Cornell University Law Library The Moak Collection PURCHASED FOR The School of Law of Cornell University And Presented- February 14, 1893 IN HEnORY OF JUDGE DOUGLASS BOARDMAN FIRST DEAN OF THE SCHOOL By his Wife and Daughter A. M. BOARDMAN and ELLEN D. WILLIAMS RA1051T23"l873r '*>''■'''"'>' A ""anual of medical urisprudence. 3 1924 017 532 759 Cornell University Library The original of tiiis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924017532759 A MANUAL MEDICAL JURISPRUDENCE, BY ALFRED SWAINE^T^LOR, M.D., F.R.S., FELLOW OP THE ROYAL COLLEGE OP PHYSIOIAMS, AND PROFESSOR OP MEDICAL JURISPBDDENOE AND CHEMISTRY IN GUy'S HOSPITAL. Qui nesoit ignorare ignorat scire. SEVENTH AMERICAN EDITION, REVISED FROM THE AtJTHOE'S LATEST NOTES, AND EDITED WITH ADDITIONAL NOTES AND REFERENCES, BY JOHB" J. REESE, M.D., PBOFBBBOR OP MEDICAL JtrRISPRUDENCB AND TOXICOLOGY IN THE UNIVERSITY OF PENNSYLVANIA, FELLOW OF THE COLLEGE OF PHYSICIANS OP PHILADELPHIA, HONORARY MEMBER OF THE NEW YORK MEDICO-LEGAL SOCIETY, WITH ILLUSTRATIONS ON WOOD. PHILADELPHIA: HEIi?"ET 0. LEA, 1873. Entered according to the Act of Congress, in the year 1873, by HENRY C. LEA, in the Office of the Librarian of Congress. All rights reserved. PHIIADEIPHIA: COLlilNS, PRI HTBR. AMEEICAN PUBLISHER'S NOTICE. In preparing for the press this seventh American edition of the "Manual of Medical Jurisprudence" the editor. has, through the courtesy of Dr. Taylor, enjoyed the very great advantage of con- sulting the sheets of the new edition of the author's larger work, "The Principles and Practice of Medical Jurisprudence," which is now ready for publication in London. This has enabled him to introduce the author's latest views upon the various topics discussed, which are believed to bring the work fully up to the present time. The notes of the former editor, Dr. Hartshorne, as also the nu- merous valuable references to American practice and decisions by his successor, Mr. Penrose, have been retained, with but few slight exceptions : they will be found inclosed in brackets, distinguished by the letters [H.] and [P.]. The additions made by the present editor, from the material at his command, amount to about one hundred pages ; and his own notes are designated by the letter [E.J. Several subjects not treated of in the former edition have been noticed in the present one ; and the work it is hoped will be found to merit a continuance of the confidence which it has so long en- joyed as a standard authority. Philadelphia, September, 1873. PREFACE THE EIGHTH ENGLISH EDITION. In preparing for the press the eighth edition of the Manual of Medical Jurisprudence, it has been considered advisable to make a few changes in the volume. The subjects have been reduced in extent by the omission of the details of cases, which now find a more appropriate place in the large work lately published under the title of The Principles and Practice of Medical Juris- prudence. Those facts only are retained which are likely to be of practical utility to students of medicine and law, as well as to junior medical practitioners. For the information and guidance of medi- cal men, two chapters on evidence and the duties and responsibilities of medical witnesses have been placed at the commencement of the volume, and some medico-legal subjects, not hitherto treated in the previous editions, have been introduced. Among other changes may be noticed the introduction of numerous engravings represent- ing the crystalline forms of poisons and the apparatus used for their' detection. From the additions thus made, it is hoped that this edition of the Manual will be found a convenient guidance to medico-legal practice. 15 St. James's Terrace, Regent's Park: May, 1866. CONTENTS. MEDICAL EVIDENCE. CHAPTER I. PAGE The practice of Medical Jurisprudence — Medical and medico-legal duties— In- spection of bodies in death from wounds or poisoning — Uses of notes — Medico-legal reports — Dying declarations . . . . .17 CHAPTER II. Coroners' inquests — Trial at the assizes— Subpoenas — Examination in court — Duties of medical witnesses — Rules for the delivery of evidence . . 