render 
 one expert than can be devoted to the subject by a 
 medical practitioner. We have thought it best, there- 
 fore, to include in this volume only the subject of 
 general toxicology, by which we mean such considera- 
 tion of the subject as is necessary to enable a medical 
 practitioner, who usually is the first to have knowledge 
 of the facts in any alleged case of poisoning, to so 
 conduct the preliminary examination that the subse- 
 quent and more particular chemical examination by an 
 
302 MEDICAL JURISPRUDENCE. 
 
 expert chemist may not be vitiated by the negligence 
 or ignorance of those who have preceded him. It would 
 be better, perhaps, if both the preliminary inspection 
 and the subsequent chemical analysis could be con- 
 ducted by one and the same person ; but considering the 
 magnitude of the subject, and the tendency to speciali- 
 zation which exists at the present time, this is perhaps 
 not to be expected. 
 
 From the definition of toxicology above given it is 
 evident that a correct understanding of the subject will 
 involve an intimate acquaintance not only with the 
 science of chemistry, but also with materia medica, 
 semiology, physiology, therapeutics, and pathology. It 
 wUl also at times include within its scope the exami- 
 nation and investigation of fictitious or adulterated 
 articles, medicines, food, drink, pigments on walls, dyes 
 on clothing, etc. 
 
 Notwithstanding the immense accumulation of learn- 
 ing upon the subjects above mentioned, it must be con- 
 fessed that, in not a few instances, it is very difficult if 
 not impossible to discriminate with certainty during life 
 between poisoning and ordinary disease ; and in an equal 
 number of cases it will be found that the inspector is 
 also incapable of laying down any characteristic distinc- 
 tions between the appearances left in a dead body by 
 certain diseases and those which result from the action 
 of poison on the tissues. Moreover, when we come to 
 the evidence derived from chemical analysis, it wiU be 
 found in the case of the organic poisons that, in the 
 present state of our knowledge (or rather ignorance), it is 
 impossible thus to determine the existence in the body 
 of some such poisons. 
 
GENERAL TOXICOLOGY. 303 
 
 The subject of ptomaines, or certain basic bodies 
 developed during putrefactive decomposition of animal 
 substances, moreover, opens up a new field of investiga- 
 tion, and one which has thus far been comparatively little 
 cultivated. Certain poisonous principles have also been 
 found in certain pathological conditions of the body, 
 and even according to some observers, in normal tissues 
 and secretions, the exact conditions of the development 
 of which do not appear to have yet been determined. 
 
 Again, the subject of bacteriology probably has an 
 intimate connection with the subject under consid- 
 eration, and notwithstanding the infancy of this sci- 
 ence there is already a vast accumulation of learning 
 and research upon the subject. Indeed, with reference 
 to any one of these subjects the field is sufficiently 
 broad to occupy the best part of an ordinary life-time ; 
 so that, repeating what we have said before, we feel 
 fully justified in this connection in confining ourselves 
 to preliminary considerations, and not entering upon 
 the subject of chemical analysis. 
 
 A poison is defined by Dr. Wormley, in his work 
 upon the "Micro-Chemistry of Poison," as "any sub- 
 stance which, when taken into the body and either being 
 dbsorhed, or by its direct chemical action upon the parts 
 with which in contact, or when applied ■externally and 
 entering the circulation, is capable of producing deleteri- 
 ous effects." 
 
 Dr. Taylor defines a poison as " a substance which, 
 when absorbed into the blood, is capable of seriously 
 affecting the health or of destroying life " This defini- 
 tion does not seem sufficiently comprehensive, and we 
 prefer the definition of Dr. Wormley. The legal scope 
 
304 MEDICAL JUKISPRUBENCB. 
 
 of the statutes against poisoning is not unfrequently 
 enlarged by the use of other terms, such as " other de- 
 structive or noxious thing;" but the definition above 
 quoted from Wormley is believed to be medically 
 correct. 
 
 When the suspicion of poison's having been admin- 
 istered arises upon any occasion, the services of a medi- 
 cal practitioner or medical jurist may be called for under 
 a variety of circumstances. A medical practitioner may 
 be called upon to treat the party during life ; to inspect 
 the body after death ; to testify upon the preliminary 
 examination or upon the trial of the indictment, or 
 upon both these occasions. In order to qualify him to 
 act in these important relations, it is necessary that he 
 should possess a most intimate acquaintance with the 
 effect of a large majority of known poisons, and also 
 with the course and termination of acute and chronic 
 diseases generally. 
 
 Although the most satisfactory evidence of poisoning 
 consists in the isolation of some particular poison from 
 the tissues, or tissue secretions, or matter ejected from 
 the body, there are some instances in which the medical 
 probability of poisoning may, in conjunction with other 
 circumstances of general evidence, raise so high a prob- 
 ability of poisoning that there can be little room for 
 doubt, even though the particular poison has not been 
 isolated. 
 
 It will of course be impossible in the scope of this 
 manual to present anything like even an outline of the 
 collateral sciences a knowledge of which is necessary to 
 the full understanding of the subject under considera- 
 tion. The student is referred for further particulars 
 
GENERAL TOXICOLOGY. 305 
 
 upon these important subjects to the general treatises 
 upon Practice of Medicine, Materia Medica, Therapeu- 
 tics, Pathology, etc. 
 
 In this connection, however, certain things may be 
 touched upon which more particularly appertain to this 
 subject, — such as the channels of entrance and mode 
 of action of poisons, etc. 
 
 The channels of entrance of a poison into the human 
 body may be thus enumerated : 1. The blood vessels, 
 including wounds. 2. The skin and cellular membranes. 
 3. The air passages and lungs. 4 The stomach. 
 ,5. The intestines. 
 
 In this connection it may be well, perhaps, to specify 
 the channels of exit by which poisons are eliminated 
 or excreted from the body, and the organs and tissues 
 in which they undergo an intermediate deposit. The 
 channels of exit are: 1. The urine. 2. The bUe. 3. 
 The milk. 4. The saliva. 5. Mucous secretions. 6. 
 Serous secretions. 7. The perspiratory fluid. 
 
 The organs or tissues where they undergo intermedi- 
 ate deposit are : 1. The liver. 2. The kidneys. 3. The 
 spleen. 4. The heart. 5. The lungs. 6. The muscles. 
 7. The brain. 8. The fat. 9. The bones. 
 
 For further information upon these subjects, the 
 student is referred to Wood's and Bartholow's excellent 
 treatises upon Materia Medica and Therapeutics. 
 
 With respect to most poisons, their entrance into the 
 blood, as the result of absorption or injection, is a con- 
 dition necessary to their action. Stiychnia or prussic 
 acid, applied directly to the brain, spinal marrow, or 
 nerves, produces no effect, or only a slight local action 
 after some time ; but when a portion of either of these 
 
 20 
 
306 MEDICAL JURISPRUDENCE. 
 
 poisons is carried by absorption into the arterial capil- 
 lary system symptoms of poisoning appear. Using, 
 however, the term "poison " in the broader sense in which 
 it is above defined, there appear to be some substances 
 in poisoning with which death is caused by local chemi- 
 cal changes ; the mineral acids and caustic alkalies con- 
 stitute the principal poisons producing this direct local 
 chemical effect. 
 
 Action o£ Poisons. — The greater portion of our 
 knowledge as respects the action of different poisons is 
 derived from empirical sources, such as observation of 
 the symptoms caused by them in the living, and the 
 morbid traces left by them on the dead body. A few 
 poisons destroy the tissues with which they come into 
 immediate contact; a larger number irritate and inflame 
 the part reached by them ; a limited number act injuri- 
 ously on the brain or spinal cord, or both, or on both 
 the brain and the heart ; whUe a large proportion of poi- 
 sonous articles act either simultaneously or successively 
 both on the mucous surfaces and on the cerebro-spinal 
 system ; on the former as irritants, on the latter either 
 as stimulants or sedatives. Some poisons have a direct 
 action on the organ or organs to which they are applied, 
 and an indirect action on the system, generally, or on 
 some one or more of its remote organs. It is only in 
 the case of concentrated mineral acids, and a few of the 
 more powerful irritants, that the local action is suffi- 
 ciently powerful to destroy life. What was once con- 
 sidered as the purely local effects of different poisons 
 is now known to be equally producible whether the 
 poison in question has been directly applied to the 
 organ affected, or has reached it through the circulation. 
 
GENERAL TOXICOLOGY. 307 
 
 Arsenic, for instance, exerts its irritant action on the 
 intestinal canal equally when swallowed, when applied 
 to a wound, or when introduced into the veins by 
 injection. 
 
 Certain poisons have an unquestionable affinity for 
 particular viscera ; thus, opium, chloroform, and chloral 
 hydrate act on the cerebro-spinal system ; strychnia on 
 the spinal cord, etc. Such special actions are not, how- 
 ever, always witnessed on the organ for which they 
 have a special affinity, and they are variably influenced 
 by dose, mode of administration, constitutional peculi- 
 arities, and proclivity to morbid action, or the reverse, 
 in the system. Certain poisons, without doubt, undergo 
 changes within the body after their absorption and prior 
 to their elimination. The mineral acids combine with 
 alkalies, the vegetable acids are in some cases decom- 
 posed, in others eliminated unchanged, and in others 
 enter into combination with the alkalies of the body. 
 
 The action of poisons is modified by a variety of cir- 
 cumstances, such as : 1. Quantity of dose. 2. Form in 
 which the poison is administered. 3. Chemical action. 
 4. The tissues directly acted upon. 5. Habit. 6. Idio- 
 syncrasy. 
 
 1. Quantity of Dose. — There are great differences 
 among different drugs as respects the amount necessary 
 to be taken to produce deleterious effects. There are 
 few poisons which are not harmless in small doses, while 
 many of them in moderate doses are medicinal Some 
 are so active that they can only be administered with 
 safety in very small quantities, — such as strychnia, conia, 
 veratria, aconitine, prussic acid, etc. Other poisons are 
 injurious only when taken in very large doses, — such 
 
308 MEDICAL JUKISPEUDENCE. 
 
 as alum, sulphate of potash, cream of tartar, etc! One 
 fiftieth of a grain of aconitine has produced alarm- 
 ing results to an adiilt ; while an ounce of magnesium 
 sulphate can generally be administered without dan- 
 ger, although in large quantities it has several times 
 caused death. 
 
 In some instances the largeness of a dose of poison 
 may save the patient by producing speedy and copious 
 vomiting, leaving only irritability of the stomach for a 
 few days. 
 
 Some poisons act on different parts of the system 
 according to the amount of the dose. 
 
 2. Form in -which the Poison is Administered. — The 
 form in which the poison is administered has great in- 
 fluence upon its action. Some poisons require to be 
 dissolved before they can produce their characteristic 
 effect ; others act most energetically in a state of vapor, 
 such as chloroform or ether ; others, again, are weakened 
 in their effect by admixture and dilution, although this 
 rule is not universal. 
 
 3. Chemical State. — The chemical state of the poison 
 materially affects its results ; some substances cease to 
 be poisonous when neutralized, while neutralization ren- 
 ders others more energetic ; others, again, are not affected 
 by neutralization provided the compound is soluble. 
 Generally the effects of a base are little influenced by 
 the acid with which it combines ; and the same rule gen- 
 erally holds true as to acids, such as prussic, oxalic, 
 arsenious, and arsenic acids. Salts which are isomor- 
 phous are closely allied in action. 
 
 4. The Tissues directly Acted upon. — The tissue acted 
 upon by the poison influences the results. The unbroken 
 
GENERAL TOXICOLOGY. 309 
 
 skin is insensible to the action of most poisons un- 
 less when applied in a state of gas or vapor, or assisted 
 by friction. Many medicines may, however, be intro- 
 duced into the system by inunction. The action of poi- 
 sons introduced into the veins is very rapid and energetic, 
 as is also their action when brought into contact with 
 the air-cells of the lungs ; next follow serous surfaces, 
 and lastly, mucous membranes. 
 
 Certain vegetable poisons which are very powerful 
 when applied directly to the wound, may be swallowed 
 with impunity. 
 
 5. Habit. — Habit has great influence in modifying the 
 effect of certain poisons. Its effect is most striking in 
 the case of opium and alcohoL Dr. Ogston, from whose 
 excellent work we abridge the principal part of this chap- 
 ter, states that he has known a quart of laudanum being 
 consumed in a few weeks by an opium-eater, although 
 this was not done with ultimate impunity. He states 
 that habit has no effect in mitigating the action of inor- 
 ganic poisons, and says that notwithstanding the alleged 
 facts which have been brought forward in proof of what 
 is termed the tolerance of increasing doses of certain of 
 these, — such as arsenic, tartar emetic, and sulphate of 
 copper, — the truth seems to be that beyond certain 
 limits, undoubtedly pretty wide in the case of arsenic, 
 the system in the use of these poisons becomes more 
 and more instead of less and less susceptible to the same 
 doses where their administration has been continued for 
 any length of time and in quantities at aU considerable. 
 On the other hand. Dr. Wormley regards as authentic 
 the accounts of the Styrian arsenic-eaters published by 
 Dr. Eoscoe, but states that the experience of most medi- 
 
310 MEDICAL JURISPRUDENCE. 
 
 cal practitioners in the use of this drug does not accord 
 with the results of this Styrian practice. 
 
 In certain pathological conditions of the body there 
 is an increased susceptibility to the action of some drugs 
 and a diminished sensibility to others. In delirium tre- 
 mens, hydrophobia, tetanus, mania, or peritonitis, quanti- 
 ties of opium are beneficial which in health would be 
 highly dangerous, if not fatal. On the other hand, where 
 a predisposition to apoplexy exists, an ordinary dose of 
 opium may cause death. 
 
 6. Idiosyncrasy. — Idiosyncrasy shows itself in an 
 unusual susceptibility in some persons to the action of 
 certain drugs in medicinal doses, or even in very small 
 quantities. In some persons common articles of food or 
 drink may produce symptoms of irritant poisoning. Dr. 
 Ogston records one case in his practice in which opium 
 in any shape or dose caused distressing nervous irrita- 
 tion ; a second in which it led to erythema, and a third 
 in which it brought on diarrhoea. Other interesting 
 instances will be found narrated by the same author and 
 by other writers upon this subject. 
 
 Evidence of Poisoning. — 1. Suddenness of onset of 
 the symptoms in a healthy person soon after partak- 
 ing some liquid or solid usually awakens suspicion of 
 poisoning. This criterion is not usually a safe one, for 
 the reason, as medical men well know, that there are 
 many diseases whose onset is sudden and whose course 
 is rapid ; taken in connection, however, with other symp^ 
 toms, these indications are of value. The time within 
 which a poison takes effect after its administration, 
 varies in different cases, — the action in some cases tak- 
 ing place either immediately or within a short time, and 
 
GENEEAL TOXICOLOGY. 311 
 
 iu others the symptoms being delayed an hour or even 
 several hours. When several persons have partaken of 
 the same liquid or solid and are all suddenly attacked in 
 the same manner, this of course raises a much stronger 
 presumption of poisoning. 
 
 2. In cases of poisoning, the symptoms usually 
 rapidly run their course, their duration, however, being 
 subject, even in the same drug, to considerable variation. 
 A few poisons, notably prussic acid, very rapidly pro- 
 duce a fatal termination, although even in the case of 
 hydrocyanic acid there are recorded instances in which 
 death has not occurred until the lapse of several 
 hours. 
 
 It should be remembered in this connection that there 
 are certain diseases whose symptoms resemble irritant 
 poisoning, such as cholera-, inflammation of the stomach 
 and bowels, and perforation of the stomach ; and that 
 the symptoms of other diseases may resemble narcotic 
 poisoning, as in the case of apoplexy, inflammation of the 
 brain, etc. In such cases the true cause of death may 
 in some instances be discovered by the post-mortem in- 
 spection, while in others, there may be no characteristic 
 morbid appearances. 
 
 Although, as above stated, symptoms resembling 
 poisoning are not a safe criterion in many cases, still 
 there are some cases in which alone they afford very 
 strong evidence thereof; thus in the case of strychnia 
 and oxalic acid it is conceded by Christison that there 
 are no natural diseases which successfully simulate the 
 effects of these poisons, and if it should happen that 
 several persons who have partaken together of the same 
 articles of food, drink, or medicine, have been simul- 
 
312 MEDICAL JUEISPRUDENCE. 
 
 taneously attacked with similar symptoms, the evidence 
 would amount almost to demonstration. 
 
 In some instances also very strong evidence may he 
 derived from the condition of the lips and mouth, the 
 impending suffocation from closure of the larynx, coldness 
 of the surface and depression of the heart's action, together 
 with acid stains upon the lips, mouth, and clothes ; and 
 although the evidence from the symptoms except in a 
 few instances, may be short of actual proof of the ad- 
 ministration of poison, they always constitute important 
 confirmatory evidence. It is to be remembered, howr 
 ever, as stated by Christison, that it does not follow he- 
 cause a poison has been given that it has been the 
 cause of death ; hence, in every medico-legal inquiry 
 the cause of the first symptoms and the cause of the 
 death should be made two distinct questions. 
 
 3. Evidence of Poisoning deduoible from the Post- 
 mortem. — The evidence from this source is either nega- 
 tive or positive. No reliance is to be placed on such 
 appearances in the dead body as unusual lividities or its 
 rapid decomposition ; and it is believed that except in a 
 very few particular instances the morbid appearances 
 left by poison upon the corpse do not differ specifically 
 from those following natural diseases or some other 
 kinds of violent death. The entire absence of those 
 morbid appearances on the body which are indicative 
 of the action of poisons, even if conjoined with the pres- 
 ence of those which result from disease to an extent 
 sufficient to account for death from natural causes, will 
 not always suffice to negative the possibility of poison 
 having been administered. In such a case, however, 
 it will be very difficult if not impossible to secure a 
 
GENERAL TOXICOLOGY. 313 
 
 convietion of poisoning. The only chance of the truth's 
 being brought to light in such a case is where the 
 symptoms and appearances produced by the disease are 
 widely different from those caused by the poison alleged 
 to have been taken. 
 
 In order properly to make a post-mortem inspection in 
 a case of suspected poisoning, the ezamiuer should be 
 well versed in pathology and should be especially familiar 
 with the numerous changes which may simulate the 
 appearances due to the administration of poison during 
 life; thus, while he should expect evidence of irrita- 
 tion, inflammation, or corrosion of parts of the alimen- 
 tary canal after the ingestion of several of the irritant 
 poisons, he must remember that all these may have 
 arisen from natural causes. Thus the stomach of 
 drunkards is sometimes found to be intensely red, or 
 what is more common, reddening on exposure to the 
 air. Appearances of superficial inflammation or even 
 ulceration are sometimes encountered in the mouth, 
 throat, and stomach of new-born' infants, all of intra- 
 uterine origin. Again, decomposition may cause red- 
 ness of the stomach; and in some cases of sudden 
 death, as in executed criminals, the stomach has been 
 found highly vascular where no symptoms of irritation 
 or inflammation existed during life. Severe inflamma- 
 tion or ulceration in the mouth, throat or oesophagus 
 observed in the dead body, are much more likely to 
 have been the consequence of previous disease than of 
 any irritant or corrosive poison. Corrosions of the stom- 
 ach or smaller intestines from the action of poisons of 
 this class will scarcely be confounded by a competent 
 observer with ulcerations caused by disease. 
 
314 MEDICAL JURISPKUDENCE. 
 
 Softening of the coats of the stomach is common both 
 to disease and to the action of corrosive poisons ; such 
 softening has been known in a few instances of sudden 
 death to be caused by the solvent action of the gastric 
 juice on the coats of the stomach after death, or it may 
 present itself as an example of the disease termed gelat- 
 iniform softening ; in both cases the tissues are com- 
 pletely disorganized and usually broken up into shreds 
 over a considerable portion of the organ. In such cases 
 the examiner should not attribute the appearance in 
 question to any corrosive poison unless the poison is 
 actually found in the stomach. 
 
 Rounded perforations of small size in certain un- 
 healthy states of the stomach and smaller intestines 
 sometimes destroy life in a few hours, preceded by 
 symptoms not unlike the effect of irritant poisoning; 
 the symptoms where death occurs in such cases are 
 generally clearly due to peritonitis, while the edges of 
 the perforations are rounded, thickened, and of almost 
 cartilaginous hardness. 
 
 In many of the deaths from narcotic and narcotico- 
 acrid poisoning, the inspection of the body affords no 
 evidence, either the appearances being such as are 
 common to other cases of death, or there being no traces 
 whatever of morbid action in the body ; this last may 
 happen even with sonie of the irritant poisons. 
 
 Putrefaction in the dead body may obliterate the 
 traces of a large number of those poisons which produce 
 marked changes in the fresh corpse. 
 
 Some poisons, however, leave traces of their morbid 
 action which are not easily obliterated ; such as intense 
 phlogosis in the upper part of the alimentary canal from 
 
GENERAL TOXICOLOGY. 315 
 
 certain of the irritants, and the destruction of its coats 
 and even perforation of the tube by the more powerful 
 escharotics, as well as the less marked effect on the skin, 
 throat, or oesophagus by some of the mineral acids. It 
 is, however, in connection with the symptoms and the 
 general evidence that the morbid appearances after 
 death furnish distinctive proof of poisoning. 
 
 Method of Making the Autopsy. — Inasmuch as the 
 post-mortem will nearly always be conducted by a 
 medical practitioner, and not by the chemist who makes 
 the analysis, it is important that due care should be 
 taken by the practitioner in making such examination, 
 in order that the results of the chemical analysis may 
 not be invalidated by the preceding negligence or igno- 
 rance of the party who made the post-mortem. The 
 importance of this part of the examination can scarcely 
 be over-estimated. The general method of making a 
 medico-legal inspection has already been sufficiently 
 treated in a preceding chapter ; the attention of the 
 reader will therefore here only be directed to some 
 general considerations of importance in addition to those 
 already given. 
 
 In inspecting the body of a person suspected to have 
 been poisoned, it is of the utmost importance for the 
 examiner before commencing his examination to be in 
 possession of all the authentic information which can 
 be procured regarding the previous history of the case. 
 Such information is of importance at the inspection, as 
 leading the inspector to attend particularly to the state 
 of those organs which are most usually affected by the 
 individual poison suspected to have been administered, 
 and may prevent his overlooking points and circum- 
 
316 MEDICAL JURISPEUBENCE. 
 
 (Stances to which otherwise his search and observation 
 might not have extended. 
 
 Before proceeding to the inspection, the examiner 
 should provide himself with ligatures, distilled water, 
 and vessels for containing the stomach, the intestines, 
 and any matters which may have been vomited ; if this 
 has not already been done, all suspected articles whethec 
 food, drink, or medicines, which may be found in the 
 apartments of the deceased should be collected and care- 
 fully sealed up for future examination. If any sub- 
 stances have been spilt on the floor, a new or carefully 
 washed sponge or clean cloth should be used to wipe 
 them up, when they may be preserved in separate ves- 
 sels. If the deceased has vomited, the vomited mat- 
 ters, especially those first ejected, should be preserved 
 and their quantity, odor, color, and acid or alkaline re- 
 action noted. If- the vomiting has taken place on 
 articles of dress or on the floor or furniture of the room, 
 the stained portion of the clothing, sheet, or carpet 
 should be cut out and preserved for analysis. If the 
 vomiting occurred on a wooden floor, a portion of the 
 wood may be scraped off or cut out ; if upon a stone 
 pavement, a clean piece of cloth or sponge soaked in 
 distilled water should be used to remove any traces of 
 the substance. 
 
 The vessels in which vomited matters were contained 
 will sometimes present valuable evidence, since heavy 
 mineral poisons fall to the bottom or adhere to the sides 
 of the vessel. 
 
 When the vomited substance consists of animal mat- 
 ters liable to putrefaction it has been advised that they 
 be kept in alcohol diluted with its own weight of water ; 
 
GENERAL TOXICOLOGY. 317 
 
 but the addition of any preservative fluid should be 
 avoided, as it might complicate or embarrass future 
 chemical analysis. 
 
 Urine and fcecal matters should also be preserved. 
 
 In making the external examination the procedure 
 recommended in a previous chapter should be adopted. 
 If any spots are found upon the skin, lips, or fingers, 
 they should be removed with the scalpel for future 
 analysis ; the same thing should be done with the teeth 
 when they present any appearances of having been 
 stained or corroded. 
 
 In the examination of the interior of the body the 
 chief attention should be directed to the alimentary 
 canal; the oesophagus should not be disturbed in the ex- 
 amination of the trachea. The condition of the mouth 
 and pharynx should be first noted before the organs 
 in the chest are inspected. The left lung should be 
 reversed upon the heart to expose the course of the 
 oesophagus, and a ligature placed around it close to the 
 diaphragm ; two ligatures should then be placed round 
 the duodenum near the pyloric end of the stomach and 
 the duodenum divided between them to allow the re- 
 moval of the stomach ; the same thing should be done 
 at the termination of the ilium and the smaller intestines 
 removed. Finally, the extremity of the rectum being 
 secured, the larger intestines are to be removed. The 
 stomach and intestines should then be opened separately 
 in clean glass vessels of known capacity ; the contents 
 of the separate portions of the alimentary canal, the 
 state of their tissues and the alterations they have un- 
 dergone should be carefully noted. The quantity, odor, 
 acidity or alkalinity of the contents of the stomach, 
 
318 MEDICAL JUEISPRUDENCB. 
 
 whether luminous or not in the dark, the presence or 
 absence therein of crystalline matter, foreign substances, 
 undigested food, and spirituous fluid, should be carefully 
 noted. The appearance of the mga of the stomach and 
 of their interspaces, particularly in the vicinity of the 
 great cul-de-sac, should be noticed, as it is in this situa- 
 tion that the traces of poison and its effects are most 
 frequently left. The seat of inflammation, if any, should 
 be exactly specified, as also that of any softening or un- 
 usual coloration, ulceration, effusion of blood, corrosion, 
 or perforation, if there should be any. 
 
 The same minute attention should be paid to the 
 smaller and larger intestines and their contents^ The 
 parts of the intestines where morbid appearances are 
 most frequently found in case of poisoning, are the duoi 
 denum, the upper part of the jejunum, the lower part of 
 the ilium and the rectum. The comparative intensity 
 of the appearances of irritation in different parts of the 
 alimentary canal should be noticed, as it may throw 
 much light on a suspected case of poisoning, and may 
 sometimes obviate the necessity for any further pro- 
 ceedings : thus, if the stomach is sound and the intes- 
 tines only inflamed the possibility of irritant poisoning 
 may be pretty safely negatived. 
 
 After this examination of the stomach and intestines 
 the organs are to be put into wide-mouthed glass vessels, 
 each part by itself, and the vessels in which they were 
 contained washed out with distilled water into the ves- 
 sel appropriated to the morbid part, adding sufficient 
 distilled water to cover the contained viscus. 
 
 When the poison has led to the perforation of the 
 stomach and bowels the substance effused into the 
 
GENERAL TOXICOLOGY. 319 
 
 abdominal cavity should be carefully collected and 
 separately preserved. 
 
 In a case of poisoning by arsenic and the greater 
 number of the metallic poisons, the liver and the mass 
 of the blood may require to be preserved. In cases of 
 suspected poisoning M^ith opium and its salts and all 
 the vegetable alkaloids, besides the portion of the vis- 
 cera most largely supplied with blood, portions of the 
 blood and the whole of the urine should be kept. 
 • The remaining organs of the abdomen must be in- 
 spected, particularly the spleen, the kidneys, and the 
 rectum ; and in the female, the uterus and its append- 
 ages including the vagina. 
 
 No portion of the suspected articles should be wasted 
 at the inspection or in preliminary trials or testing. In 
 some instances it may be necessary to preserve, besides 
 a portion of the liver and the blood, other parts of the 
 body, — such as the kidneys, spleen, heart, brain, and por- 
 tions of the muscles ; all the organs and the blood thus 
 removed should be collected and preserved in separate 
 clean glass vessels, great care being taken that none of 
 the organs or substances thus removed at any time be 
 brought in contact with any substance which might 
 give rise to a suspicion of contamination. A sealed and 
 signed label ought to be attached to each of the vessels 
 before removal from the apartment. Great care should 
 be taken to prevent the possibility of their being tam- 
 pered with, and they should be retained in the sole 
 possession of the inspector until delivered by him to a 
 person duly authorized to receive the same. 
 
 It may be necessary occasionally to examine a dead 
 body for poison, after a considerable period of interment. 
 
320 MEDICAL JURISPBUDENCE. 
 
 Mere putrefaction should not be allowed to prevent an 
 inspection necessary for medico-legal purposes. It has 
 been shown by the experiments of Orfila and Lesueur 
 that the decay of the body does not always render im- 
 possible the detection of the poison. They placed in a 
 dead body, and allowed to remain there for some time, 
 each of the following poisons, namely : sulphuric and 
 nitric acid, arsenic, corrosive sublimate, tartar emetic, 
 sugar of lead, protochloride of tin, sulphate of copper, 
 verdigris, nitrate Of silver, chloride of gold, acetate of 
 morphia, chloride of brucia, acetate of strychnia, prussic 
 acid, opium, and cantharides. They found that the 
 acids become neutralized by the ammonia generated 
 during the decay of the animal matter ; that by the 
 action of the animal matter the salts of mercury, anti- 
 mony, copper, tin, gold, silver, and likewise the salts of 
 the vegetable alkaloids, undergo chemical decomposition 
 in consequence of which the bases become less soluble in 
 water ; that acids may be detected after several years' in- 
 terment, not always, however, in the free state ; that the 
 bases of the decomposed metallic salts may also be found 
 after interment for several years; that arsenic, opium, and 
 cantharides undergo little change after a long interval 
 of time, and are scarcely more difficult to discover in 
 decayed than in recent animal mixtures ; but that 
 hydrocyanic acid disappears very soon, so as to be 
 indistinguishable after a few days. 
 
 4. JBvidence of Poisoning derivable from Chemical 
 Analysis. — We have already indicated our opinion that 
 the chemical analysis in cases of suspected poisoning 
 should be made by a competent chemist, and cannot, 
 as a rule, be safely undertaken by a general medical 
 practitioner. 
 
GENERAL TOXICOLOGY. 321 
 
 ' For details as to the different methods of analysis the 
 reader is referred to the treatises of Wormley, Taylor, 
 and Christison. 
 
 In this connection the possibility should always be 
 borne in mind that the poison may have been introduced 
 into the body after death with the design to impute 
 poisoning ; or that although the poison was swallowed 
 during life the fatal event may have arisen from natural 
 causes; it should always be remembered that a large 
 number of the best known poisons are constantly em- 
 ployed as medicinal agents. 
 
 5. Zispeiiments on animals with suspected articles 
 of food, drink, or medicine, were formerly much relied 
 on as evidence of poisoning; now, however, this line 
 of proof is properly objected to both as a waste of 
 useful material, and on the ground that the effects of 
 poisons on the lower animals are frequently different 
 from those produced on man. For details see Ogston's 
 "Medical Jurisprudence" and professed treatises on 
 Therapeutics. 
 
 6. With the moral aspects of the case the medical jur- 
 ist as such, has usually nothing to do ; but in his capa- 
 city as a practitioner these aspects will not unfrequently 
 be brought before his attention, and in the interests of 
 justice should be carefully observed and noted by him. 
 In many instances he may not only thereby materially 
 aid the interests of justice, but he may sometimes there- 
 by be enabled to protect his patient against further 
 attempts at poisoning. 
 
 Treatment of Poisoning, generaUy. Before proceeding 
 farther it may be well to insert at this place a few gen- 
 eral principles as to the methods of treatment in cases 
 
 21 
 
322 MEDICAL JURISPRUDENCE. 
 
 of poisoning. The details must of course be sought in 
 larger works upon Therapeutics and Toxicology. 
 
 In treating a case of suspected poisoning there are 
 three indications to be met: 1. The removal of the 
 poison ; 2. The counteracting of the primary effects of 
 such portions of the poison as may have gotten beyond 
 reach; and 3. The cure of the resulting disorders it may 
 have occasioned. 
 
 The modes of remoTing the poison vary according to 
 circumstances. 
 
 Ezternal Applications, etc. — Some poisons, such as the 
 strong mineral acids and the caustic alkalies, act on the 
 unbroken surface^ of the body, while the far greater 
 number require to be introduced below the surface. 
 Where the poison has been applied outwardlyi careftd 
 ablution will in many instances be all that may be re- 
 quired to fulfil the first indication. 
 
 When, however, the poison has penetrated below the 
 external surface, the following steps should be taken : 
 A ligature should be applied between the wound or sore 
 a;nd the heart as far from the wound as possible, so as 
 to arrest the circulation in the veins but not in the ar- 
 teries ; this will if adopted in time, prevent the absorp- 
 tion of the poison or arrest its further absorption, at least 
 for a time. The next step to be taken is to wash the 
 wound carefully from every trace of the poison, and to 
 attempt the removal of so much of the poison as may 
 adhere to the wound or have entered the circulation at 
 the wounded part. Some authors advise the opening of 
 a vein near the ligature, and the withdrawing of as much 
 of the local blood as is necessary to insure the safety of 
 the patient. Others recommend the manipulation of 
 
GENERAL TOXICOLOGY; 323 
 
 the soft parts around the wound so as by compression 
 to squeeze out from it as much as possible of the blood 
 it contains. A better procedure, and that generally 
 recommended, is suction, either by the mouth or cup- 
 ping glass ; dry cupping is perhaps the best method and 
 may be practised, if no better means are at hand, by 
 burning a small piece of paper saturated with alcohol, 
 in a small wine-glass or tumbler, and having removed 
 the remains of the paper immediately placing the glass 
 over the wounded part. Free scarification of the part 
 will add to the efficiency of this operation. 
 
 Excision of the soft parts in the vicinity of the wound, 
 or even the amputation of the part when the wound is 
 situated in a finger or a limb, may sometimes be 
 necessary. 
 
 Caustics or escharotics or actual cautery have been 
 recommended. 
 
 When poisons have been applied to the unbroken 
 surface or the entrance of the various mucous canals, so 
 much of the noxious substance as possible should be 
 speedily washed out; and in the case of the mineral 
 acids and alkalies, the remainder neutralized, with some 
 appropriate reagent. 
 
 Where a volatile poison has been drawn into the 
 lungs by inspiration it is rapidly absorbed and will 
 usually be beyond reach before any attempt at its re- 
 moval can be made ; in such case the only resource 
 within our power is the continuance of full and rapid 
 inspirations and expirations to dilute and carry it off. 
 Artificial respiration with or without the addition of 
 vapor of ammonia or other appropriate drug, may be 
 necessary. 
 
324 MEDICAL JUEISPRUDENCE. 
 
 In most instances in which the intervention of a 
 practitioner is necessary, the poison wUl have been 
 swallowed and the first most important aim in such 
 case will be to procure its complete and speedy removal 
 from the stomach. In some instances the poison will 
 itseK have provoked vomiting, which should in most 
 instances be encouraged by the use of the mildest dilu- 
 ents. Where vomiting has not thus spontaneously 
 occurred, or, if it has commenced, is not sufficiently free, 
 emetics should be at once administered and repeated at 
 suitable intervals till their full action is obtained. As 
 a general rule, the milder vegetable emetics, such as 
 ipecac or the preparations of squill, are best adapted for 
 the irritant and many of the narcotico-acrid poisons; 
 while sulphate of zinc, in a dose of five grains repeated 
 every ten minutes until it has acted freely, will be found 
 useful in the case of a narcotic poisoning. Common 
 table-salt, in a dose of one or two tablespoonfuls dis- 
 solved in eighteen or twenty ounces of warm water, or, 
 though more irritating, one or two teaspoonfuls of 
 mustard in warm water, will be found useful in an 
 emergency. Simple diluents may be given freely to 
 assist the action of the above emetics and vomiting 
 may be hastened or assisted by tickling the throat or 
 compressing the epigastrium. There are cases, however, 
 where it will be either unsafe to administer emetics or 
 where if administered, they will fail to act ; in the first 
 category are patients predisposed to or who have al- 
 ready suffered from apoplexy or haemoptysis. 
 
 In many cases the hypodermatic injection of from 
 ■^ to -^^ of a grain of apomorphia will be found 
 a most valuable agent in procuring the complete and 
 
GENERAL TOXICOLOGY. 325 
 
 speedy evacuation of the stomacli. A strong recom- 
 mendation in its favor is the fact that it can be used in 
 cases where the patient cannot swallow, and in cases 
 where, as in strychnia poisoning, the administration 
 of an emetic or the use of a stomach-pump is difficult 
 or impossible, by reason of convulsions. In many cases 
 the stomach-pump may be safely used ; its use, however, 
 is sometimes difficult or impossible in the case of chil- 
 dren, and as before mentioned, during the continuance 
 of convulsions ; while it may be altogether contra-indi- 
 cated in some cases of corrosive poisoning. Where the 
 patient's mouth cannot be opened, on account of spasms, 
 it should be remembered that a small tube may be in- 
 troduced into the stomach through the nostril. It may 
 occasionally be necessary, as a means of fulfilling the 
 first indication, to expel 'per anum, by the use of laxa- 
 tive medicines, portions of the poison which have passed 
 from the stomach into the intestines. Castor oil is the 
 cathartic usually chosen, on account of its mildness; 
 when necessary its efficacy may be increased by addition 
 to it of one or two drops of croton oil. 
 
 The second indication is the counteracting of the 
 primary effects of such portions of the poison as have 
 gotten beyond our reach ; and the third indication is the 
 cure of the resulting disorders the poison may have 
 occasioned. 
 
 Inasmuch as it is seldom that the whole of the poison 
 can at once be removed from the system by any means 
 at our command, we may usually find it necessary to 
 attempt to meet these second and third indications. 
 To consider this subject at length or even partially 
 would occupy more space than is at our disposal ; we 
 
326 MEDICAL JURISPRUDENCE. 
 
 are obliged, therefore, to refer the student for particulars 
 in this important subject to the excellent works of Drs. 
 Wood and Bartholow on Therapeutics. 
 
 Feigned Poisoning, Imputed Poisoning, etc. — The 
 imputation of the crime of poisoning by feigning or 
 actually producing the symptoms and contriving that 
 the poison shall be detected in the quarters where in 
 actual cases it is usually sought for, has sometimes been 
 attempted. It is very easy for an artful person to put 
 poison into food and accuse another of having admin- 
 istered it, as well as to introduce poison into faeces or 
 matters vomited. The possibility also of the introduc- 
 tion of a poisonous substance into the body after death, 
 with a view of accusing an innocent person of the crime 
 of poisoning, should also be borne in mind. 
 
 In cases of feigned poisoning, the absence of the 
 characteristic symptoms of the poison alleged to have 
 been taken, with other inconsistencies in the account of 
 the party, wUl usually disclose the fraud. In such 
 cases, in forming a diagnosis little reliance should be 
 placed on the unsupported statement of the patient; 
 the practitioner, while allowing the patient apparent 
 credit for the truth of his statements and seemingly 
 sympathizing with his fears, — real, imaginary or as- 
 sumed, — should request him to give a full history of 
 existing symptoms, their origin and progress, their rela- 
 tion in point of time to various meals, and the mode 
 and vehicle in which the supposed poison was admin- 
 istered. The same course should be taken with attend- 
 ants, witnesses or others interested in supporting the 
 statement, either during his lifetime or after death in 
 cases of suspected fatal poisoning. No unprofessional 
 
GENERAL TOXICOLOGY. 327 
 
 person can go through such an ordeal without bringing 
 out many circumstances irreconcilable with the idea of 
 poisoning generally, and still more the administration 
 of a particular poison, unless it has in fact been 
 administered. 
 
 In many cases it will be found that the party is not 
 entirely free from some complaint. In imaginary poi- 
 soning there will often be disorder of the digestive 
 organs, irritation of the alimentary canal, febrile or 
 inflammatory symptoms, with or without delusion or 
 hallucination showing that the mind is disordered. In 
 suspected poisoning the same circumstances will have 
 served as grounds for suspicion. 
 
 In feigned and imputed poisoning, if there be no ill- 
 ness to give a color to the imposture there will be a 
 fictitious disorder produced. In all these cases, there- 
 fore, it should first be settled whether or not there be 
 any actual departure from the state of health. This 
 done, the additional evidence which the ejecta and 
 dejecta (if any such are produced) are capable of afford- 
 ing, care being taken to ascertain that poison has not 
 purposely, been added to these, will usually be sufficient 
 to determine the question. It may be necessary in 
 order to settle the question definitely, to have the per- 
 son and those about him secretly watched. 
 