37 CHAPTER III. Causes of death — Sudden death — Syncope — Asphyxia — Coma — Signs or in- dications of death — Cessation of circulation and respiration — Cooling of the body — Cadaveric rigidity — The eyes — The skin — Circulation of the blood — Putrefaction — Cadaveric lividity — Adipocere . . . . .57 POISONING. CHAPTER IV. Definition of the term Poison — Deadly poisons — Mechanical irritants — Law in relation to administering poison — Influence of habit and idiosyncrasy — • Classification — Special characters of Irritant, Corrosive, and Neurotic poi- sons .......... 79' CHAPTER V. Evidence of poisoning in the living body — Action of poison increased or dimi- nished by disease — Symptoms connected with food or medicine — Several persons attacked simultaneously — Evidence from the detection of jJoison in the food, etc. ......... 89 CHAPTER YI. On the evidence of poisoning in the dead body —Period at which poisons prove fatal — Chronic poisoning — Appearances produced by the different classes of poisons — Redness of mucous membrane mistaken for inflammation — Ulcera- tion and corrosion — Softening — Perforation of the stomach from poison and disease . . . . ' • • • • • .98 CHAPTER VII. Iebitant Poisons.— Sulphuric acid or Oil of vitriol— Nitric acid or Aquafor- tis — Hydrochloric acid— Symptoms — Appearances — Analysis . . 110 Vlll CONTENTS. CHAPTER VIII. PAGE Poisoning by Vegetable Acids — Oxalic acid— Symptoms and appearances — Chemical analysis — Acid oxalate of potash or Salt of sorrel — Tartaric and Acetic acids ......... 120 CHAPTER IX. Poisoning by Alkalies and Alkaline salts — Potash, Soda, and Ammonia — Ni- trate and Sulphate of potash— Chloride of barium .... 128 CHAPTER X. Phosphorus — Symptoms and appearances — Chronic poisoning — Chemical anal- ysis — Eed or AUotropic Phosphorus — Iodine ..... 133 CHAPTER XI. Metallic Ibritantb. — Arsenic — Arsenious acid — Symptoms — Chronic poi- soning — Appearances after death^Patal dose — Chemical analysis — Arse- nites — Arsenic acid — Orpiment and other compounds . . . 140 CHAPTER XII. Poisoning by Mercury — Corrosive sublimate — Symptoms — Chronic poisoning — Appearances after death — Chemical analysis — Process for mercury in or- ganic liquids — White and red precipitates — Mercuric methide and other com- pounds . . . . . . . . . .160 CHAPTER XIII. On poisoning with Lead — Sugar of Lead — Symptoms — Appearances after death — Chemical analysis — Lead in organic mixtures — Carbonate, or White lead — Chronic poisoning — Poisoning with Copper — Blue vitriol — Symptoms — Ap- pearances — Chemical analysis — Copper in organic liquids . . . 169 CHAPTER XIV. Tartar emetic — Symptoms — Appearances — Chronic poisoning — Chemical anal- ysis — Chloride or butter of antimony — Poisoning with salts of Zinc and Iron 176 CHAPTER XV. Vegetable and Animal Ibbitants. — Vegetable Irritants — Aloes — Savin — Croton oil — Colchicum — Hellebore — Yellow Jessamine — Carbolic acid — Ani- mal Irritants — Cantharides — Noxious Animal Food — Pish, Mussels, Cheese, Sausages — Poisoned Flesh of Animals — Trichiniasis .... 186 CHAPTER XVI. Nbueotio Poisonb. — Opium — Symptoms — Appearances — Its action on in- fants — Poisoning with opiate compounds — Morphia and its salts — Process for detecting Opium in organic mixtures ...... 205 CHAPTER XVII. Prussic acid — Symptoms and appearances — Tests for the acid — Process for or- ganic mixtures — Cyanide of jf otassium — Essential oil of bitter almonds — Ni- trobebzole — Bichloride of Methylene — Fusel oil . . . .212 CHAPTER XVIII. Alcohol — Ether— Chloroform — Hydrate of Chloral — Camphor — Tobacco — Ni- cotina — Cocculus indicus — Picrotoxine — Calabar bean — Fungi — Henbane . 222 CONTENTS. IX CHAPTER XIX. PAGE Nux vomica — Stryclinia — Symptoms and appearances — Cliemical and micro- scopical analysis of Nux vomica and Strychnia — Process for organic mix- tures — Brucia ......... 233 CHAPTER XX. Conium maculatum (Hemlock) — Conia — CEnanthe crocata — iEthusa cynapium Aconite or monkshood — Aconitina ...... 