 In a case of importance where active disease is found 
 to exist, the medical jurist will not be justified in de- 
 ciding positively that a poison has not been exhibited 
 without a previous careful examination of the suspected 
 articles, food or drink, and of the ejecta. The chemical 
 investigation may sometimes lead to proof of the reality 
 of an apparent case of feigned, suspected, or imaginary 
 poisoning. 
 
CHAPTEE XXI. 
 
 The compiler of this little volume has felt great 
 embarrassment in the preparation of this chapter and 
 the chapter upon Toxicology, on account of the wealth 
 of material and the difficulty of determining what to 
 omit ; for with the limited space at his disposal nothing 
 more than a mere outline can be attempted. 
 
 It is, perhaps, impossible to frame a perfect definition 
 of insanity ; if space permitted it would be a matter of 
 great interest to collate and compare the different defini- 
 tions, and to study their development. Quite a full 
 compilation of the various definitions of insanity will be 
 found in Dr. Hammond's work on that subject, who de- 
 fines it as "a manifestation of disease of the brain, 
 characterized by general or partial derangement of one 
 or more faculties of the mind, and iu which, while con- 
 sciousness is not abolished, mental freedom is weakened, 
 perverted, or destroyed : " insanity is regarded by this 
 writer as, strictly speaking, " only a symptom of cerebral 
 disease." 
 
 Dr. Spitzka gives the following comprehensive defini- 
 tion of insanity, which, be states, complies with the 
 chief rec[uirements of a practical definition, although 
 
 1 The material for this chapter haa with the author's consent been 
 largely drawn from the manual of Dr. Spitzka upon Insanity, which 
 every student should consult for further details. 
 
INSANITY. 329 
 
 laboring under the disadvantage of length : " Insanity is 
 either the inability of the individual to correctly regis- 
 ter and reproduce impressions (and conceptions based 
 on these) in sufficient number and intensity to serve as 
 guides to actions in harmony with the individual's age, 
 circumstances, and surroundings, and limit himself to 
 the registration as subjective realities of impressions 
 transmitted by the peripheral organs of sensation ; or 
 the faUure to properly co-ordinate such impressions and 
 thereon to frame logical conclusions and actions ; these 
 inabilities and failures being in every instance considered 
 as excluding the ordinary influence of sleep, trance, 
 somnambulism, the common manifestation of the general 
 neuroses, such as epilepsy, hysteria, and chorea, of 
 febrile delirium, coma, acute intoxication, intense men- 
 tal pre-occupation, and the ordinary immediate effects 
 of nervous shocks and injuries." In another place the 
 same author gives the following definition : " Insanity 
 is a term applied to certain results of brain disease and 
 brain defect which invalidate mental integrity. It is in- 
 accurate to state that insanity is itself a disease. It is, 
 strictly speaking, merely a symptom which may be due to 
 many different morbid conditions, showing this one fea- 
 ture in common, — that they involve the organ of the 
 mind." 
 
 Dr. Kiernan, of Chicago, has favored the author with 
 the following definition : " Insanity is a morbid mental 
 condition arising from brain disease, or disorder, or mal- 
 formation, which perverts the mental relations of the in- 
 dividual to his surroundings, or to what from his birth, 
 education, and circumstances, might be expected to be 
 such surroundings." 
 
330 MEDICAL. JURISPRUDENCE. 
 
 Dr. Henry M. Bannister of the Illinois Hospital for 
 the Insane, at Kankakee, has also favored, us with 
 the following, definition: "Insanity is a disease or 
 defect of the brain, causing such disorder in the action 
 of the mind as to affect the individual's conduct, put 
 him out of relation to his surroundings, and render him 
 liable to be dangerous or inconvenient to himself or 
 others. Under insanity ' are not usually included the 
 delirium of fever, or the direct effects of toxic agents, 
 intoxicants, etc." 
 
 Dr. Bucknill, in his essay on ". Unsoundness of Mind in 
 relation to Criminal Acts," defines insanity as " a conr 
 ditiou of mind in which a false action of conception or 
 judgment, a defective power of the wiU, or an uncontrol- 
 lable violence of the emotions and instincts, have separ- 
 ately or conjointly been produced by disease." 
 
 The same author has lately propounded a new defini- 
 tion which is intended to express the essential features of 
 insanity from a legal point of view. He says : " Insanity 
 is incapacitating weakness or derangement of mind 
 caused by disease." 
 
 It does not appear to us that this definition adds 
 greatly to our stock of knowledge upon this important 
 subject ; it only removes the difficulty one step further) 
 without in the least aiding in the solution of the ques- 
 tion as to what does amount to legal irresponsibility. 
 But this subject will be referred to further on. 
 
 Dr. Tuke, in " Bucknill and Tuke's Manual of Psycho- 
 logical Medicine," regards insanity as "a condition in 
 which the intellectual faculties, or the moral sentiments, 
 or the animal propensities, — any one or all of them, — 
 have their free action destroyed by disease, whether con- 
 
INSANITY. 331 
 
 genital or acquired." " He [the student] will not go far 
 wrong," says Dr. Tuke, " if he regard insanity as a disease 
 of the train (idiopathic or sympathetic) affecting the 
 integrity of the mind, whether marked hy intellectual or 
 emotional disorder, — such effects not being the mere 
 symptom or immediate result of fever or poison." 
 
 It wiU be seen from the above definitions and others 
 quoted in Dr. Hammond's work that there is a great 
 difference of opinion as to what is a proper definition of 
 insanity. We have quoted the above definitions for the 
 reason that, excepting the proposed new definition of Dr. 
 Bucknill, they seem to us to define the condition of in- 
 sanity more clearly than those proposed by other authors. 
 Some of these authors, it wiU be observed, regard insan- 
 ity as a disease or defect of the brain, causing certain 
 mental phenomena ; others apply the term to the phe- 
 nomena themselves, or the mental condition which they 
 represent, caused by a disease or defect of the brain ; or 
 as Dr. Hammond expresses it, " insanity, strictly speak- 
 ing, is only a symptom of cerebral disease," Dr. Spitzka 
 Ukewise, as we have seen, characterizes insanity as 
 Kierely a symptom. 
 
 In the present state of our knowledge, it seems to the 
 writer better to apply the term " insanity " to the condi- 
 tion of mind evidenced by the mental phenomena ob- 
 served, rather than to the disease of the brain causing 
 such condition. This, however, is perhaps not a vital 
 point, and any one of the three definitions above quoted 
 of Dr. Bannister, Dr. Spitzka, or Dr. Hammond, wUl 
 perhaps include the vast majority of cases. 
 ' It is probably more convenient than necessary that 
 any attempt should be made to frame a definition of 
 
332 MEDICAL JUEISPRDDENCB. 
 
 insanity which will include all, or the greater number 
 of cases. A very superficial view of the growth of our 
 knowledge upon this subject shows clearly the folly of 
 attempting to frame a rigid definition. A definition 
 which at the time it is made may appear to be perfect 
 will, with the enlargement of our knowledge and ex- 
 perience, be found defective. As is well observed by 
 Dr. Spitzka, the chief need of a definition is a medico- 
 legal one, and we think that it may be stated that this 
 need is not a pressing one; it is much better in our 
 judgment, as in the case of fraud, to decide each case 
 upon its individual facts, than to attempt to make 
 it square with any rigid and, very likely, imperfect 
 definition. 
 
 With reference to this subject, Dr. Spitzka observes : 
 "On some occasions the question of defining what is 
 called ' legal insanity ' may be presented to the reader 
 of these lines. When that question is asked he may 
 safely challenge the questioner to show him a broken 
 leg, or a case of small-pox in a hospital ward, which is 
 not a broken leg or a case of small-pox in law ; or show 
 him a tumor, or case of softening of the brain, which is 
 meningitis or sclerosis in law ; or to define the condition 
 under which any disease-symptom becomes an indication 
 of health. When these conditions are complied with, and 
 not till then, may physicians attempt to define ' insanity 
 in law ' as distinguishable from insanity in science ; in 
 the meantime he may rest contented with the dictum of 
 one of the best legal authorities, ' that that cannot be 
 sanity in law which is insanity in science, just as nothing 
 can be a fact in science and a fiction in law at one and 
 the same time.' " 
 
INSANITY. 333 
 
 The characteristic evidences of insanity are, by Dr. 
 Spitzka in his manual, for practical purposes, divided 
 into two groups: the somatic or physical indications, 
 and the mental symptoms proper. The physical symp- 
 toms furnish evidence of the physical nature of the 
 disorder, and are indications for medical treatment. It 
 is, however, beyond the scope of this work to consider 
 them in this place ; for details upon this subject, see 
 the treatises of Drs. Spitzka and Hammond. We may, 
 however, in this connection mention, as frequent ac- 
 companiments of insanity, certain disturbances of sen- 
 sibility; the facts that the functions of the intestinal 
 canal in some forms of insanity show great disturbance, 
 that the condition of the skin and its secretions are 
 sometimes greatly altered ; anomalies of appetite ; mo- 
 tor and trophic disturbances, etc. 
 
 The mental symptoms proper, while furnishing hints 
 for moral treatment, are principally valuable for general 
 diagnostic and medico-legal purposes, and to these our 
 attention will at present be confined. 
 
 The principal mental symptoms are the existence 
 of hallucinations, illusions, delusions, incoherence, de- 
 lirium, imperative conceptions, morbid propensities, a 
 variety of emotional disturbances, and various disturb- 
 ances of the memory, the consciousness, and the will. 
 We do not mean to be understood as saying that all or 
 any considerable number of these symptoms are to be 
 expected in any one case, nor that any one may be con- 
 sidered as a criterion of the existence of insanity. 
 
 It may perhaps be well to define some of these 
 symptoms, although little more can be attempted in 
 this connection than a definition. 
 
334 MEDICAL JURISPRUDENCE. 
 
 An iUusion is defined by Dr. Hammond as being a 
 false perception of a real sensorial impression. Illusions 
 of all senses, but especially of sight: and hearing, are 
 found in insanity, and particularly in acute forms with 
 delirium. Persistent presence of illusions, while not 
 conclusive evidence of insanity, is evidence of brain 
 disease, which, if it has not alre9,dy caused insanity, 
 may do so at any time. 
 
 An hallucination is defined by the same author 
 as a false perception without any material basis, and 
 therefore centric in its origin. These are always evi- 
 dences of cerebral disease, and common phenomena of 
 insanity. 
 
 A delusion exists where an illusion or hallucination 
 is accepted and acted upon as real, and of the falsity 
 of which the patient cannot be convinced. It is de- 
 fined by Dr. Spitzka as a faulty belief out of which 
 for the time being the subject cannot be reasoned by 
 adequate methods. 
 
 The existence of delusions was formerly regarded as 
 the true criterion of insanity. This rule was laid down 
 by Sir John Nichol in the celebrated case of Bew vs, 
 Clarke ; but it cannot now be regarded as sound, inas- 
 much as there are undoubtedly cases of insanity in 
 ■which there is no delusion. Where a delusion exists^ 
 however, it is clear evidence of insanity, provided it 
 relates to a matter of fact, as distinguished from faith, 
 and is contrary to the customary mode of thought of 
 the individual, and held in opposition to such evidence 
 as is logically opposed thereto. Where, however, a de- 
 lusion, though based partly on f3,ith, urges the subject 
 to do some criminal act of violence, as, for instance, to 
 
INSANITY. 335 
 
 sacrifice his son, — this would be considered an insane 
 delusion. 
 
 Spitzka divides delusions into two classes, genuine 
 and spurious ; the former of which have been princi- 
 pally created by the patient himself, and the latter 
 adopted from others. Genuine delusions are again 
 divided by this author into systematized and unsys- 
 tematized. 
 
 Incoherence needs no definition ; it appears to be 
 due to an inability to concentrate the attention, or to 
 a lack of power in co-ordinating the different parts of 
 the brain concerned in the formation and expression 
 of ideas. It will generally be found some time or other 
 in cases of acute mania, and is common in imbecility 
 and in chronic insanity of any kind. 
 
 Delirium is defined by Dr. Hammond as being that 
 condition in which there are illusions, hallucinations, 
 delusion, and incoherence, together with a general ex- 
 cess of motility, and inability to sleep, and accelei'ation 
 of pulse. It is commonly found in the first stage of 
 acute mania, although it may exist at the beginning 
 of any kind of insanity. 
 
 Morbid propensities and imperative conceptions, lead- 
 ing to what is called morbid impulse, are character- 
 istics of those groups of insanity called pyromania, 
 ■where there is a morbid impulse to commit arson, klep- 
 tomania, to steal, etc. The acts arising from these 
 morbid impulses have been made by some writers the 
 foundation of many different classes of insanity ; these 
 terms are perhaps convenient as a means of designating 
 the leading symptoms of particular cases of insanity, 
 but as a basis of classification are of little value. • 
 
336 MEDICAL JURISPRUDENCE. 
 
 Emotional disturbances exist almost universally in 
 the insane. Spitzka lays it down as a cardinal canon 
 of psychiatry that in insanity the moral feelings are 
 usually more or less dulled or perverted. 
 
 The memory often suffers temporary disturbance in 
 cases of acute and transitory forms, and in exacerba- 
 tions of chronic forms. In terminal deterioration there 
 is a progressive and permanent loss of memory. 
 
 Disturbances of consciousness may rarely result in a 
 change in the sense of identity, and in the rare con- 
 dition of double or alternating consciousness. 
 
 The will some time or other in the progress of the 
 disease more or less disturbed in all cases of insanity. 
 
 Classification. — There are almost as many different 
 systems of classification of the various forms of in- 
 sanity as there are writers upon this subject. Classi- 
 fications have been made in a variety of methods, 
 depending on the standpoint from which the subject 
 has been viewed. Insanity has thus been classified 
 from the anatomical, physiological, etiological, psycho- 
 logical, pathological, and clinical or symptomatological 
 standpoint. Considering the imperfect state of our 
 knowledge upon the subject, the classification based 
 upon the clinical or symptomatological characteristics 
 of insanity would seem to be the most practical, and 
 it is at the present time, perhaps, the system of classi- 
 fication adopted by the best authors. With advancing 
 knowledge it is very likely that a new and more satis- 
 factory classification may be made in some one of the 
 other different methods above specified, but at present 
 it does not seem possible. 
 
 We can in this connection do little more than repro- 
 
INSANITY. 337 
 
 duce the leading classifications of Krafift-Ebing, and of 
 the three leading American- writers upon this subject, — 
 Dr. Spitzka, Dr. Hammond, and Dr. Eay. 
 The classification of Krafft-Ebing is as follows : — 
 
 A. Mental afieotions of the developed train. 
 
 I. Psychoneurosea. 
 
 1. Primary curatle' conditions. 
 
 a. Melancholia. 
 
 a. Melancholia passiva. 
 $. Melancholia attonita, 
 
 b. Mania. 
 
 a. Maniacal exaltation. 
 0. Maniacal frenzy. 
 
 c. Stupor. 
 
 2. Secondary incurable states. 
 
 a. Secondary monomania (secundaere verrueoktheit), 
 
 b. Terminal dementia. 
 
 a. Dementia agitata. 
 p. Dementia apathetioa. 
 II, Psychical degenerative states. 
 
 a. Constitutional affective insanity (folie raissonante). 
 
 b. Moral insanity. 
 
 c. Primary monomania (primaere verruecktheit). 
 
 a. With delusions. 
 
 aa. Of a persecutory tinge. 
 
 J3j3. Of an ambitious tinge. 
 j8. With imperative conceptions. 
 
 d. Insanities transformed from the constitutional neuroses. 
 
 o. Epileptic. 
 
 /3. Hysterical. 
 
 y. Hypochondriacal. 
 
 e. Periodical insanity. 
 
 III. Brain diseases, with predominating mental symptoms. 
 
 a. Dementia paralytica. 
 
 b. Lues cerebralis. 
 
 c. Chronic alcoholism. 
 
 d. Senile dementia. 
 
 e. Acute delirium. 
 
 B. Mental results of arrested brain development : idiocy and cretinism. 
 
 22 
 
338 MEDICAL JURISPRUDENCE. 
 
 Dr. Spitzka's classification is as follows : — 
 
 GROUP FIRST. — PURE INSAKITIES. 
 Sub-Gkoup a. 
 Simple Insanity, not essentially the manifestation of a constitutional 
 neurotic condition. 
 
 First Class. 
 Not associated with demonstrable active organic changes of the brain. 
 
 I. Division. Attacking the individual irrespective of the physiologi- 
 
 cal periods, 
 a. Order, Of primary origin. 
 Sub-Order A. Characterized by a fundamental emotional disturbance. 
 
 Genus 1 : of a pleasurable and expansive character, — simple mania. 
 
 Genus 2 : of a painful character, — simple melancholia. 
 
 Genus 3 : of a pathetic character, — katatonia. 
 
 Genus 4 : of an explosive, transitory kind, — transitory frenzy. 
 Sub-Order B. Not characterized by a fundamental emotional dis- 
 turbance. 
 
 Genus 5 : with simple impairment or abolition of mental energy, 
 — stuporous insanity. 
 
 Genus 6 : with confusional delirium, — primary confusional insanity. 
 
 Genus 7 : with uncomplicated progressive mental impairment, — 
 primary deterioration. 
 /3 Order. Of secondary origin. 
 
 Genus 8 : secondary confusional insanity. 
 
 Genus 9 : terminal dementia. 
 
 II. Division. Attacking the individual in essential connection with 
 
 the developmental or involutional periods. (A single order. ) 
 Genus 10 : with senile involution, — senile dementia. 
 Genus 11: with the period of puberty, — insanity of pubescence 
 
 (hebephrenia). 
 
 Second Class. 
 Associated with demonstrable active organic changes of the brain. 
 (Orders coincide with genera.) 
 Genus 12 : which are diffuse in distribution, primarily vaso-motor 
 in origin, chronic in course, and destructive in their results, — 
 paretic dementia. 
 
INSANITY. 339 
 
 Genus 13 : having the specific luetic character, — syphilitic de- 
 mentia. 
 
 Genus 14 : of the kind ordinarily encountered by the neurologist, 
 such as encephalo-malacia, haemorrhage, neoplasms, meningitis, 
 parasites, etc., — dementia from coarse brain disease. 
 
 Genus 15 : which are primarily congestive in character and furi- 
 bund in development, — delirium grave (acute delirium, manie 
 grave). 
 
 Sub-Gboup B. 
 
 Constitutional Insanity, essentially the expression of a continuous 
 neurotic condition. 
 
 Third Class, 
 Dependent on the great neuroses. (Orders and genera coincide.) 
 
 I. Division. The toxic neurose-s. 
 
 Genus 16 : due to alcoholic abuse, — alcoholic insanity. 
 (Analogous forms, such as those due to abuse of 
 opium, the bromides, and chloral, need not be 
 enumerated here, owing to their rarity.) 
 
 II. Division. The natural neuroses. 
 
 Genus 17 : the hysterical neurosis, — hysterical insanity. 
 Genus 18 : the epileptic neurosis, — epileptic insanity. 
 
 Fourth Class. 
 Independent of the great neuroses (representing a single order). 
 
 Genus 19 : in periodical exacerbations, — periodical insanity. 
 
 „ , i , , 1 J. ( Genus 20 : idiocy and imbecOity. 
 
 Order: arrested developments „ _, ^r. 
 
 ( Genus 21 : cretmism. 
 
 Genus 22 : manifesting itself in primary dissociation of the mental 
 
 elements or in a failure of the logical inhibitory power, or of 
 
 both, — paranoia (monomania). 
 
 GEOUP SECOND. — COMPLICATING INSANITIES. 
 
 These may be divided into the following main orders, which, as a 
 general thing, are at the same time genera : Traumatic, Choreic, Post- 
 febrile, Eheumatic, Gouty, Phthisical, Sympathetic, Pellagrous. 
 
340 MEDICAL JURISPRUDENCE. 
 
 Dr. Hammond's classification is as follows : — 
 
 I. Pereeptional Insanities. Insanities in wMoh there are derange- 
 ments of one or more of the perceptions. 
 
 a. Illusions. 
 
 b. Hallucinations. 
 
 II. Intellectual Insanities. Forms in which the chief manifestations 
 of mental disorder relate to the intellect, being of the 
 nature of false conceptions (delusions) or clearly abnor- 
 mal conceptions. 
 
 a. Intellectual monomania with exaltation. 
 
 b. Intellectual monomania with depression. 
 
 c. Chronic intellectual mania. 
 
 d. Reasoning mania. 
 
 e. Intellectual subjective morbid impulses. 
 
 f. Intellectual objective morbid impulses. 
 
 III. Emotional Insanities. Forms in which the mental derangement 
 
 is chiefly exhibited with regard to the emotions. 
 
 a. Emotional monomania. 
 
 b. Emotional morbid impulses. 
 
 c. Simple melancholia. 
 
 d. Melancholia with delirium. 
 
 e. Melancholia with stupor. 
 
 f. Hypochondriacal mania, or melancholia. 
 
 g. Hysterical mania, 
 h. Epidemic insanity. 
 
 IV. Volitional Insanities. Formscharacterizedby derangement of the 
 
 will, either by its abnormal predominance or inertia. 
 
 a. Volitional morbid impulses. 
 
 b. Aboulomania (paralysis of the will). 
 
 V. Compovmd Insanities. Forms in which two or more categories 
 of mental faculties are markedly involved. 
 
 a. Acute mania. 
 
 b. Periodical insanity. 
 
 c. Hebephrenia. 
 
 d. Circular insanity. 
 
 e. Katatonia. 
 
 f. Primary dementia. 
 
INSANITY. 
 
 341 
 
 g. Secondary dementia. : m 
 
 h. Senile dementia. 
 
 i. General paralysis. 
 VI. ConstUiUional Insanities. Forms which are the result of a pre- 
 existing physiological or pathological condition, or of 
 some specific morbid influence affecting the system. 
 
 a. Epileptic insanity, 
 
 b. Puerperal insanity. 
 
 c. Pellagrous insanity. 
 
 d. Choreic insanity, etc. 
 VII. Arrest of Mental Vevdopment. 
 
 a. Idiocy. 
 
 b. Cretinism. 
 
 Inasmuch as Dr. Eay's classification has long been 
 before the profession,, and has been adopted in whole or 
 in part by many other writers, we reproduce it in this 
 connection as follows : — 
 
 ' 1. Resulting from con- 
 genital defect. 
 2. Resulting from an ob- 
 stacle to the develop- 
 ment of the faculties 
 supervening in infancy. 
 
 1. Resulting from con- 
 genital defect. 
 
 2. Resulting from an ob- 
 stacle to the develop- 
 
 Insanity. ■ ment of the faculties 
 
 supervening in infancy. 
 
 Intellectual, i J- ^^°«''^- 
 ( 2. Partial. 
 
 {1. General. 
 2. Partial. 
 
 1. Consecutive to mania, 
 or injuries of the 
 brain. , 
 
 2. Senile, peculiar to old 
 
 DefectiTe devel- 
 opment of the 
 faculties. 
 
 Lesion of the 
 faculties sub- 
 sequent to 
 their develop- 
 ment. 
 
 Idiocy. 
 
 Imbecility. 
 
 Mania. - 
 
 Dementia. 
 
 Affective. 
 
342 MEDICAL JUEISPRUDENCE. 
 
 With respect to the subject of classification Dr. Eay 
 observes that "it is not pretended that any classifica- 
 tion can be rigorously correct, for such divisions have 
 not been made by nature and cannot be observed 
 in practice. Diseases are naturally associated into some 
 general groups only, and if these be ascertained and 
 brought into view, the great end of classification is ac- 
 complished. We shall often find them run into each 
 other, and be puzzled to assign to a particular disease 
 its proper place." 
 
 With reference to Dr. Eay's classification, which with 
 some modifications is that' adopted by Esq[uirol, it is to 
 be observed that it is at present, as it seems to the 
 writer, too narrow in its limits, and does not include 
 many well-recognized forms of insanity. 
 
 Dr. Hammond's classification is not claimed by him 
 to be perfect. Its several groups are not, so he says, 
 in aU cases clearly separated from each other. Particular 
 forms of insanity, in his classification, are placed in the . 
 divisions indicated respectively; by their chief manifes- 
 tations of mental disorder. 
 
 The classification of Krafft-Ebing is objectionable on 
 account of his making to some extent curability and in- 
 curability the basis of the same, as well as on other ac- 
 counts which will be found well stated by Dr. Spitzka 
 in Chapter XI. of his manual. 
 
 So far as we have been able to understand the subject, 
 the classification of Dr. Spitzka, whQe somewhat more 
 complex than other systems, appears to be the most 
 scientific, and more exhaustive than any other classifica- 
 tion which has been proposed. But as we have already 
 stated, any classification made in the present state of our 
 
INSANITY. 343 
 
 knowledge will probably be of comparatively temporary 
 value, and must be modified with the advance of our 
 knowledge of the subject. 
 
 We can in the further consideration of this subject 
 do little more than define the principal sorts of insanity ; 
 and we desire here generally to express our indebtedness 
 in this respect to the manual of Dr. Spitzka, to whose 
 work we refer the reader for detailed descriptions of the 
 different types of insanity. 
 
 Mania is a form of insanity characterized by an 
 exalted emotional state, which is associated with a cor- 
 responding exaltation of other mental and nervous 
 functions. 
 
 The typical condition of the maniac may be summa- 
 rized in one phrase, — loosem'ng of the inhibitions, or 
 checks, both of organic and of mental life. The percep- 
 tions appear more acute ; the associations are quick, so 
 rapid, indeed, that the ease with which the patient forms 
 new and extravagant combinations, and the readiness with 
 which novel suggestions present themselves, impress the 
 novice as manifestations of a naturally quick wit, or of a 
 talented and original mind. Illusions are frequent, and 
 hallucinations sometimes present. With the excitement 
 in the sensorial, intellectual, and vegetative spheres, 
 there develops a corresponding condition of the motor 
 apparatus. Sometimes no furious stage is developed, 
 and hallucinations are absent. The outbreak of mania 
 is rarely, if ever, sudden or rapid ; its duration varies, an 
 average case having an initial stage of depression lasting 
 about six weeks, a maniacal period of about three 
 months, while the period of convalescence will occupy 
 about a fortnight. Its prognosis is very favorable. 
 
344 MEDICAL JURISPRUDENCE. 
 
 Melancholia is a form of insanity whose essential and 
 characteristic feature is a depressed, that is, subjectively 
 arising painful emotional state, -which may be associated 
 -with a depression of other nervous functions. At its 
 , height it is the antithesis of mania. The common basis 
 upon which the symptoms in aU melancholiacs develop 
 is the subjective painful emotion. Unsystematized de- 
 lusions of a depressive nature are the most common 
 symptoms. The delusions of the melancholiac may be 
 modified by sensory disturbances,^ such as neuralgias, 
 anaesthesias, or disordered smeU and tasta Hallucina- 
 tions are very common. 
 
 At some stages in the disorder the patient may be- 
 come restless from fear, and spurious states of fury may 
 thereby be developed. In mania the outbreak is the 
 result of an expansive or angry emotion ; while in 
 melancholia, the outbreak best known as melanehoUc 
 frenzy is the outcome of an anxious terror. This mel- 
 ancholic frenzy is of shorter duration than maniacal 
 furor, and unlike the latter, it termhiates suddenly. 
 
 The average duration of melancholia is from three to 
 eight months, although it may last years. Its prognosis 
 is less favorable than that of mania, although about six 
 out of ten patients completely recover. 
 
 Katatonia is a form of insanity characterized by a 
 pathetical emotional state, and verbigeration, combined 
 with a condition of motor tension. According to 
 Dr. Hammond, it is characterized by alternate periods, 
 supervening with more or less regularity, of acute mania, 
 melancholia, and epileptoid and cataleptoid states, with 
 delusions of an exalted character and a tendency to 
 dramatism. Its most striking phenomena are its cata- 
 
INSANITY. 345 
 
 leptoid periods. Its prognosis is favorable as regards 
 life. 
 
 Transitory frenzy is a condition of impaired conscious- 
 ness characterized by either an intense maniacal fury or 
 a confused hallucinatory delirium, whose duration does 
 not exceed a period of a day or thereabouts. This 
 condition is designated by some observers as transitory 
 mania, by others transitory melancholia ; others have 
 classed it among epileptic disorders. Dr. Spitzka 
 prefers the term "transitory frenzy," in view of the 
 specific feature of amnesia, and because this term com- 
 mits to no doubtful hypothesis and best expresses the 
 leading symptom of the disorder. It is a comparatively 
 rare affection. Insolation, prolonged insomnia, exposure 
 to extreme cold, violent emotional and intellectual strain, 
 have frequently been determined to have been the ex- 
 citing causes. 
 
 Stuporous insanity consists in the simple impairment 
 or suspension of the mental energies, unmarked by any 
 emotional or other perversion. At the height of this 
 disorder the patient is in , a state of immobility, and 
 does nothing of his own initiative. Sensibility is im- 
 paired as much as mobility; the reflex acts are some- 
 times greatly impaired; the pupils are dilated, and 
 react poorly ; the pulse is tardy, small, and frequent ; 
 the temperature slightly lowered; the extremities are 
 cold, while csdema of the feet is constantly, and of the 
 hands and face sometimes, observed ; mental activity 
 shares in the depression, and abolition of other ner- 
 vous and general somatic functions. The stuporous 
 lunatic's recollection of the period of his illness is en- 
 tirely destroyed. 
 
346 MEDICAL JURISPRUDENCE. 
 
 This disease may run its course in a few weeks, but 
 its usual duration is from one to three months. Its 
 prognosis is highly favorable, nine-tenths of the pa- 
 tients recovering. This disorder is known in English 
 and American asylums as acute or primary dementia. 
 
 Primary confusional insanity is a form of mental de- 
 rangement characterized by incoherence and confusion 
 of ideas, without any essential emotional disturbance or 
 true dementia. This disorder is rare, and develops 
 rapidly on a basis of cerebral exhaustion. Patients suf- 
 fering from this disease after a rapid rise of their symp- 
 toms during a period of incubation rarely exceeding 
 a few days, present hallucinations and delusions of a 
 varied and contradictory character. Delusions of iden- 
 tity are very common. The speech of the patient is 
 characteristic; sentences are left incomplete, and are 
 entirely irrelevant as well as incoherent. Eecovery is 
 gradual ; in only a small proportion of cases does the 
 insanity remain and the patient become permanently 
 deteriorated, his disorder then constituting a form of 
 chronic confusional insanity. 
 
 Primary mental deterioration is an uncomplicated 
 enfeeblement of the mind, occurring independently of 
 the developmental and involutional periods. In most 
 persons surviving their sixtieth year, a pronounced and 
 general failure of the mental powers occurs at or after 
 that period ; this is the ordinary senile change and 
 cannot be considered in all cases pathological; but 
 where a similar deterioration anticipates the senile 
 period, it can only be accounted for on a pathological 
 basis. Such a decay of mind is observed in paretic, 
 syphilitic, and organic dementia, and is also found to 
 
INSANITY. 347 
 
 be the sequel of numerous other forms of insanity. In 
 all these cases the mental failure is accompanied by 
 active symptoms characterizing the given variety of 
 mental disorder. 
 
 In primary mental deterioration, however, progressive 
 deterioration is chiefly Kmited to the higher mental 
 faculties, and is the only notable indication of cerebral 
 disturbance. The patient experiences a lack of energy 
 both mental and physical; finds it difficult to go to 
 sleep; there is an irritable condition of the brain mani- 
 festing itself in dreams ; the patient becomes dyspep- 
 tic, and there may be signs of functional or organic 
 heart disorder, or of the prodromal period of Bright's 
 disease. At this stage a comparatively healthful men- 
 tal state may be regained by rest and proper treatment ; 
 but if the exciting causes, which are principally excite- 
 ment and mental strain, are kept in operation, actual 
 dementia may follow. There are no delusions or mor- 
 bid propensities, although there may be occasionally a 
 suicidal tendency. Complete rest and proper tonic and 
 moral treatment will check the disease at any but its 
 later periods; but a complete restoration to the pa- 
 tient's former condition. Dr. Spitzka says he has never 
 observed, even the most favorable cases revealing some 
 -permanent damage. 
 
 Secondary and Terminal Deterioration. — In certain 
 cases of mania, melancholia, stuporous, and other pri- 
 mary forms of insanity, while death does not ensue, the 
 patient does not recover, but a secondary and chronic 
 psychosis develops from the primary disease. Terminal 
 dementia is the ordinary conclusion of most chronic 
 and uncured acute insanities. Numerous grades and 
 
348 MEDICAL JURISPRTJDENCE. 
 
 varieties of this affection exist, and it is customary in 
 characterizing these varieties to state the primary. form 
 which preceded them. The residua of the delusions of 
 primary insanity may sometimes be detected. 
 
 Dementia, must not be confounded with imbecility. 
 While both dementia and imbecility imply a profoimd 
 defect in the mental sphere, the former term should 
 always be limited to acquired imbecility, and the latter 
 to original feeblemindedness due to foetal or infantile 
 arrested development. The fundamental feature of ter- 
 minal dementia is an acquired mental defect, which 
 may vary from mere loss, of memory, usually of recent 
 events, or of the reasoning power, to a nearly complete 
 extinction of mind, and a reduction of the patient to a 
 mere vegetative existence. 
 
 Senile demenaai is a progressive and primary dete- 
 rioration of the mind connected with the period of 
 involution, but exceeding the ordinary extent of such 
 involution to a pathological degree. It is characterized 
 by an increased egotism or by penuriousness, enfeeble- 
 ment of memory, prejudices formed on trivial or no 
 ground, and frequently a profound moral deterioration. 
 Unsystematized ambitious delusions are sometimes pres- 
 ent, although the majority have depressive delusions, 
 chiefly in respect to their property. Hallucinations 
 and illusions may exist. 
 
 Should no other intercurrent illness cut short the 
 course of the disease, bed-sores and colliquative diar- 
 rhoeas, complicated sometimes with diseases of the 
 bladder, terminate the patient's life. If the patient 
 lives long enough, complete fatuity rasults, when he 
 
 1 Senile dementia and senQe insanity are not convertible terms. 
 
INSANITY. 349 
 
 may become voracious and filthy, to die finally with 
 apoplectiform symptoms, or with those of a gradual and 
 general paralysis. 
 
 Insanity of pubescence (hebephrenia) is characterized 
 by mental enfeeblement marked by a silly disposition, 
 following a primary period of depression which has the 
 same tinge as, but without the depth of, that character- 
 izing melancholia, and which coincides with or follows 
 the period of puberty. It occurs between the fifteenth 
 and twenty-second year, and begins with a period of 
 sadness without, however, the depth of depressive emo- 
 tion of melancholia, and in the midst of which there 
 may be sudden outbursts of causeless laughter or siUy 
 jokes. After this preliminary period the patients may 
 exhibit vague or blind propensities ; have no settled 
 aim, or may display stupid malice towards their sur- 
 roundings. While there is no incoherence there is a 
 peculiar tendency to verbosity and the use of long 
 words or such as have an odd sound, etc; The in- 
 tellect weakens progressively and the patient, who is 
 usually a confirmed masturbator, gradually passes into 
 a terminal dementia. Everything connected with the 
 mental state of these patients appears shallow and even 
 unreal. 
 
 The course of this form of insanity is protracted, and 
 its prognosis exceedingly unfavorable. Many of the 
 cases are still classed as primary dementia, particularly 
 when the deterioration is very rapid. Where masturba- 
 tion is! a pronounced feature, some writers use the 
 designation " insanity of masturbation." 
 
 Paretic Dementia. — The cases of insanity thus far de- 
 scribed have been those whose essential characteristics 
 
350 MEDICAL JURISPRUDENCE. 
 
 are the mental symptoms proper. We now come to a 
 second class of cases, in which there are demonstrable 
 active organic changes of the brain. The first of these 
 diseases to which we shall refer is paretic dementia, a 
 disease presenting so many diverse symptoms and char- 
 acteristics that we cannot hope, with the limited space at 
 our disposal, to describe it with anything like complete- 
 ness. It is characterized in its full development by a 
 combination of mental and somatic deteriorations ; the 
 brain and the spinal cord of patients dying with this 
 disease, show the results of long continued and often 
 intense degenerative morbid processes, which many 
 authors regard as of an inflammatory character. The 
 brain itself is found to be wasted, — not • uniformly so, 
 however, but to a more marked degree in some, and to a 
 less marked degree in other districts. A very frequent 
 appearance in advanced paretic dementia is cystic de- 
 generation of the cortex of the brain. But for details 
 upon this subject reference is made to Chapter XIII. of 
 Dr. Spitzka's manual. 
 
 The mental symptoms of this disease generally pre- 
 sent the picture of unsystematized ambitious delusions, 
 combined with progressive paresis and dementia ; they 
 may range, however, from atonic depression to the most 
 furious delirium ; from the construction of fanciful pro- 
 jects to extreme incoherency; from slight and almost 
 undemonstrable mental impairment to the absolute ex- 
 tinction of higher mental life. The physical signs may 
 vary from a slight disturbance of speech to gross 
 paralysis, or may present themselves under the mask 
 of a posterior spinal sclerosis (locomotor ataxia), of a 
 disseminated organic disease, or of apoplectiform and 
 
INSANITY. 351 
 
 epileptiform seizures. Among the individual signs 
 there may be found almost any and every focal and 
 general symptom known to the neurologist : paresis 
 of various voluntary and involuntary muscles ; anaesthe- 
 sias, parsesthesias, hyperaesthesias, pains, and trophic 
 disturbances ; changes in the vascular tone ; amblyopia, 
 hemiopia, color-blindness, aphasia, choreiform and athe- 
 toid movements; progressive muscular atrophy ; pseudo- 
 , hypertrophic, and bulbar paralysis. All these may be 
 found co-existent with the mental disorder and, indeed, 
 depending on the same morbid process. 
 
 The mental symptoms of the prodromal period are 
 attributable to simple brain failure ; the attention is not 
 readily aroused ; amnesia is noted from the beginning.; 
 there is more or less moral deterioration ; there is a mor- 
 bid irritability on slight provocation; simultaneously 
 with this moral deterioration is a disturbance of the will 
 and emotional nature. 
 
 In the active phase there are marked exacerbations 
 of the physical signs ; there are defects in the movement 
 of the tongue and lips, so that the patient finds it difficult 
 to pronounce, particularly the explosive and hissing 
 sounds. A most characteristic feature is the association 
 of other normally unnecessary movements with those of 
 the lips and tongue ; there is a tremor at the angles of 
 the mouth ; alternate dilation and contraction of the nos- 
 trils ; corrugation of the eye-brows, etc., after which the 
 word is thrown out precipitately. With these speech 
 innervations all the finer motor co-ordinations seem to 
 suffer. The depressive moods of the patient and com- 
 plaints about head symptoms, if they existed, usually 
 disappear about this time. Unsystematized delusions 
 
352 MEDICAL JUEISPEUDENCE. 
 
 of grandeur appear, and are often joined with morbid 
 projects and extravagant expenditures. Trophic dis- 
 turbances and all the motor disturbances become more 
 and more marked ; bed-sores, furuncles, diaiThceas, pul- 
 monary gangrene, etc., may supervene. Apoplectiform 
 or epileptiform seizures sometimes mark the course of 
 the disorder from the beginning, to which the patient 
 may finally succumb. 
 
 The delusions of paretic dements although usually are 
 not always expansive, but on the contrary may be de- 
 pressive in their Jiature. Hallucinations and illusions 
 sometimes exist. 
 
 There are three sorts of episodical attacks to which 
 paretic dements are subject, which are among the most' 
 important signs of this disease, and which from their 
 resemblance to maniacal delirium, epileptic fits, and 
 apoplectic diseases, are called, respectively, maniacal, 
 epileptiform, and apoplectiform, attacks of paretic de- 
 mentia. Tor a particular description of these, the reader 
 is referred to Dr. Spitzka's manual. 
 
 The prognosis of paretic dementia is very bad ; there 
 are, however, a few cases where there appears to have 
 been a permanent recovery. The duration of the dis- 
 ease is commonly within three years, and in some cases 
 it may terminate as soon as six months, although in 
 other cases the disease may continue for six, or even ten 
 years. 
 
 Syphilitic dementia bears a strong resemblance to pare- 
 tic dementia, and to dementia from organic brain dis-. 
 ease. In this disease demonstrable brain lesions, standing 
 in constant relation to the symptoms, are found in a ma- 
 jority of cases. It is not always possible, clinically, to 
 
INSANITY. 353 
 
 make a sharp discrimination between syphilitic de- 
 mentia and paretic dementia proper; syphilis plays a 
 prominent r61e in the etiology of the latter affection. 
 Delusions are not prominent and are rarely expansive. 
 After a prodromal period the course of the disease pro- 
 gresses very slowly towards a fatal termination. 
 