240 CHAPTER XXI. Atropia belladonna or Deadly nightshade — Poisoning by Atropia — Lobelia — Foxglove — Digitaline — Datura stramonium or Thornapple — Daturia . 249 WOUNDS AND PERSONAL INJURIES. CHAPTER XXII. Definition of a wound — Danger to life — Grievous bodily harm — Examination of vrounds — Description of wounds — Characters of wounds inflicted on the living and dead body — Ecchymosis on the living and dead — Effects of vio- lence on the dead body — Ecchymosis not always a result of violence . 258 CHAPTER XXIII. Evidence of the use of a weapon — Characters of wounds caused by weapons — Incised, Punctured, Lacerated, and Contused Wounds— Stabs and cuts — What are weapons ? — Examination of the dress — Imputed or self-inflicted wounds .......... 367 CHAPTER XXIV. Wounds indicative of homicide, suicide, or accident — Evidence from the situa- tion of a wound— Evidence from nature and extent — Evidence from the di- rection of a wound— Wounds inflicted by the right or left hand — Several wounds — Use of several weapons ...... 275 CHAPTER XXV. Evidence from circumstances— The position of the body and of the weapon — Evidence from blood, hair and other substances on weapons — Marks of blood on clothing and furniture, on the deceased, and on the assailant . . 282 CHAPTER XXVI. Chemical examination of blood-stains — Stains of blood on linen and other stuffs — Age or date of the stain — Other stains resembling blood— Blood on wea- pons — Arterial and Venous blood — Varieties of blood — Blood of man and animals — Microscopical evidence ...... 291 CHAPTER XXVII. The cause of death from wounds — Wounds directly or indirectly fatal — Death from hemorrhage — internal bleeding — Death from mechanical injury and shock — Death from numerous personal injuries irrespective of any mortal wound .......... 310 X CONTENTS. CHAPTER XXVIII. PAQE Death of wounded persons from natural causes — Distinction between real and apparent cause — Death from wounds, or latent disease — Accelerating cause — Death from wounds after long periods — Avoidable causes of death — Neg- lect — Imprudence — Unskilful treatment — Unhealthy state of the body . 318 CHAPTER XXIX. Wounds indirectly fatal — -Tetanus following wounds — Erysipelas — Delirium tremens — Gangrene — Death from surgical operations — Primary and second- ary causes of death — Unskilfulness in operations — Pyaemia — Medical respon- sibility in reference to operations — Actions for malapraxis . . 338 CHAPTER XXX. Cicatrization of wounds — Evidence from cicatrices — Changes in an incised wound — Are cicatrices when once formed indelible 1 — Characters of cicatrices — Colored cicatrices — Tattoo marks ...... 336 CHAPTER XXXI. Wounds of the head — Concussion — How distinguished from intoxication — EflFu- sion of blood as a result of violence, disease, or mental excitement — Wounds of the face — Deformity as a consequence of wounds of the face — Injuries to the spine and spinal marrow — Fractures of the vertebra . . . 840 CHAPTER XXXII. Wounds of the chest — Wounds and ruptures of the lungs and heart — Wounds of large bloodvessels — Wounds and ruptures of the diaphragm — Direction of wounds of the chest — Wounds of the abdomen — Death from blows on the cavity — Ruptures of the liver, gall-bladder, spleen, kidneys, intestines, stomach, and urinary bladder — Wounds of the genital organs . . 351 CHAPTER XXXIII. Fractures — Produced by a blow with a weapon, or by a fall — Brittleness of the bones — Fractures caused by slight muscular exertion — In the living and dead body — Has a bone ever been fractured ? — Locomotion — Dislocation from vio- lence, or natural causes — Medical opinions-— Action for malapraxis . . 363 CHAPTER XXXIV. Gunshot wounds — In the living and dead body — Was the piece flred near or from a distance ? — Accidental, suicidal, or homicidal wounds — Position of the wounded person when shot — Wounds from small shot — Wounds from wad- ding and gunpowder ........ 