 Delirium grave is a comparatively rare form of de- 
 rangement, approximating in many respects to maniacal 
 deUrium. It has been variously termed, typhomania, 
 mania gravis, phrenitis, and acute delirium. It is 
 preceded and undoubtedly caused by profound nervous 
 or physical exhaustion and over-strain. Its mental 
 symptoms resemble the highest degrees of maniacal 
 furor and melancholic frenzy, but differ from these states 
 in their mode of development, in that the outbreak of 
 grave delirium is either sudden or preceded by a state 
 of impaired consciousness of a kind not found in mania 
 or melancholia proper. The ideation of grave delirium 
 is much more incoherent than that of frenzy, and is 
 usually the expression of an angry or frightened state. 
 At the outset the patient may still articulate sentences, 
 but his speech rapidly deteriorates and he is finally un- 
 able to pronounce syllables. The patients appear to 
 be afBicted with hallucinatory visions, of the day of 
 judgment, of conflagrations, of bloody scenes, or of those 
 connected with the exciting cause. There is great rest- 
 lessness ; sometimes there are rhythmical motions ; in 
 many cases there is absolute insomnia. 
 
 The second period of the disease is analogous to the 
 post-maniacal reaction following the outbreak of simple 
 mania ; there is now extreme mental and physical de- 
 pression. If the patient does not die in this condition, 
 
 23 
 
354 MEDICAL JURISPRUDENCE. 
 
 he pas-ses into a state resembling convalescence from 
 typhus, -without the favorable termination of the latter. 
 The majority of patients afflicted with this disease die 
 in a delirious state within a few weeks. In those who 
 do not die within this period the excitement continues 
 without abatement four or five weeks, and the case ends 
 with fatal coma. Complete recovery rarely occurs : in 
 rare instances the patients emerge from the disease with 
 a slight mental defect ; in other cases paretic and ter- 
 minal dementia supervene. 
 
 Chronic Alcoholic Insanity. — Insanity resulting from 
 alcoholic excesses ordinarily belongs to groups already de- 
 scribed. The various states of drunkenness and delirium 
 tremens are not ordinarily considered insanity. There 
 are also various forms of dementia depending on organic 
 changes produced by alcohol in the brain and its mem- 
 branes which pertain to the group of dementia from 
 organic disease. Just as epileptic and hysterical in- 
 sanity may develop from the epileptic or hysterical 
 neuroses, so a special form of alcoholic insanity may 
 become engrafted on the alcoholic neurosis. It has dis- 
 tinct clinical characters, and is called chronic alcoholic 
 insanity. 
 
 On the chronic alcoholic constitution as a background, 
 with which most readers are sufficiently familiar, is 
 developed the psychosis of chronic alcoholic insanity. 
 After a brief prodromal period, marked by congestive 
 attacks and headaches, and under the influence of fright- 
 ful hallucinations, chiefly of visions, the patient becomes 
 the subject of delusions of persecutions, to which are 
 rarely added expansive delusions. The persecutory de- 
 lusions of alcoholism relate to the sexual organs, sexual 
 
INSANITY. 355 
 
 relations, and to poisons. Many inebriates entertain also 
 delusions of marital infidelity. Delirious exacerbations 
 are likely to occur in consequence of the patient's mor- 
 bid fear. Similar hallucinations to those found in acute 
 alcoholic delirium may exist ; the patient may see snakes, 
 insects, dead bodies, mocking faces, etc. There is quite 
 constantly more or less disturbance of the memory, and 
 occasionally there is stupor. 
 
 The prognosis is very unfavorable, and there is a clear 
 tendency to dementia. 
 
 Chronic Hysterical Insanity. — The forms assumed by 
 hysteria are so manifold that anything like even a fuU 
 enumeration of them would be impossible. So with 
 chronic hysterical insanity. Its symptoms are various ; 
 the patients are changeable, emotional, fretful, careless, 
 and superficial in their behavior and thoughts, extremely 
 egotistical, and desirous of notoriety or sympathy, or 
 both. To be the sufferer from an equally interesting, 
 rare, and hopeless nervous disease is the ambition of 
 some ; to be considered the most abused woman on 
 earth is the ambition of others. A patient with this 
 hysterical character may develop psychoses quite analo- 
 gous to those found in epileptic and alcoholic patients. 
 There may be a transitory hysterical psychosis mani- 
 festing itself in deliria of fear ; so we may have maniacal 
 and melancholic states. The psychosis in hysteria may 
 be protracted in duration, as in the alcoholic disorder. 
 There is a tendency to simulate a theatrical behavior ; 
 there is an intensification of the hysterical character, 
 to which is frequently added a silly mendacity. Sexual 
 ideas are common, and manifested in two opposite ex- 
 tremes ; hallucinations are frequent ; in some patients 
 
356 MEDICAL JURISPRUDENCE. 
 
 obstinate mutism is observed, whicb by skilful cross- 
 questioning will be found to be wilful. 
 
 A few cases of hysterical insanity and hystero- epilepsy 
 in males have been described. 
 
 The prognosis of this form of insanity is unfavorable 
 as to lasting recovery. 
 
 Epileptic Insanity. — Aside from epileptic dementia^ a 
 mental degeneration intimately dependent on the fre- 
 quency of the convulsive attacks, and which may deter- 
 mine stupor, imbecility, or actual idiocy, according as 
 these attacks begin later or earlier in life, — aside also 
 from those attacks of furious madness replacing the con- 
 vulsive attack, and which may be regarded as psychical 
 equivalents of the convulsions, ^ there are forms of 
 more or less protracted insanity following some indi- 
 vidual epileptic attack, or breaking out in the interval, or 
 finally extending over the entire interval, which are to 
 be distinguished from the above forms. 
 
 Acute post-epileptic insanity may take the form of 
 simple post-epileptic stupor, which may be complicated 
 with dreamy deliria or with illusional or hallucinatory 
 confusion and verbigeration; or post-epileptic morbid 
 conditions of fear or fright, either simple or complicated 
 with delire raissonante or great excitement; or post- 
 epileptic maniacal moria, — a rare form, which closely 
 simulates ordinary acute mania. There are also cases 
 of chronic protracted epileptic insanity closely related 
 to the post-epileptic forms. 
 
 Dr. Spitzka suggests the following chronological classi- 
 fication of epileptic insanity : — 
 
 1. The epileptic psychical equivalent which replaces 
 the convulsive attack. 
 
INSANITY. 357 
 
 2. The acute post-epileptic insanity which almost 
 immediately follows the convulsive attack. 
 
 3. The pre-epileptic insanity which precedes the out- 
 break of the convulsive attack or its equivalent, and 
 increases up to the moment when the paroxysm 
 explodes. 
 
 4. The purely intervallary epileptic insanity which, 
 neither immediately folio wing nor preceding a paroxysm, 
 occurs in the interval between such. 
 
 ; Dr. Spitzka says it is possible for all these forms to 
 occur together, and in addition there is very apt to be 
 a background of protracted epileptic dementia ; it is only 
 where epilepsy is recent that the above forms are found 
 in an unmixed state. 
 
 The immediate prognosis of epileptic insanity is favor^ 
 able as regards the more acute explosions ; the protracted 
 forms are sometimes recovered from, but mental en- 
 feeblement is more likely to ensue than in the former 
 case. 
 
 Periodical Insanity is characterized by the recuiTcnce 
 of mental disorder at more or less regular intervals, the 
 attacks being separated by periods during which the 
 patient presents a state of apparent mental soundness. 
 An important characteristic of periodical insanity is the 
 similarity of the manifestations of the different attacks 
 in the same patient for long periods. The intervals 
 between these attacks are not always entirely lucid, but 
 rather sub-lucid. It may take the form of periodical 
 mania or periodical melancholia. 
 
 Periodical insanity does not always manifest itself 
 under the guise of a single form of derangement. There 
 is a subdivision, known as Circular Insanity, character- 
 
358 MEDICAL JURISPRUDENCE. 
 
 ized by the alternation of mania and melancholia in 
 regularly recurring cycles, the order of which varies in 
 different patients. As a rule, the mania and melancho- 
 lia correspond to each other in intensity, and, generally, 
 the shorter the cycle the more intense the symptoms 
 and the better the prognosis. Circular insanity gen- 
 erally begins at or about the age of puberty, and, 
 like other periodical insanities, is more frequent with 
 females than with males, is intractable to treatment, 
 and while not ordinarily leading to dementia, some 
 mental deterioration sooner or later is manifested. 
 
 The States of Arrested Development. — Under this 
 head are included the conditions known as idiocy, im- 
 beoiUty, and cretinism. They are usually divided into 
 three grades: a subject deprived of all higher mental 
 power, and who is unable to acquire the simplest ac- 
 complishments is termed an idiot ; one who is capable 
 of acquiring the simplest accomplishments, but who is 
 unable to exercise the reasoning power beyond the ex- 
 tent to which a child is capable, is termed an imbecile; 
 finally, there is a large class of subjects who are de- 
 fective in judgment, and in whom this defect is of simi- 
 lar origin to — though not as intense as — that of the 
 imbecile and idiot. These classes are not separated by 
 any distinct margin of demarcation, but shade indef- 
 initely from one class to the other. 
 
 In idiocy there is usually, besides the mental defect, 
 some deficiency in the peripheral organs or their func- 
 tions. Many idiots are deaf or mute, or both; some 
 are blind, and anaesthesia as well as anosmia has been 
 observed. They learn to walk late or not at all ; the 
 skeleton is usually poorly developed ; rachitis is com- 
 
INSANITY. 359 
 
 mon, and the somatic functions are generally imperfectly 
 performed ; the sexual organs particularly are found to 
 be rudimentary or deformed, and the sexual function 
 is usually in abeyance in idiots, although this is not 
 always the case. The imitative tendencies in idiots 
 are often very strong ; in imbeciles they may be util- 
 ized to make good artisans. In the lowest forms of 
 idiocy speech may be altogether absent or limited to 
 a few inarticulate sounds; in others, a few words or 
 short sentences may be acquired. Idiots rarely reach 
 maturity. 
 
 The mental state of the imbecile has been very well 
 expressed by the statement that "those mental co- 
 ordinations acquired in the course of a higher civiliza- 
 tion have not been formed in him." While defective 
 as to reasoning capacity, his emotional state may present 
 every analogy to that of healthy persons or approxi- 
 mate that of other forms of insanity. Moral defect is 
 a prominent feature of some cases. In Dr. Spitzka's 
 opinion the term " moral insanity " of authors should be 
 limited to this class of subjects, and a much better term 
 to use would, in his opinion, be " moral imbecility." 
 
 Morbid projects, imperative impulses, and morbid 
 egotism are common in some imbeciles, and in such 
 cases it may be difi&cult to decide whether they pertain 
 to the group of imbecility or of original monomania. 
 
 Both imbecility and idiocy are sometimes marked by 
 other disturbances of the nervous functions than those 
 comprised in the mind. Epilepsy is common ; spastic 
 symptoms, contractures, strabismus, peculiar speech- 
 defects, and stuttering sometimes exist. The condi- 
 tion of idiocy and imbecility is usually a stable one. 
 
360 MEDICAL JURISPEUDENCE. 
 
 although occasionally progressive deterioration is caused 
 by epileptic fits. 
 
 The mental phenomena of cretmic idiocy are like 
 those of ordinary idiocy. For further description of 
 this subject the reader is referred to Dr. Spitzka's Work, 
 and to other treatises on nervous and mental diseases. 
 
 Paranoia (Monomania) — Monomania, as it has hitherto 
 usually been called, or as Dr. Spitzka now terms it, 
 " paranoia," is a chronic form of insanity based on an ac- 
 quired or transmitted neuro-degenerative taint, and mani- 
 festing itself in anomalies of the conceptional sphere, 
 which, while they do not destructively involve the 
 entire mental mechanism, dominate it. 
 
 . The symptoms of classical paranoia may be numerous 
 or varied, or they may be few or limited in range. In 
 some patients, usually encountered without asylums, a 
 single imperative conception or impulse, or a delusive 
 suspicion which may never become organized into an 
 insane belief, may be the sole mental symptom. De- 
 lusional monomania is the most frequent form of this 
 disorder. The delusions of this form of monomania 
 are alone sufficient to characterize the disorder, and 
 when found serve to establish the diagnosis. They are 
 of the systematized variety. Delusions of persecution 
 are the most common ones ; hallucinations, particularly 
 of hearing, are very common. Their beliefs are almost 
 as numerous as the patients, but are all characterized 
 by the feature that the occurrences in the outer world 
 are anxiously examined by, the patient with a view of 
 tracing their connection with himself. Sometimes, as 
 the result of inward reflection and reasoning, there is 
 a rapid transformation of the delusions of persecution 
 
INSANITY. 361 
 
 into those of aggrandizement. The varieties ai-e nu- 
 merous. (For details see the larger treatises upon In- 
 sanity and Medical Jurisprudence.) 
 
 The outbreak of the disorder usually coincides with 
 some one of the physiological periods, such as puberty, 
 the second climacteric, pregnancy, and the puerperal 
 state. It is sometimes precipitated by sexual excesses, 
 and occasionally by visceral disease and fevers. 
 
 The prognosis is very unfavorable. The disease, 
 when not cured, remains stationary for years. Mental 
 deterioration, however, does not proceed rapidly, and 
 never reaches the degree of chronic confusional insanity 
 or terminal dementia unless there is some intercurrent 
 disease. 
 
 Simulation of Insanity. — Insanity may be simulated 
 by ignorant persons, or by persons who have had more or 
 less opportunity for observing or studying the disease. 
 In the former case detection is easy ; in the latter it 
 is more difficult, and there are recorded instances where 
 competent observers have been deceived by simulators. 
 (See instances narrated by Dr. Spitzka.) 
 
 A common test with some persons is that the simu- 
 lator does not repudiate his insanity as does the truly 
 insane person. Aside from the fact that the insane do 
 sometimes recognize their condition and exceptionally 
 admit it, this criterion is at present entirely worthless, 
 for the reason that many simulators now know that it 
 is by some considered as a test, and govern their actions 
 accordingly. 
 
 Usually the observer's attention will be directed to 
 the possibility of simulation by some inconsistency in 
 the clinical picture presented by the subject. Clearly 
 
362 MEDICAL JURISPRUDENCE. 
 
 marked cases of different kinds of insanity before de- 
 scribed, are very difficult to feign correctly in every 
 feature, and the simulator, through ignorance, will not 
 unfrequently confound different types of disease and 
 thus disclose the fraud. But there are some obscure 
 and mixed groups not easily recognized, in which a skil- 
 ful sinmlator may succeed in imposing upon even a 
 competent observer. 
 
 The existence or non-existence of a motive for simu- 
 lation wiU often throw much light upon the subject. 
 The simulator, by his adoption of the popular idea of 
 insanity, that the insane are either raving and inco- 
 herent, at all times and on all points, or in a condition 
 of fatuity, wiU thereby frequently reveal the fact of 
 simulation. A knowledge of the clinical features of 
 the different sorts of insanity will usually enable one 
 to expose such simulation. As a rule, the simulator, in 
 those quiet periods following upon his artificial excite- 
 ment, which are the expression of inability to maintain 
 the exacting efforts of simulation, does not recognize his 
 friends or surroundings, or recollect anything that oc- 
 curred about that period of time in which he has a 
 motive for making people believe he was irresponsible. 
 The true maniac, however, will be lucid in these very 
 periods, and will recollect his family and his friends per- 
 fectly well ; and if he has committed a crime, while he 
 may be acute enough to desire to conceal his recollection 
 of it, he will not, if the examination is led up to the 
 period of its commission, gradually claim to forget real 
 circumstances occurring before and after it, as does the 
 simulator. Aside from toxic, hysterical, and other tran- 
 sitory morbid conditions, it is only in epileptic mania 
 
INSANITY. 363 
 
 and in paretic dementia that such amnesia really oc- 
 curs; but here the physical signs or the history, or 
 both, will afford unmistakable evidence of these affec- 
 tions if they really exist. The simulator will also err 
 generally in allowing his feigned disorder to explode 
 and to recede too rapidly. 
 
 Another characteristic feature with many simulators 
 is the intensification of their symptoms when under 
 examination. The simulator also labors under the 
 mistake that the insane do not reason; too great a 
 degree of incoherence in a delusion justifies a doubt 
 of its genuineness. Persons feigning a quiet sort of 
 insanity usually attempt to imitate dementia. The 
 simulator of imbecility or dementia either talks more 
 confusedly than harmonizes with the thread of rea- 
 son he unwarily exhibits, or he talks less confusedly 
 than he should in the utter absence of a connecting 
 bond in his thoughts ; in short, he does not bal- 
 ance the defects in ideation and in their expression 
 properly. 
 
 The absence of insomnia and impaired digestion in 
 the acute psychoses is exceptional in real insanity, and 
 is, in that respect, a ground of suspicion. The simu- 
 lator's task is rendered difficult whenever he is kept 
 under continued observation. The best actor may fail 
 to adhere to his assumed character for days and nights 
 in succession. 
 
 Dr. Spitzka mentions the following special signs as 
 justifying the suspicion of simulation: — 
 
 1. Studious efforts to avoid looking at the physician 
 upon his entrance. 
 
 2. Extravagantly absurd answers to simple questions. 
 
364 MEDICAL JUEISPRUDENCE. 
 
 3. Taking a long time to answer q^uestions, and hesi- 
 tation in answering. 
 
 4. Furtively glancing when he supposes himself un- 
 watched to see if any one is approaching to necessitate 
 his being on guard. 
 
 5. A person feigning epileptic and somnambu- 
 listic states may recollect perfectly his feigned acts 
 and expressions, and carry them, into his quasi-lucid 
 period. 
 
 6. Bhythmical movements are made by certain simu- 
 lators which may have no analogy in insanity or are 
 out of harmony with the form . of mental disturbance 
 assumed. > 
 
 7. Simulators complain much more about odd and 
 painful sensations in the head than the insane usu- 
 ally do. 
 
 8. A clumsy simulator may say, " I have the delusion 
 that I am lost," etc., or, " I have hallucinations of faces," 
 etc. Such a person can be readily exposed to be a 
 simulator on other grounds, but the feature here men- 
 tioned alone suggests simulation. A true lunatic may 
 admit he has delusions or hallucinations, especially 
 when examined for the purpose of being committed to 
 an asylum ; but when he does so he affects to admit that 
 he imagines those things.; but a real lunatic never 
 gives them names, showing that he recognizes their 
 abnormal nature : he is lost ; he is pursued by the 
 devil; he hears voices, and he sees faces. 
 
 9. It is suspicious if insanity appears immediately 
 after a crime, or after an arrest, or sentence, where its 
 previous existence can be disproved. 
 
 Among devices which may be legitimately resorted 
 
INSANITY. 365 
 
 to to expose simulation, Dr. Spitzka mentions the fol- 
 lowing : — 
 
 1. When examining the patient let the speaker re- 
 mark in an undertone to a by-stander, that if such 
 and such a sign were present he would know in which 
 ward to put him, or know in which form of insanity 
 to classify the subject., 
 
 2. While being examined as to his general sensibility 
 the simulator may believe that anaesthesia is a desir- 
 able part of the clinical picture ; he will wince when 
 probed with a pin unexpectedly, but will remain im- 
 moble when pricked after being warned. 
 
 3. When a simulator is accused of shamming he may 
 either turn away from the examiner or suddenly lapse 
 into stupor or undergo some other unnatural change of 
 the symptoms. A real lunatic will either act as a sane 
 person under those circumstances, or, as in apathetic 
 states, show no change whatever. 
 
 4. A simulator, if transferred from one ward to an- 
 other of an asylum, will imitate the different forms of 
 insanity he sees there. Imitations may occur in real 
 insanity, but it is limited to delusive conceptions which 
 are accepted by the weak-minded lunatics from more 
 intelligent ones, — in what the French call folie oommu- 
 niqu^e and folie d deux. 
 
 Simulation should not be directly charged until all 
 other means have been exhausted. Anaesthesia, by 
 the use of ether, may sometimes be of value ; and the 
 application of the Faradic wire brush may sometimes 
 expose the simulation. It should be remembered in 
 this connection that the insane sometimes simulate a 
 different form of insanity from that which they ac- 
 
366 MEDICAL JUEISPRUDENCE. 
 
 tually have ; this combination of real and feigned dis- 
 ease is by no means rare. See Dr. Spitzka's Work, and 
 an article upon the "Simulation of Insanity by the 
 Insane," by Dr. Kiernan, in the "Alienist and Neuro- 
 logist," April, 1882. 
 