368 CHAPTER XXXV. Death from burns and scalds— Symptoms— Stupor— Cause of death— Post-mor- tem appearances— Burns on the dead body — Accident, homicide, or suicide ■ Wounds caused by flre— Scalding — Burns by corrosive liquids . . 375 ASPHYXIA. CHAPTER XXXVI. Drowning.— Cause of death— Secondary causes— Post-mortem appearances- Medical proofs of death from drowning— Specific gravity of the body— Co- incidental causes of death— Marks of violence— Accidental fractures— Homi- cidal and suicidal drowning ....... 384 CONTENTS. XI CHAPTER XXXYII. PAOB Hanging. — Cause of death — Death from the secondary effects — Post-mortem appearances — Mark of the cord or ligature — Was death caused by hanging? — Hanging after death — Summary of medical evidence — Marlss of violence on the hanged — Was the hanging the result of accident, suicide or homicide ? — The position of the body ....... 404 CHAPTER XXXVIII. SxHANGrLATiON. — Causc of death — Appearance after death — Was death caused by strangulation, or was the constriction applied to the neck after death ? — Marks of violence— Accidental, homicidal, and suicidal strangula- tion .......... 421 CHAPTER XXXIX. Suffocation. — Suffocation from mechanical causes — Cause of death — Appear- ances after death — Evidence of death from suffocation — Accidental, suicidal, and homicidal suffocation — Smothering ..... 436 CHAPTER XL. Gaseous Poisons. — Carbonic acid — Symptoms — Appearances — Analysis — Effects of charcoal vapor — Carbonic oxide — Coal and coke vapor— Sulphur- ous acid — Vapors of lime, cement, and brick-kilns — Confined air — Coal gas — Carburetted hydrogen — Nitrous oxide ..... 446 CHAPTER XLI. Sulphuretted Hydrogen Gas — Its poisonous properties — Symptoms — Post- mortem appearances — Effluvia from drains and sewers — Analysis — Mephitic vapors — Exhalations from the dead ...... 466 CHAPTER XLII. Lightning, Cold, Heat, Stabvation. — Effects of the electric fluid — Post- mortem appearances — Cold an occasional cause of death — Symptoms — Cir- cumstances which accelerate death — Post-mortem appearances — Case of murder by cold — Effect of heat— Starvation a rare cause of death — Symp- toms — Appearances after death — Legal relations .... 475 PREGNANCY. CHAPTER XLIII. Signs of pregnancy— Suppression of the menses— Prominence of the abdomen- Quickening— Sounds of the foetal heart — Changes in the mouth and neck of the uterus— Feigned pregnancy— Concealed pregnancy— Pregnancy in the d.ead — Impregnation in a state of unconsciousness — Legal relations . 494 CHAPTER XLIV. Delivekv.— Delivery in the living— Concealed delivery— Abortion in the early stages of pregnancy— Signs of recent and remote delivery— Feigned de- livery Delivery in a state of unconsciousness — Signs of delivery in the dead— True and false corpora lutea— Characters of the ovum or embryo— Moles— Concealment of birth . . . . .. • .507 Xll CONTENTS. CHAPTER XLV. FAGB Criminal Abohtion. — Abortion from natural cause — Criminal causes — Me- chanical means — Medical substances — Signs of abortion — Specific abortives — Local applications — Feigned abortion — Meaning of the word "noxious" as applied to drugs — On inducing premature labor — Proof of pregnancy not necessary — Abortion of monsters — Moles and hydatids . . . 536 INFANTICIDE. CHAPTER XL VI. Nature of the crime — Proof of life — Medical evidence at inquests — Uterine age or maturity of the child — Viability — Characters of the child from the sixth to the ninth month — Signs of maturity — Rules for inspecting the body . 548 CHAPTER XLVII. Evidence of life before respiration — Putrefaction in utero — Evidence of life after respiration — Color, volume, consistency, and absolute weight of the lungs — Static test — Weight increased by respiration .... 554 CHAPTER XLVIIL The hydrostatic test — Sinking of the lungs from disease, or atelectasis — Life with perfect atelectasis or entire absence of air from the lungs — Erroneous medical inference from sinking of the lungs — Floating of the lungs from putrefaction — Effects of putrefaction on the lungs .... 