 The legal effect of Insanity may come before courts 
 of law for decision in a variety of cases : — 
 
 1. Where insanity is pleaded as a defence to an in- 
 dictment for crime. 
 
 2. In civil causes where the insanity is alleged in 
 order to supersede a person in the management of his 
 affairs, or where it is alleged for the purpose of avoiding 
 a contract or will. 
 
 3. In either civil or criminal causes when it is ob- 
 jected to a witness that he was insane at the time of 
 the occurrence of the events of which he is to testify, 
 or that he has had an attack of insanity between those 
 events and the trial, — which objection is by Dr. Ogston 
 said to be valid in Scottish practice, although it is not 
 either in England or in this country. 
 
 1. The attempts of the courts to fix upon a criterion 
 by which to settle legal responsibility for crime in cases 
 of alleged insanity have been numerous, but have not 
 thus far met with success. By most of the courts the 
 law is still laid down in accordance with the doctrine 
 of McNaghten's Case, which will be found reported in 
 vol. 10 of Clark & Finnelly's " Eeports of Cases in the 
 House of Lords," p. 200. In this case McNaghten was 
 indicted for the murder of Drummond by shooting on 
 Jan. 20, 1843, and the verdict was " Not guilty, on the 
 ground of insanity." This verdict and the question of 
 the nature and extent of the unsoundness of mind 
 
INSANITY. 367 
 
 ■whicli excuse the commission of a felony of this sort 
 having been made the subject of debate in the House 
 of Lords, the opinion of the judges on the law govern- 
 ing such cases was required upon a series of questions ; 
 to which they answered in substance that the responsi- 
 bility of a person alleged to be insane, and who is ac- 
 cused of crime, depends upon whether or not the accused 
 at the time had sufficient capacity to know the nature 
 and quality of the act he was doing, and whether what 
 he was doing was right or wrong. As the case is one 
 frequently referred to, we have thought it proper to 
 state the questions and answers thereto at length in a 
 note.^ 
 
 1 Tindall, C. J. : " The first question proposed by your Lordships is 
 this: 'What is the law respecting alleged crimes committed by per- 
 sons afflicted with insane delusion in respect of one or more particular 
 subjects or persons ? — as, for instance, where at the time of the com- 
 mission of the alleged crime the accused knew he was acting contrary 
 to law, but did the act complained of with a view, under the influence 
 of insane delusion, of redressing or revenging some supposed grievance 
 or injury, or of producing some supposed public benefit.' 
 
 " In answer to which question, assuming that your Lordships' in- 
 quiries are confined to those persons who labor under such partial 
 delusions only, and are not in other respects insane, we are of the opin- 
 ion that, notwithstanding the party accused did the act complained of 
 with a view, under the influence of insane delusion, of redressing or re- 
 venging some supposed grievance or injury, or of producing some pub- 
 lic benefit, he is nevertheless punishable according to the nature of the 
 crime committed, if he knew at the time of committing such crime that 
 he was acting contrary to law ; by which expression we understand 
 your Lordships to mean the law of the land. 
 
 " Your Lordships are pleased to inquire of us, secondly, ' What are 
 the proper questions to be submitted to the jury, where a person al- 
 leged to be afflicted with insane delusion respecting one or more par- 
 ticular subjects or persons is charged with the commission of a crime 
 (murder, for example), and insanity is set up as a defence?' And 
 
368 MEDICAL JURISPRUDENCE. 
 
 The criterion laid down in this case is, to say the 
 least, very unsatisfactory. Although without doubt a 
 person who is by reason of mental disease unable to 
 comprehend the difierence between right and wrong in 
 a particular instance ought not to be punished as for a 
 crime, the criterion under consideration is entirely of 
 too limited application, and if strictly applied must 
 lead to the conviction and punishment of many per- 
 sons clearly irresponsible. 
 
 The limited space at our disposal will not permit the 
 full discussion of this important subject ; the reader is 
 accordingly referred to the very clear and conclusive 
 argument upon the subject by Dr. Eay, in the first 
 
 thirdly, ' In what terms ought the question to be left to the jury as to 
 the prisoner's state of mind at the time when the act was committed ? ' 
 And as these two questions appear to us to be more conveniently an- 
 swered together, we have to submit our opinion to be that the jurors 
 ought to be told in all cases that every man is to be presumed to be 
 sane, and to possess a sufficient degree of reason to be responsible for 
 his crimes, until the contrary be proved to their satisfaction; and that 
 to establish a defence on the ground of insanity, it must be clearly 
 proved that at the time of the committing of the act the party accused 
 was laboring under such a defect of reason, from disease of the mind, 
 as not to know the nature and quality of the act he was doing ; or if 
 he did know it, that he did not know he was doing what was wrong. 
 The mode of putting the latter part of the question to the jury on 
 these occasions has generally been, whether the accused at the time of 
 doing the act knew the difference between right and wrong ; which 
 mode, though rarely, if ever, leading to any mistake with the jury, is 
 not, as we conceive, so accurate when put generally and in the abstract 
 as when put with reference to the party's knowledge of right and wrong 
 in respect to the very act with which he is charged. If the question 
 were to be put as to the knowledge of the accused solely and exclusively 
 with reference to the law of the land, it might tend to confound the 
 jury, by inducing them to believe that an actual knowledge of the law 
 of the land was essential in order to lead to a conviction ; whereas the 
 
INSANITY. 369 
 
 chapter of his work upon the Medical Jurisprudence 
 of Insanity. 
 
 This doctrine has not always been approved by legal 
 authors and courts. Upon this subject Mr. Bishop, in 
 his work upon Criminal Law, voL i. sect. 381, says 
 that " in the criminal law insanity is any defect, weak- 
 ness, or disease of the mind rendering it incapable of 
 entertaining the criminal intent, which constitutes one 
 of the elements in every crime." 
 
 In the further consideration of the subject he ob- 
 serves that a legal test for insanity has never been 
 found, because it does not exist; that the question 
 
 law is administered upon the principle that every one must be taken 
 conclusively to know it, without proof that he does know it. If the 
 accused was conscious that the act was one which he ought not to do, 
 and if that act was at the same time contrary to the law of the land, 
 he is punishable ; and the usual course therefore has been to leave the 
 question to the jury whether the party accused had a suficient degree 
 of reason to know that he was doing an act that was wrong ; and this 
 course we think is correct, accompanied with such observations and ex- 
 planations as the circumstances of each particular case may require. 
 
 "The fourth question which your Lordships have proposed to us is 
 this : ' If a person under an insane delusion as to existing facts, com- 
 mits an offence in consequence thereof, is he thereby excused ?' To 
 which question the answer must, of course, depend on the nature of the 
 delusion ; but making the same assumption as we did before, namely, 
 that he labors under such partial delusion only, and is not in other re- 
 spects insane, we think he must be considered in the same situation as 
 to responsibility as if the facts with respect to which the delusion ex- 
 ists were real. For example, if under the influence of his delusion he 
 supposes another man to be in the act of attempting to take away his 
 life, and he kills that man, as he supposes in self-defence, he would be 
 exempt from punishment. If his delusion was that the deceased had 
 inflicted a serious injury to his character and fortune, and he killed 
 him in revenge for such supposed injury, he would be liable to 
 punishment." 
 
 24 
 
370 MEDICAL JURISPRUDENCE. 
 
 whether in a particular instance the act; alleged to be 
 a crime proceeded from a sane or insane mind, is a pure 
 question of fact for the jury, and not of law for the court ; 
 as, for example, it is a question of fact for the jury, and 
 not of law for the court, whether there is such, a disease 
 as dipsomania, and whether the act ia question was' occa- 
 sioned by this: disease, or was the act of a sound mind.^ 
 
 This seems a much more rational method; of proced- 
 ure than to attempt to define any rigid test. Where 
 each case is determined upon its own circumstances by 
 the evidence of competent experts before a jury, in the 
 same manner as, other disputed questions of fact are de- 
 termined, there will be comparatively little danger of 
 going astray, although it is possible that there might be 
 improvements in the method of securing the opinion of 
 such experts. 
 
 For the further consideration of this subject the 
 reader is referred to the preliminary chapter of Eay's 
 "Medical Jurisprudence," and to chap. 26, voL. i. 
 Bishop's "Criminal Law." 
 
 2. The procedure upon inquiries as to the idiocy or 
 lunacy of any person having estate, real or personal, 
 which is likely to be dissipated so as to expose himself 
 or family to want or suffering, is regulated by statute 
 in most of the States, to which statutes the student is 
 referred. The question in such cases as to the inability 
 of a person to manage his affairs, on the ground of in- 
 sanity and consequent incapacity, is one of fact to be 
 
 1 See 1 Bishop Crim. Law, § 383; The State vs. POce, 49 N. H. 
 399 ; Bradley vs. The State, 31 Ind. 492 j The Slate vs. Jones, 50 
 N. H. 369 ; The State vs. Johnson, 40 Conn. 136; Stevens vs. The 
 State, 31 Ind. 485 ; 4 Law Review, 236. 
 
INSANITY. 371 
 
 determined by the circumstances of each particular case. 
 The principles hereinafter stated wiU throw some light 
 upon the question of capacit}' in such cases. 
 
 If physicians who have certified to. the insanity of 
 ,a person have not made the inquiry and examination 
 which the statute requires, or if their evidence and 
 certificate in any respect of form or substance are not 
 sufficient to justify a commitment to an asylum, the 
 authorities should not commit; and if they do, it is 
 not the fault of the physicians, provided the latter have 
 Stated facts and opinions truly, and have acted with due 
 professional care and skill. 
 
 If a medical man takes upon himself the responsi- 
 bility of imprisoning a person on. the ground of insanity 
 on mere statements made to him by others; he will be 
 liable to an action . unless he can show that the party 
 imprisoned was insane at the time. A medical man or 
 any other person may, however, justify an assault where 
 it is committed for the purpose of putting restraint on 
 a dangerous lunatic in such a state that he is likely to 
 do mischief to some one ; this restraint, however, can- 
 not be continued indefinitely without due process of 
 law, but only so far as may be necessary to prevent 
 damage and to have his case . properly passed upon by 
 legally constituted authorities. 
 
 It is well settled that insanity may be pleaded by an 
 insane person in avoidance of his contracts made while 
 insane. The degree of unsoundness of mind required 
 to incapacitate a person from contracting may be stated 
 to be such a condition of insanity or idiocy as from its 
 character or intensity disables him from understanding 
 the nature and effects of his acts, and therefore dis- 
 
372 MEDICAL JURISPRUDENCE. 
 
 qualifies him for transacting business and managing 
 his property. It is well settled that in the absence of 
 fraud, imposition, or undue influence, mere weakness 
 or feebleness of understanding short of this is insuf- 
 ficient. 
 
 One who seeks to set aside a contract upon the 
 ground of insanity alone, general or partial, must show 
 that it was the offspring of mental disease. Thus mono- 
 mania, in no way connected with the subject of the 
 contract, will not invalidate it. The unsoundness of 
 mind required to vitiate a contract must also exist at 
 the time of making such contract. 
 
 The contract of a person non compos mentis is void- 
 able only, and not void ; and hence on his restoration to 
 reason may be ratified or avoided by him. After a ju- 
 dicial finding of the fact of insanity, however, the deeds 
 and other contracts of persons non compos mentis are 
 held to be void ; though in some cases this seems to be 
 the result of statutory provisions. The marriage of a 
 person non compos mentis is, according to the better 
 opinion, void. 
 
 As to the executed contracts of insane persons, the case 
 of Molton vs. Camroux, 2 Exchequer Reports, 487 ; s. c. 
 4 id. 17 ; Swell's Leading Cases, 614, lays down the rule 
 that where a person apparently of sound mind, and not 
 known to be otherwise, enters into a contract which is 
 fair and bona fide, and which is executed and completed, 
 and the property the subject matter of the contract can- 
 not be restored so as to put the parties in statu quo, such 
 contract cannot afterwards be set aside either by the al- 
 leged lunatic or by those who represent him. The rule 
 of this case has been adopted in New Hampshire, Iowa, 
 
INSANITY. 373 
 
 New York, Pennsylvania, New Jersey, South Carolina, 
 Indiana, and perhaps other States ; and on principles of 
 public policy must ultimately prevail everywhere. 
 
 Although a lunatic has not a general capacity to 
 enter into contracts, it is well settled that he may bind 
 himself by implied contracts for necessaries suitable to 
 his condition in life. It is well settled, also, that idiocy 
 or lunacy is no defence to an action for a tort, that is, a 
 wrong not connected with contract. 
 
 A contract entered into by a lunatic during a lucid 
 interval Will also bind him. By the term " lucid inter- 
 val " is to be understood a condition in which there is a 
 cessation of the symptoms of mental aberration, and a 
 restoration to reason occurring between two paroxysms 
 of insanity ; such a total cessation of the symptoms of 
 mental aberration and such a complete restoration to 
 reason, according to Dr. Hammond, probably does not 
 exist except in recurrent and epileptic forms of in- 
 sanity, and in certain varieties of monomania, and of 
 morbid impulse. He well states that the idea of a 
 lucid interval being a temporary cure is now confined 
 to the writings of those whose notions of the disease 
 have been derived from books rather than the wards 
 of hospitals. Like most other diseases, insanity is sub- 
 ject to remissions more or less complete, and there is 
 no more propriety in regarding them as recoveries than 
 there would be in considering the interval between the 
 paroxysms of a quotidian fever as a temporary recovery. 
 
 General insanity being established, the burden of 
 proof is thrown upon the party alleging a lucid inter- 
 val, who must establish, beyond a mere cessation of the 
 violent symptoms, a restoration of mind suflBcient to 
 
374 MEDICAL JURISPRUDENCE. 
 
 enable the party soundly to' judge ofitfae act Where 
 a disease itltimately afifecting th6 mind is insidious and 
 slow in its development, and there is ground for sus- 
 picion that previous to the fectum,. apprehensions were 
 entertained of thet possible approach of. mental- de- 
 rangement, there should be a careful scrutiny of an act 
 performed shortly before an • accession of undoubted' 
 symptoms, in- order < to see. whether it was a rational 
 and natural act comformable with the views and wishes 
 of tliE party, when in a state of health. 
 
 Contracts or other legal instruments executed in al- 
 leged lucid intervals should therefore- be closely scruti- 
 nized and looked upon with some degree of suspicion ; 
 but where capacity to contract is clearly shown to exist, 
 the contract or other act must be sustained. 
 
 As to the degree of mental capacity requisite to make 
 a valid -will, Judge Eedfield. stated that a lower degree 
 of intellect . is requisite to make • a valid wi\l than to 
 make a valid contract ; but in the former case something 
 more is required than mere passive memory. There 
 must be sufficient active memory to collect and retain 
 the elements of the business to be performed for a sufB.* 
 cient time to perceive their obvious relations to each' 
 other.. The testator must have a sotmd mind and dis- 
 posing memory; in other words, he ought to be capable 
 of making his will with an understanding of the nature 
 of the business in whicb he is engaged, the elements of 
 which the, will is composed, and a recollection of the" 
 property of which he means to dispose, of the persons 
 who are the objects of his bounty, and the manner in 
 which it is to be distributed among them. 
 
 A morbid delusion is good in defeasance of a will 
 
INSANITY. 375 
 
 founded immediately in or upon such delusion. This 
 was settled by the celebrated case of Dew vs. Clarke; 
 decided by Sir John NichoL in the Prerogative Court 
 of Canterbury in 1826. In this case Sir John Nichol 
 stated his opinion that the true criterion of the absence 
 or presence of insanity is the absence or presence of 
 delusion. This, however, cannot at the present time 
 be regarded as the law. If a delusion exists it is, of 
 course, dearly: evidence of insanity; but its absence is, 
 as we have already . seen, by no means proof or even 
 evidence of a sane condition. 
 
 Deaf and Dumb Persons. — Deaf and dumb persons, 
 although formerly in presumption of law idiots, are no 
 longer so considered ; ■ and it may perhaps now be said 
 that) there is in the United States at least, as to them 
 no presumption of a, defective understanding. In order, 
 however, to ensure protection and prevent fraud, proof 
 would probably be required that such a person was 
 capable of comprehending what he was about in exe- 
 cuting any instrument. 
 
 Where a person presented as a witness is: of unsound 
 mind to such an extent as to be incapable of compre- 
 hending the; nature and obligation of an oath, or the 
 nature and : relations of the subject matter about which 
 he is, to testify, it is very clear that he is not a com- 
 petent witness. A person to some extent insane but 
 not wholly devoid of. reason, may, however, be permitted 
 to testify if the court is satisfied that he possesses suffi- 
 cient capacity to comprehend the facts, to understand 
 the nature of an oath, and to communicate his testi- 
 mony. Where such testimony has been received, evi- 
 dence that the witness has been of unsound mind and 
 
376 MEDICAL JURISPRUDENCE. 
 
 memory is admissible to affect the credibility of Ms 
 testimony; whether he has sufficient understanding 
 must be decided by the court upon examination of the 
 proposed witness himself and other witnesses who can 
 speak as to the nature and extent of the insanity in 
 question. Where the witness at the time of the trial 
 is of sound mind and memory, but the evidence shows 
 that his intellect was to a greater or less degree im- 
 paired at the time of the transaction as to which he 
 testifiesj he is a competent witness, but the question of 
 his credibility is for the jury. 
 
 See this whole subject considered at length in 16 
 " Western Jurist," 122. 
 
 Somnambulism. — As to the legal responsibility of 
 persons accused of crime alleged to have been com- 
 mitted in the somnambulistic state, or in that state of 
 mental confusion sometimes met with between sleeping 
 and waking, the difficulty, as it seems to us, is prin- 
 cipally one of proof If it can be established to the 
 satisfaction of the jury that the accused did not enjoy 
 the free and rational exercise of his understanding, and 
 was unconscious of his outward relations at the time of 
 the commission of the alleged crime, there would seem 
 to be no doubt that he is not criminally responsible. 
 
 Induced Hypnotism. — The subject of induced hyp- 
 notism is undergoing investigation both in France and 
 in this country, and important questions as to criminal 
 responsibility may arise therefrom. At present, how- 
 ever, in advance of any adjudicated cases upon the sub- 
 ject, its consideration here would be premature. 
 
 Drunkenness. — Voluntary drunkenness is no defence 
 to a criminal charge. Where, however, a permanent 
 
INSANITY. 377 
 
 condition of insanity has resulted from the hatit of 
 drunkenness, the same rule should be applied as in the 
 case of insanity due to other causes. As to contracts, 
 it is well settled that a contract entered into by a per- 
 son when in such a state of intoxication as to deprive 
 him of the exercise of his understanding is voidable, 
 although the intoxication was voluntary and not pro- 
 cured through the circumvention of the other party. 
 
 A last will and testament made by a person while 
 so intoxicated as not to understand the nature or effect 
 thereof will not be allowed to stand. 
 
CHAPTEE XXII. 
 
 SOME EULES 0? XffE .COMMON jLAW- KESPECTING, THE 
 DISPOSITION PF HUMAN J)MP. BODIES.,, ■ 
 
 LEGISLATION UPON THE SUBJECT OP ANATOMY, AND A DEAUSHT 
 OP AN ACT TO PROMOTE THE SCIENCE OP ANATOMTJ 
 MEDICINE, AND SUEGEEY. 
 
 So far as the writer has been ahle to discover, there 
 seems in all ages to 'have been, in the non-professional 
 mind at least, a peculiar aversion towards and horror of 
 dead bodies of human beings. The laws of Menu, en- 
 acted, according to Sir William Jones, from 880 to 1,280 
 years before Christ (" Sir William Jones's Works," pp. 
 79, 80), contain many provisions respecting uncleanness 
 and purification therefrom, by reason of the dead, and it 
 seems everywhere assumed that dead bodies are unclean. 
 Thus, among many other provisions, we find the follow- 
 ing: "He who has touched a chandala, a woman in 
 her courses, an outcast for deadly sin, a new-born child, 
 a corpse, or one who has touched a corpse, is made pure 
 by bathing." — Laws of Menu, ch. 5, § 85. 
 
 " Should a Brahmin touch a human bone moist with 
 oil, he is purified by bathing ; if it be not oily, by strok- 
 ing a cow, or by looking at the sun, having sprinkled 
 his mouth with water." — lb. § 87. 
 
 The Koran likewise denounced as unclean the person 
 who touched a corpse, and the rules of Islamism stUl 
 
DISPOSITION OE HUMAN DEAD BODIES. 379 
 
 forbid dissection. Likewise by the laws of the Franks, 
 a person who dug. a corpse out of the ground in order 
 to strip ' it. was banished from society, and no one suf- 
 fered to relieve his' wants till the relations of the de- 
 ceased consented to hia readniission. — 4 Black. Com., 
 235 ; Montesq. Spir. Laws, b. xxx. c. 19. 
 
 By the common law of England— ^ and the rule of 
 the American ' common law is believed tOi be the same 
 — it is an indictable offence to take up a dead 
 body, even for the purpose of dissection, as being 
 "■contra, bonos mares, at the bare idea alone of which," 
 say the court in JRexvs. Lynn, -2 Term, E. 7.33, " nature 
 revolted." 
 
 It is said that a surgeon may retain the limbs he 
 amputates from a patient, upon the ground that parts 
 of the body when severed become dead, and at common 
 law there- is no property in a dead body. 
 
 While it is true that at the common law there can 
 be no ptoperty in a corpse (see Williams ys.'Williams-, 
 English High Court of Justice, Chancery Division, re- 
 ported in 21 Am. Law Eeg. [N. S.], August, 1882, 
 p. 508, in the note to which the cases upon the subject 
 are quite fully > collected by the writer), and therefore 
 stealing it is no felony, yet it is a very high misde- 
 meanor at the common law, and at the present time 
 "body-snatching," so-called, is made a statutory crime 
 in probably every State of this Union. 
 
 In • the case of Dr. Handyside, where . trover was 
 brought against him for the bodies of two children that 
 grew together. Lord Chief Justice Willes held that the 
 action would not lie, as no person had any property in 
 corpses. 
 
380 MEDICAL JUKISPKUDENCE. 
 
 The case of Williams vs. Williams above cited, which 
 referred to the subject of cremation, and in which it 
 was held that a man cannot dispose of his body by 
 will, that it is the executor's duty to bury it, and that 
 meantime he has the right to possession of it, is an 
 interesting case in this connection. 
 
 If, however, the coffin or any of the grave-clothes 
 be stolen with the body, it was a felony at common 
 law. 
 
 By the common law it is an offence against decency 
 to take a person's dead body with intent to sell or dis- 
 pose of it for gain or profit. Even to sell the dead 
 body of a capital convict for the purposes of dissection, 
 where dissection is no part of the sentence, is a mis- 
 demeanor and indictable at common law. 
 
 Even the refusal or neglect to bury dead bodies by 
 those whose duty it is to perform the office appears 
 also to have been considered a misdemeanor. So the 
 prevention of the interment of a dead body has been 
 considered indictable. To cast a dead body into a 
 river has been held indictable at common law as an 
 offence against common decency. 
 
 A gaoler has no right to detain the body of a person 
 who has died in prison for any debts due to himself, 
 and is indictable for so doing. 
 
 It seems that in a proper case the court, in the in- 
 terest of justice, will order the disinterment and exam- 
 ination of a dead body, where there is good reason to 
 believe that without such examination a fraud wiU be 
 perpetrated, and where the defendant has exhausted all 
 other legal methods of exposing it. One such case has 
 recently come to the notice of the writer in the city of 
 
DISPOSITION OF HUMAN DEAD BODIES. 381 
 
 Chicago, where the exhumation furnished conclusive evi- 
 dence of an attempt to defraud an insurance company. 
 
 The dissection of human bodies being necessary for 
 the advancement of anatomical and medical science, 
 statutory enactments were made upon the subject in 
 England at an early date, and also exist in many of the 
 States in this country. The statutes of every State and 
 Territory of this country have been examined with 
 reference to this subject, and it was the writer's in- 
 tention to have incorporated a digest of the same in 
 this chapter, but it has been found that such a digest 
 would consume more space than the merits of many of 
 these statutes deserve, and it has been thought better 
 to give the English legislation upon the subject, and at 
 the close to submit a draught of an act containing the 
 best features of them all. 
 
 The first English statute upon the subject of anatomy 
 and dissection that we have been able to find is section 
 2 of chapter 42 of 32 Henry VIIL, enacted in 1540, 
 and entitled, " For Barbers and Surgeons." The second 
 section of this act is as follows : — 
 
 " And further be it enacted by the authority afore- 
 said, that the said masters or governors of the mystery 
 and commonalty of barbers and surgeons of London, 
 and their successors yearly forever, after their said dis- 
 cretions, at their free liberty and pleasure, shall, and 
 may have, and take without contradiction, four persons 
 condemned, adjudged, and put to death for felony, by 
 the due order of the King's laws of this realm, for an- 
 atomies, without further suit or labor to be made to 
 the King's highness, his heirs or successors, (2) and to 
 make incision of the same dead bodies, or otherwise 
 
382 MEDICAL JUKISPRUDENCE. 
 
 to order the same after their said discretions at their 
 pleasures, for their further and better knowledge, . in- 
 struction, insight, learning, and experience in the said 
 science or faculty of surgery." A similar grant, was 
 made by Elizabeth in 1565 to the CoHege of Physicians. 
 By the statute 25 Geo. II., c. 37, 1752, «ntitled^ "An 
 Act for better preventing the horrid crime of murder " 
 (repealed by 9 Geo. IV., c. 31, § 1, 1828, for consoli- 
 dating and' amending the statutes in England relative 
 to offences against the person; re-enacted in substance 
 in Sections 4 and 5 of the same statute, but repealed in 
 1838 by sebtion 16 of '2 and 8 Win. IV., ch. 75, which 
 section 16 was itself repealed by 24 and 25 Vict., ch. 95, 
 § '1), it was enacted, after providing (sect. 1) that mur- 
 derers should be executed' the next day but one after sen- 
 tence passed, that (sect. 2) " the body of such murderer 
 so convicted shall, if such conviction, and execution 
 shall be in the county of Middlesex, or within the city 
 of London or the liberties thereof, be immediately con- 
 veyed by the sheriff or sheriffs, his or their deputy or 
 deputies, and his or their officers, to, the haU of the sur- 
 geons' company, or such other place as the said com- 
 pany shall appoint for this purpose, and be delivered 
 to such person as the said company shall appoint for 
 this purpose, and be delivered to such person as the 
 said company shall depute or appoint, who shall give 
 to the sheriff or sheriffs, his or their deputy or deputies, 
 rebeipt for the same ; and the body so delivered to the 
 said company of surgeons shall be dissected and anat- 
 omized by the said surgeons or such person as they 
 shall appoint for that purpose ; and in case said convic- 
 tion and execution shall happen to be in any other 
 
DISPOSITION OF HUMAN DEAD BODIES. 383 
 
 county or place in Great Britain, then the judge or 
 justice of assize, or other proper judge, shall award the 
 sentence to be put in execution the next day but one 
 after'such conviction (except as before excepted), and 
 the body of such murderer shall in like manner be de- 
 livered by the sheriff or his deputy, and. his officers, to 
 such surgeon as such judge or justice shall direct for 
 the purpose aforesaid." 
 
 ' That- the purpose of this act was less to advance the 
 interests of science than to terrify wrong-doers is evi- 
 dent from section 3, which directs sentence to be pro- 
 nounced immediately, stating the time of execution and 
 the marks of infamy above specified, " in order to im- 
 press a just horror in the mind of the offender, and on 
 the minds of such as shall be present, of the heinous 
 crime of murder." 
 
 • The statute above quoted has furnished a model, 
 which, with more or less modifications, has been fol- 
 lowed by several of the States of this Union, and among 
 •others, by the State of Illinois, -^ sect. 443 of whose 
 criminal code provides that " the court may order, 
 on the application of any respectable surgeon or sur- 
 geons, that the body of the convict shall after death be 
 delivered to such surgeon or surgeons for dissection, 
 unless the same be objected to by some relative of the 
 convict." ^ 
 
 In 1832, the elaborate act ,of 2 and 3 Wm. IV., 
 ch. 75, entitled, " An Act for Eegulating Schools of 
 Anatomy," was passed, the preamble of which is as 
 follows : — 
 
 ^ Seei however, the provisions of the act of 1885 j ch. 91, E. S. 
 111. 1885. 
 
384 MEDICAL JURISPRUDENCE. 
 
 " Whereas, a knowledge of the causes and nature of 
 sundry diseases which affect the body, and of the best 
 methods of treating and curing such diseases, and of heal- 
 ing and repairing divers wounds and injuries to which 
 the human frame is liable, cannot be acquired without 
 the aid of anatomical examination ; and whereas, the 
 legal supply of human bodies for such anatomical ex- 
 amination is insufficient fully to provide the means 
 of such knowledge; and whereas, in order further to 
 supply human bodies for such purposes divers great 
 and grievous crimes have been committed, and lately 
 murder, for the single object of selling for such pur- 
 poses the bodies of the persons so murdered; and 
 whereas, therefore, it is highly expedient to give pro- 
 tection, under certain regulations, to the study and 
 practice of anatomy, and to prevent, so far as may be, 
 such great and grievous crimes and murder as afore- 
 said, be it enacted," etc. 
 
 The act then proceeds to provide (sect. 1) for licenses 
 to practise anatomy; (sect. 2) for the appointment of 
 inspectors of schools of anatomy ; (sect. 3) the districts 
 they shall superintend ; (sect. 4) for returns by the in- 
 spectors of subjects removed for anatomical examina- 
 tion ; (sect. 5) for the inspection of places where anatomy 
 is practised ; (sect. 6) for salaries of inspectors. 
 
 Sect. 7 makes it lawful for any executor or other 
 person having lawful possession of the body of any de- 
 ceased person, and not being an undertaker or other 
 party entrusted with the body for the sole purpose of 
 interment, to permit such dead body to undergo ana- 
 tomical examination, unless, to the knowledge of such 
 executor or other person such person during his life 
 
DISPOSITION OF HUMAN DEAD BODIES. 385 
 
 expressed a desire that his body should not undergo 
 such examination, or unless the surviving husband or 
 wife, or any known relative of the deceased, shall re- 
 quire the body to be interred without such examination. 
 
 Sect. 8 requires the party, having lawful possession 
 of the dead body of any deceased person who has, dur- 
 ing his life, directed the anatomical examination of his 
 body, to direct such examination to be made, unless the 
 deceased person's surviving husband or wife, or nearest 
 known relative, shall require the body to be interred 
 without such examination. 
 
 Sect. 9 prohibits the removal for anatomical exami- 
 nation of the body of any person from the place where 
 such person died, within a certain time, and without a 
 certificate of the manner of death. 
 
 Sect. 10 makes it lawful for professors, surgeons, 
 etc, being licensed as aforesaid, to receive bodies for an- 
 atomical examination .under the provisions of the act. 
 
 Sect. 11 provides that the persons mentioned in the 
 last section shall receive with the body a certificate as 
 aforesaid, which shall be transmitted to the inspector 
 of the district, with a return stating from whom received, 
 date and jilace of death, sex, name, etc., and that the 
 said certificate and particulars shall be by such license 
 recorded in a book kept by him for that purpose, etc. 
 
 Sect. 12 requires notice to be given to the Secre- 
 tary of State of places where anatomy is about to be 
 practised. 
 
 Sect. 13 regulates the manner of removing bodies for 
 examination, provides for their interment after exami- 
 nation, and for the transmission of a certificate of in- 
 terment to the inspector of the district. 
 
 25 
 
386 MEDICAL JUEISPRUDENCE. 
 
 Sect. 14 provides that the persons licensed under the 
 act shall not be liable to punishment for having in their 
 possession or examining dead bodies according to the 
 provisions of the act. 
 
 Sect. 15 provides that nothing in the act contained 
 shall be construed to extend to or prohibit any post- 
 mortem examination of any human dead body required 
 or directed to he made by any competent legal authority. 
 
 Sect. 16 .repeals so much of 9 Geo. IV., ch. 31, as 
 directs that the bodies of murderers may be dissected 
 or hung in chains as ordered by the court ; and enacts 
 that such bodies shall be hung in chains or buried, as 
 the court shall direct. (This sect. 16 was repealed by 
 24 and 25 Vict., c. 95, § 1). 
 
 Sect. 17 limits the time within which actions for 
 anything done under the act shall be brought, and 
 regulates the pleading therein. 
 
 Sect. 18 prescribes the punishment for offences 
 against the act. 
 
 Sect. 19 defines the interpretation of certain words 
 in the act. 
 
 Sect. 20 provides that the act shall go into effect 
 August 1, 1832. 
 
 SJECT. 21 provides that the act may be altered or 
 amended during the current session of Parliament 
 
 In 1871 (34 Vict., ch. 16, § 2) the Secretary of State 
 and the chief Secretary of Ireland were empowered 
 from time to time to vary the period limited by sect. 
 13 of 2 and 3 Wm. IV., ch. 75, for transmission of cer- 
 tificates of interment to district inspectors. 
 
 This appears to be the latest legislation upon the 
 subject in England. 
 
DISPOSITION OF HUMAN DEAD BODIES. 387 
 
 In this country there is quite a diversity among the 
 statutes upon this subject, and in many of the States, 
 especially the Southern States, there is no legislation 
 whatever upon the subject, other than statutes prohibit- 
 ing the robbing of graves, etc. Many statutes provide 
 that " it shall be lawful " for the designated ofiQcers to 
 deliver up the dead bodies, etc., or that they "may" 
 deliver, etc., without containing words making it the 
 imperative duty of such oflSicers to deliver, etc. It is 
 very possible, and in some cases probable, that the word 
 " may " in such statutes should be construed to mean 
 " shall " or " must." " The words 'may' or 'shall,' when 
 used in a statute, may be read interchangeably, as will 
 best express the legislative intention. The rule is that 
 'the word may means must or shall only in cases where 
 public interests and rights are concerned, and the pub- 
 lic or third persons have a claim dejure that the power 
 shall be exercised.' " Where a statute directs the doing 
 of a thing for the sake of justice or the public good, the 
 word " may " is the same as the word " shall." Thus, 
 where a statute says that a sheriff may take bail, it has 
 been construed to mean that he shall do so. 
 
 On the other hand, if any right to any one depends 
 upon giving to the word "shall" an imperative con- 
 struction, the presumption is that the word was used' 
 in reference to such right or benefit; but where no 
 right or benefit to any one depends upon the impera- 
 tive use of the word, it may be held to be directory 
 merely. 
 
 In the draught of a statute upon this subject, therefore, 
 it is better, in order to avoid doubt, to use such words as 
 express unequivocally the intention of the legislature to 
 
388 MEDICAL JURISPRUDENCE. 
 
 impose upon the officials mentioned in the act a duty 
 to deliver, etc. 
 
 Maiiy statutes contain a provision authorizing the 
 delivery of dead bodies to county medical associations, 
 or to some reputable physician in cases where there is 
 no medical school in the county. Such a provision, as 
 well as others that might be mentioned, are doubtless 
 desirable in some cases, but they have not been included 
 in this draught. If thought desirable, it ■will be easy to 
 incorporate such provisions. It is believed that all the 
 really good features of the various acts upon this subject, 
 which are to be found upon the statute-books of the 
 various States of this Unions wiU be found in this bOl, 
 and a number of other provisions which seemed neces- 
 sary have also been incorporated in it. It is inserted 
 in this place simply as a precedent, in the hope that it 
 may be of assistance to some one called upon to draught 
 such an act. 
 
 An Act to promote the science of anatomy, medicine, 
 and surgery. 
 
 Be it enacted, etc. : — 
 
 Section 1. The right to dissect the dead body of a 
 human being or any part thereof shall exist in the fol- 
 lowing cases: 
 
 (1) In cases authorized by positive enactment of the 
 General Assembly of this State, in this and other 
 statutes. 
 
 (2) Whenever a coroner is authorized by law to hold 
 an inquest upon the body, so far as such coroner author- 
 izes dissection for the purposes of the inquest and no 
 farther. 
 
DISPOSITION OF HUMAN DEAD BODIES. 389 
 
 (3) Whenever and so far as the husband, wife, or 
 next of kin of the deceased, in case the deceased leaves 
 no surviving husband or wife, may authorize dissection 
 for the purpose of ascertaining the cause of death, and 
 no farther. 
 
 , (4) Whenever a person has, during his lifetime 
 directed that his dead body, or any part thereof, may or 
 shall be dissected, or where any person has directed or 
 given permission that any part of his body which has 
 become separated therefrom during his lifetime be dis- 
 sected, such dissection shall be lawful to the extent au- 
 thorized by such person, and no farther. 
 
 .. Sect. 2. Every person who makes, or procures to be 
 made, any dissection of the dead body of a human being, 
 or of any part thereof, contrary to the provisions of this 
 act, shall be deemed guilty of a misdemeanor, and upon 
 conviction thereof shall be fined not less than $25 nor 
 more than $100, or be imprisoned in the county jail not 
 less than one month nor more than three months, or 
 shall be punished by both said fine and imprisonment, 
 at the discretion of the court. 
 
 Sect. 3. Every superintendent of a penitentiary. 
 State, city, or county hospital for the insane, warden of 
 poor-house, coroner, sheriff, city undertaker, and every 
 other public officer by whatsoever name designated, law- 
 fully having charge of the body of any deceased person 
 required to be buried at the public expense, shall im- 
 mediately, by telegraph when practicable, otherwise by 
 letter, notify the nearest known relative of such deceased 
 person, if he knows or can with reasonable diligence as- 
 certain the same, or, if no relative can be found, then 
 some personal friend of such deceased person, if any such 
 
390 MEDICAL JURISPRUDENCE. 
 
 ' is known to exist, of the death of such person, and shall 
 deliver the body of such deceased person to any such 
 relative or personal friend, who is known or shall 
 prove himself to be such to the officer or authorities 
 having charge of the body, and who shall claim the 
 same for interment within a reasonable time after such 
 notice, not exceeding forty-eight hours after the death of 
 such person; but if no such relative or friend shall 
 claim the body within forty-eight hours after death, it 
 shall be the duty of such ofiioer or authorities having 
 charge of such body forthwith to deliver the same to 
 the officer or duly authorized agent of any respectable 
 medical college, of whatever school, regularly chartered 
 by this State, making application therefor, and which 
 has given the bond hereinafter referred to, and other- 
 wise complied with the requirements of this act neces- 
 sary to obtain its benefits ; and it shall be lawful for 
 such officer or agent to receive the said dead body, 
 and for the said medical college, through its profes- 
 sors, officers, and students, to use the same as they 
 may deem most for the advancement of anatomical 
 medical, and surgical science, but for such purposes only, 
 and in this State only. 
 
 Provided, That if any body so delivered shall be sub- 
 sequently claimed for interment by any such relative or 
 friend of the deceased, it or the remains thereof shall be 
 forthwith surrendered up for that purpose. 
 
 Provided, also, That the remains of no deceased 
 person who is known during his last sickness to have 
 expressed a desire to be buried, the remains of no 
 traveller dying suddenly, the remains of no person 
 detained on any civil process, . or as a witness, shall 
 
DISPOSITION OF HUMAN DEAD BODIES. 391 
 
 be SO delivered,' but shall be decently buried in the 
 usual manner. , ' 
 
 'Provided, also, That the bodies so delivered shall be 
 distributed among the several respectable, regularly- 
 chartered medical colleges of this State, of whatsoever 
 school of medicine, according to the number of students 
 regularly matriculated during the winter session of the 
 college year next preceding the time of application and 
 distribution ; provided, however, that no medical college 
 shall receive more than three (3) bodies, till every other 
 medical college which has filed the bond hereinafter re- 
 quired, otherwise complied with the requirements of 
 this act, arid made application therefor, shall have re- 
 ceived at least one (1) ;' and no application shall be made, 
 or if made, shall be allowed, till the college so applying is 
 ready to receive and remove the body or bodies applied 
 for, and has given the bond hereinafter required and 
 otherwise complied with the requirements of this act. 
 Any violation of any provision of this section shall be 
 deemed a misdemeanor, and shall be punished by a fine 
 of not less than $50 nor more than |200, or by im- 
 prisonment in the county jail not less than three nor 
 morie than six iiionths, or by both said fine and imprison- 
 ment at the discretion of the court. 
 
 Sect. 4. In order to facilitate the equitable distri- 
 bution of said bodies, it shall be the duty of every 
 medical college so applying to file with each and every ap- 
 plication for a body or bodies a statement of the number 
 of students matriculated as aforesaid, and the number of 
 bodies received by it from all sources up to the date of 
 such application under the provisions of this act during 
 the current college year, which for the purposes of this act 
 
392 MEDICAL JURISPEUDENCE. 
 
 shall be deemed to commence upon the day when this act 
 goes into effect, and end on the 31st day of August next 
 ensuing, and every year thereafter shall commence with 
 the 1st day of September and end on the 31st day of 
 August of each and every year ; and no application shall 
 be allowed which is not accompanied by such statements. 
 In making the distribution and delivery of dead bodies 
 above provided for, each and any of&cer or person con- 
 cerned in the same shall be governed by the statements 
 thus filed and by the principles stated in this and the 
 preceding sections. In order to equalize any irregu- 
 larity of distribution resulting therefrom, it shall be the 
 duty of each and every medical college claiming the 
 benefit of this act, through its clerk or other recording 
 of&cer, on or before the 5th day of September, in each and 
 every year, to file with the Secretary of the State Board 
 of Health a statement, in writing and under oath, of the 
 number of students regularly matriculated during the 
 winter session of the college year ending on the 31st 
 day of August next preceding, and the entire number of 
 bodies received from all sources under this act during 
 the same period ; and it shall be the duty of the said 
 Secretary of the State Board of Health forthwith to 
 equalize the distribution of bodies appearing from such 
 statements, according to the principles of this act, and 
 to certify the results of such equalization and transmit 
 a copy thereof under his hand and seal as soon as may 
 be to each college which has filed the statements above 
 required, showing (1) the entire number of bodies each 
 college was entitled to receive under this act during the 
 year next preceding ; (2) the number of bodies each col- 
 lege has in fact received; and (3) the number of bodies 
 
DISPOSITION OF HUMAN DEAD BODIES. 393 
 
 to be delivered by each college respectively which has 
 received an excess over the number it was entitled to 
 receive to each college respectively which has received 
 a less number than it was entitled to receive ; and there- 
 upon it shall be the duty of each college respectively 
 thus appearing to be in excess to deliver, within a rea- 
 sonable time after the reception of such copy of said 
 certificate, to each college respectively which has received 
 less than the number it was entitled to receive, so many 
 bodies as said certificate shall specify as being necessary 
 to equalize the distribution according to the principles 
 hereinbefore laid down. Every medical college neglect- 
 ing or refusing to file with the Secretary of the State 
 Board of Health the statement above required, or neg- 
 lecting or refusing to comply with the terms of equaliza- 
 tion above provided for, as shown by the said certificate 
 of the Secretary of the State Board of Health, shall 
 thereby forfeit during the time it shall so neglect or re- 
 fuse such compliance all rights and benefits otherwise 
 accruing to it under this act ; and a subsequent compli- 
 ance with such requirements shaU not entitle it to the 
 benefits which might have otherwise accrued to it dur- 
 ing the period it was so in default. 
 
 Sect. 5. Every medical college claiming the bene^ 
 fit of this act shall, before it shall be entitled to receive 
 any dead body as aforesaid, execute and file with the 
 clerk of the county in which such college is situated, 
 who shall give a receipt therefor, a bond to the People 
 of the State of . . . in the penal sum of $1,000, with 
 a .surety or sureties to be approved by said, county clerk, 
 conditioned that each and every body received under the 
 provisions of this act shall be used only for the advance- 
 
394 MEDICAL JURISPEUDENCB. 
 
 ment of anatomical, medical, and ■ surgical science, in 
 this State only, and in such a manner as not to shock 
 the public sensibilities ; that said college will cause 
 to be kept the record required by this act; and that 
 the remains of every such body, after use as afore- 
 said, shall be decently buried in some public burial- 
 ground in this State; which bond shall be renewed on 
 the first day of September of each and every ensuing 
 year. 
 
 Sect. 6. The person receiving any dead body under 
 this act shall, in the name and in behalf of the medical 
 college for which he receives it, sign and deliver to the 
 officer or person from whom the same is received, and 
 whose duty it shall be to demand and obtain such re- 
 ceipt, a receipt therefor, stating, if known, the name, age 
 and sex of every such person, and the place, date, and 
 cause of death, if known ; which receipt shall be pre- 
 served and recorded in a book to be kept for that pur- 
 pose in the institution, association, or office from which 
 such body shall be delivered, and a copy thereof imm&- 
 diately transmitted to the Secretary of the State Board 
 of Healthj whose duty it shall be to file the same in his 
 office. And every medical college receiving any dead 
 body under this act shall by its demonstrator of anatomy 
 or other analogous officer, in a suitable book to be kept 
 for that purpose, make a legible record of the time when, 
 the name and official station of the person from whom, 
 and the place where, such body was received, and whether 
 or not such body when so received was inclosed in 
 any box, cask, or other receptacle, and if so inclosed, 
 such record shall contain a description of such box, 
 cask, or receptacle sufficient to identify the same, to- 
 
DISPOSITION OF HUMAN DEAD BODIES. 395 
 
 gether with the shipping mark, or directions, if any, on 
 the same. Such record shall contain a description of 
 such body or remains, including the name, if known, 
 sex, length and weight of the body, and the probable 
 age of the deceased at the time of death, color of 
 hair and beard, if any, condition of teeth, and any 
 and all wounds, marks, or scars, if any, on such body by 
 which the same might be identified; and whether or 
 not such body when so received was mutilated so as to 
 prevent identification of the same. And such record 
 shall be preserved by such medical college through its 
 demonstrator of anatomy or other analogous officer, 
 whose duty it shall be to exhibit the same on demand, 
 as also any and all such dead bodies then in his charge, 
 for the inspection of any sheriff or deputy sheriff of 
 this State. Any violation of any provision of this 
 section shall be deemed a misdemeanor, and shall be 
 punished by a fine not of less than $50 nor more than 
 $200, or by imprisonment in the county jail not less 
 than three months nor more than six months, or 'by 
 both said fine and imprisonment at the discretion of 
 the court. 
 
 Sect. 7. Any person who shall buy or offer to buy, 
 sell or offer to sell, the dead body of any human being 
 or procure the same to be done by another; or any per- 
 son who shall offer, pay, demand, or receive any money 
 or any valuable consideration whatever, or procure the 
 same to be done by another, in consideration of the de- 
 livery for anatomical, medical, or surgical purposes, of 
 the dead body of any human being, or who shall trans- 
 port the dead body of any human being beyond the 
 limits of this State for anatomical, medical or surgical 
 
396 MEDICAL JURISPRUDENCE. 
 
 purposes, or who shall procure the same to be done by 
 another, shall be deemed guilty of a felony, and upon 
 conviction thereof shall be punished by imprisonment 
 in the State's Prison not less than one year nor more 
 than five years. 
 
INDEX. 
 
INDEX. 
 
 ABDOMEN (see Wounds), pao= 
 
 injuries to 47 
 
 ABORTION, 
 
 defined 115 
 
 means to produce 117 
 
 evidence of 118 
 
 burden of proof 289 
 
 AJDIPOCERB 67, 79 
 
 AGE, 
 
 determination of . . " 206 
 
 ALCOHOLIC INSANITY 354 
 
 ANATOMY, 
 
 legislation concerning 381 
 
 APOPLEXY, 
 
 death from 81 
 
 APNCEA, 
 
 a mode of death . . . ' 68 
 
 ASPHYXIA, 
 
 a mode of death . ..:;;...... 68, 73, 81 
 
 AUTOPSY (see Inspections), 
 
 physician not compelled to make 13 
 
 BACTERIOLOGY 303 
 
 BIRTH (see Infanticide), 
 
 ".live birth " defined Ill 
 
 evidence of lllj 136 
 
 still birth, evidence of 113, 125 
 
 BLISTERS 41, 52 
 
400 INDEX. 
 
 BLOOD-STAINS (see Stains), Page 
 
 menstrual blood 260 
 
 in rape 153 
 
 identification of 239-260 
 
 BONES (see Skeleton), 
 
 ossification of 196, 207 
 
 BUENS '40 
 
 CADAYEB, 
 
 roles of law conceniing disposition of 378 
 
 CHLOBOFOBM, 
 
 in rape I54 
 
 negligence in administering 286 
 
 CICATRICES 217 
 
 CIRCULATORY SYSTEM (see Wotinds), 
 
 injuries to 46 
 
 evidence of live birth from 127 
 
 examination of for life insurance 267 
 
 COLD (see Death). 
 
 COLOR-BLINDNESS 231 
 
 COMA, 
 
 a mode of death 69, 81 
 
 COMPENSATION (see Malpractice), 
 
 of physicians 3-9 
 
 experts 9 
 
 voluntary services 284 
 
 CONSULTATIONS 5, 287 
 
 CONTAGIOUS DISEASES, 
 
 precautions asto 5 
 
 CONTUSIONS 33 
 
 CORPUS LUTEUM 102 
 
 CRETINISM 358 
 
 DEAD BODIES, 
 
 rules of lavr concerning 378 
 
 DEAFNESS AND DUMBNESS, 
 
 simulation of 276 
 
 legal effect of 375 
 
INDEX. 401 
 
 DEATH, Page 
 
 defined 49 
 
 signs and tests of 49 «; seq. 
 
 modes and causes of 63 e< seq. 
 
 by asphyxia 73 
 
 drowning 74 
 
 hanging 81 
 
 strangulation 85 
 
 suffocation 86 
 
 heat 91 
 
 cold 90 
 
 lightning 92 
 
 starvation 93 
 
 causes of death of infants 132 
 
 presumption of 270 
 
 DEFLORATION : 142 
 
 DELIRIUM 334, 353 
 
 DELIVERY, 
 
 signs of 105, 121 
 
 DELUSIONS 334 
 
 DEMENTIA 348-352 
 
 DENTISTS 289 
 
 DIGESTIVE SYSTEM, 
 
 examination of for life Insurance 268 
 
 DISEASE (see Simulation ; Eactiiious Diseases ; Latent 
 
 Diseases). 
 DOSES (see Toxicology), 
 
 rules concerning 293 
 
 DROWNING (see Death). 
 DRUNKENNESS (sep Alcoholic Insaniit), 
 
 no defence to crime 376 
 
 EPILEPSY, 
 
 simulation of 274 
 
 EPILEPTid INSANITY 356 
 
 EPISPADIAS, 
 
 when an obstacle to marriage 165 
 
 PACTITIOUS AND EEIGNBD DISEASES (see Toxicoi^ 
 
 ogt) 273,279 
 
 26 
 
402 INDEX. 
 
 Pass 
 
 FIBRES, HAIE, ETC 226 
 
 ECETUS, 
 
 development of 198 
 
 POOTPRINTS 222 
 
 TRACTUilES U 
 
 GENITO-URINARY SYSTEM, 
 
 examination of for life insurance 269 
 
 GUNSHOT WOUNDS 37 
 
 HAIR AND FIBRES 226 
 
 HAIR-DYES 230 
 
 HALLUCINATIONS 334 
 
 HAND MARKS 222 
 
 HANGING (see Death). 
 HEARING, 
 
 limits of 231 
 
 HEAT (see Tempeeatube ; Death). 
 
 HEBEPHRENIA 849 
 
 HERMAPHRODISM (see Sex), 
 
 species of 172 
 
 an impediment to marriage . . 164 
 
 HYDROSTATIC TEST 129 
 
 HYPNOTISM 376 
 
 HYPOSPADIAS, 
 
 when an impediment to marriage . . . ... 165 
 
 HYSTERICAL INSANITY 355 
 
 IDENTITY, 
 
 evidence of 204 ef seq. 
 
 IDIOCY 35S 
 
 ILLUSIONS . . . . , 334 
 
 IMBECILITY 358 
 
 IMPOTENCE, 
 
 defined 182 
 
 causes of in male . 163, 183 
 
 female 165, 186 
 
INDEX. 403 
 
 INFANTICIDE (see Inspection), page 
 
 " newly born " defined 120 
 
 time of survival of child 121 
 
 changes in child after birth . . 122 
 
 evidence of live or still birth 125 
 
 causes of infants' death . . 132 
 
 INSANITY, 
 
 provisions concerning in life policies . . . . . 272 
 
 definitions 828-333 
 
 mental symptoms . . . . 333 
 
 illusions 334 
 
 hallucinations 334 
 
 delusions . . 334 
 
 • incoherence . 335 
 
 delirium 335 
 
 morbid propensities . 335 
 
 imperative conceptions 335 
 
 emotional disturbances 336 
 
 disturbances of memory, consciousness, and will . . 336 
 
 classification 336-343 
 
 Krafft-Ebing .... 337 
 
 Spitzka 338 
 
 Hammond 340 
 
 Kay 341 
 
 remarks upon 342 
 
 different types of 
 
 mania .... 343. 
 
 melancholia 344 
 
 katatonia 344 
 
 transitory frenzy .... 345 
 
 stuporous insanity 345 
 
 primary confusional insanity 346 
 
 primary mental deterioration 346 
 
 secondary and terminal deterioration 347 
 
 senile dementia 348 
 
 hebephrenia 349 
 
 paretic dementia 349 
 
 syphilitic dementia 352 
 
 delirium grave 353 
 
404 INDEX 
 
 INSAmiY—coniimed. Paoe 
 
 chronic alcoholic insanity 354; 
 
 chronic hysterical insanity 355 
 
 epileptic insanity 356 
 
 periodical insanity 357 
 
 idiocy, imbecility, and cretinism 358 
 
 paranoia 360 
 
 simulation of 361 
 
 legal effect of 366-375 
 
 McNaghten's Case 366 
 
 procedure 370 
 
 lucid intervals 373 
 
 deaf and dumb persons 375 
 
 effect of upon witnesses 375 
 
 somnambulism 376 
 
 hypnotism 376 
 
 drunkenness 376 
 
 INSPECTIONS (Mbdico-Legal), 
 
 method of making 17 
 
 in case of death from wounds 47 
 
 of bodies of infants 136 
 
 in case of poisoning . . 315 
 
 INSURANCE 261 
 
 KATATONIA 344 
 
 LACERATIONS 36 
 
 LATENT DISEASES 273, 280 
 
 LEGITIMACY 181 
 
 LIFE (see Death), 
 
 evidence of from examination of child Ill 
 
 medical examination for 264 
 
 LIGHTNING (see Death). 
 LIKENESS, 
 
 as evidence of paternity 202, 216 
 
 LUCID INTERVALS 373 
 
 MALPRACTICE, 
 
 civil 282 
 
 criminal 294 
 
INDEX. 405 
 
 Fasi 
 
 MANIA 343 
 
 MARRIAGE, 
 
 requisites to a valid 162 
 
 MASTURBATION, 
 
 a cause of impotence 165 
 
 MATURITY, 
 
 signs of in infants 193 
 
 McNAGHTEN'S CASE ' ! 366 
 
 MECONIUM 123 
 
 MEDICAL JURISPRUDENCE, 
 
 a misnomer . . i 
 
 MELANCHOLIA 343 
 
 MENSTRUAL BLOOD 260 
 
 MENSTRUATION 97 
 
 MICROMETRIO MEASUREMENTS 239-244 
 
 MONOMANIA 360 
 
 MONSTERS 177 
 
 MOONLIGHT, 
 
 recognition by 288 
 
 MUMMIFICATION 67 
 
 ■ NEGLIGENCE (see Malpractice). 
 NERVOUS SYSTEM (see Wounds), 
 
 injuries to 45 
 
 examination of for life insurance 267 
 
 OSSIFICATION (see Bones). 
 
 PARANOIA 360 
 
 PARETIC DEMENTIA 349 
 
 PATERNITY ISl 
 
 PELVIS, 
 
 male and female 169 
 
 PERIODICAL INSANITY 357 
 
 PHYSICIAN (see Peivilege; Compensation; Witness, 
 
 ETC.), 
 
 relation of to patient 15 
 
406 INDEX. 
 
 POISON (see Toxicology). page 
 
 POISONED WOUNDS 27 
 
 POST-MORTEM (see Inspections), 
 
 appearance after death by asphyxia 73 
 
 drowning 76 
 
 suffocation 87 
 
 strangulation 88 
 
 cold 90 
 
 starvation 94 
 
 in case of pregnancy 101 
 
 signs of delivery .... 109 
 
 abortion 118 
 
 PREGNANCY, 
 
 signs of 97 
 
 duration of 190, 199 
 
 influence of on life insurance .... 269 
 
 PRESUMPTION, 
 
 of death 270 
 
 of survivorship 271 
 
 PRIMARY GONfUSIONAL INSANITY 346 
 
 PRIMARY MENTAL DETERIORATION 346 
 
 PRIVILEGE (see Witness). 
 
 PTOMAINES 303 
 
 PUTREPACTION, 
 
 of dead bodies 63, 112 
 
 effect of upon evidence of poisoning 314 
 
 RACE (see Skull), 
 
 differences of 215 
 
 RAPE 142,183 
 
 RESPIRATORY SYSTEM, 
 
 injuries to 47 
 
 evidence of live birth from 128 
 
 examination of for life insurance 267 
 
 RIGOR MORTIS 57, 90 
 
 SCALDS 40 
 
 SCARS 217 
 
 SCHOOLS OP PRACTICE 286, 291 
 
INDEX. 407 
 
 Page 
 
 SECONDARY AND TERMINAL DETERIORATION . 347 
 
 SENILE DEMENTIA 348 
 
 SEX (see Hermapheodism), 
 
 how determined 167 
 
 sexless beiugs . 176 
 
 SIGHT, 
 
 limits of 231 
 
 SIMILARITY, 
 
 evidence of paternity 202, 216 
 
 SIMULATION, 
 
 of disease . . 273 
 
 insanity . . 361 
 
 SKELETON, 
 
 characteristics of male and female . 16S 
 
 time rec^uired to reduce body to 205 
 
 dimensions of at different ages 194, 214 
 
 SKULL, 
 
 in different races 215 
 
 SMELL, 
 
 limits of the sense of . . 237 
 
 SODOMY .159 
 
 SOMNAMBULISM 376 
 
 SPERMATOZOA • . 150 
 
 SPONTANEOUS COMBUSTION .... .92 
 
 STAINS (see Blood-stains), 
 
 on women's linen . . . 155 
 
 identification of . • . 238 
 
 STARLIGHT, 
 
 recognition by .... 233 
 
 STARVATION (see Death). 
 STATURE, 
 
 length of foetus 210 
 
 of children 212 
 
 adults '. 212 
 
 calculated from length of bones 215 
 
 STERILITY 162, 183; 189 
 
 STILL BIRTH (see Bieth). 
 
 STUPOROUS INSANITY . . 345 
 
408 INDEX. 
 
 SUBPCENA. PA8E 
 
 should be obeyed 92 
 
 SUICIDE, 
 
 evidence of as a cause of death 80, 86 
 
 provisions concerning iu life policies 272 
 
 SUPPOSITITIOUS CHILDKEN 203 
 
 SYNCOPE, 
 
 a mode of death 68 
 
 SYPHILITIC DEMENTIA 352 
 
 TATTOO MAEKS 217, 221 
 
 TEETH 225 
 
 TEMPERATURE, 
 
 of the dead body 54 
 
 of the living body 54, 89 
 
 TOXICOLOGY (see Poisons), 
 
 defined 301 
 
 poison defined 303 
 
 channels of entrance 305 
 
 exit 305 
 
 action of . . . 306 
 
 doses of 307 
 
 form of administration 308 
 
 chemical state 308 
 
 tissues acted upon ... 308 
 
 influence of habit, etc . . 309 
 
 evidence of poisoning 310, 320 
 
 post-mortem appearances 313 
 
 method of making examination 315 
 
 treatment of poisoning 321 
 
 feigned poisoning, etc. 326 
 
 TRANSITORY ERENZY 345 
 
 TREATMENT (see Toxioolosy), 
 
 discretion as to mode of 5 
 
 UMBILICAL CORD, 
 
 dropping of 122 
 
 UMBILICAL VESSELS 124 
 
INDEX. 409 
 
 VIRGINITY. P,«, 
 
 signs of _ 1 A3 
 
 VISION, 
 
 limits of _ ggi 
 
 color-blindness 23]^ 
 
 WEIGHT, 
 
 of foetus 2]^Q 
 
 children ... 211 
 
 adults 223 
 
 WITNESS, 
 
 medical, no privilege 2 
 
 statutes as to privilege 2 
 
 effect of insanity 375 
 
 WOUNDS, 
 
 defined . .... . ... ... 26 
 
 classified .... .27 
 
 description, etc. ... 26-40 
 
 prognosis of . 45 
 
 University Press : John Wilson & Son, Cambridge.