563 CHAPTER XLIX. Floating of the lungs from artificial inflation — Inflation not distinguishable from imperfect respiration — Results of compression — Improper objections to the hydrostatic test— Respiration before birth — Respiration a sign of life, not of live birth — General conclusions ...... 569 CHAPTER L. On the proofs of a child having been born alive— Evidence from respiration — Marks of violence, and natural changes in the foetal vessels — The discovery of food in the stomach — General conclusions ..... 575 CHAPTER LI. Causes of death in new-born children— Proportion of children born dead- Natural causes of death — A protracted delivery — Debility— Bleeding from laceration of the navel-string— Compression of the navel-string— Malforma- tion — Destruction of Monstrous births — Deaths from congenital diseases . 589 CHAPTER LIL Violent causes of death in new-bom children — Suffocation — Drowning Death of the child from cold and exposure.— Starvation— Death from imma- turity—Wounds in new-born children— Fractures of the skull, accidental and criminal— Twisting of the neck— Violence in self-delivery— Power of locomotion and exertion in females after delivery .... 594 CONTENTS. XUl CHAPTER LIII. PAGE Death of the child from strangulation — Strangulation by the navel-string — Ac- cidental marks resembling those of strangulation — Constriction before and after death — Before and after breathing — Before and after the severance of the navel-string — Examination of the mother .... 609 BIRTH, INHERITANCE. CHAPTER LIV. Evidence of live birth in civil cases — Legal rights of the foetus in utero — Date of birth — Difference between entire and partial birth — Signs of live birth independently of respiration or crying — Vagitus uterinus — Tenancy by courtesy — Csesarean extraction of children — Legal birth — Post-mortem births — Monsters — Deprivation of legal rights — Minority and majority . . 619 CHAPTER LY. Legitimacy. — Presumption of legitimacy — Natural period of gestation — Du- ration of pregnancy from one intercourse — Premature births — Short periods of gestation — Viability — Earliest period at which a child may be born living — Evidence from the state of the child — Protracted births — The period of gestation not fixed by law ....... 639 CHAPTER LVI. Patebnitt. — Disputed paternity — Parental likeness — Affiliation — Posthu - mous children — Superfoetation in relation to legitimacy — Supposititious children — Sexual malformations ...... 657 IMPOTENCY, STERILITY. CHAPTER LVII. Impotenct. — Causes — Procreative power in the male — Puberty — Age for vi- rility — Virility of crypsorchides and monorchides — Sterility. — Procreative power in the female — Earliest and latest periods for child-bearing — Legal relations .......... 680 RAPE. CHAPTER LVIII. Nature of the crime — Sources of medical evidence — Rape on infants and chil- dren — Marks of violence — Purulent discharges from the vagina — Evidence from gonorrhoea and syphilis — Rape on girls after puberty — Defloration — Signs of virginity ........ 699 CHAPTER LIX. Rape on married and adult women — Circumstances under which it may be perpetrated on adult women — Loss of physical evidence — Pregnancy follow- ing rape — Microscopical evidence ...... 713 XIV CONTENTS. INSANITY. CHAPTER LX. FAQE What is insanity ? — Medical definitions — Distinctions of sane from insane per- sons — Moral insanity — Legal definitions — ' ' Non compos mentis' ' — Symptoms of incipient insanity — Hallucinations and illusions — Lucid interrals . . - 739 CHAPTER LXI. Varieties of insanity — Mania — Abstinence from food — Delusions regarding poison — Delirium distinguislied from mania — Monomania — Dementia — Idiocy — Imbecility — Hereditary transmission — Feigned insanity — Appear- ance after death — Eccentricity . ..... 737 CHAPTER LXII. Medico-legal questions in relation to the insane — Imposition of restraint — Ille- gal imposition of restraint — Violence of temper — Certificates of insanity — Rules for the discharge of lunatics . . . . . . 749 CHAPTER LXIII. Interdiction — Commissions of lunacy — Examination of alleged lunatics — Medi- cal and legal tests of competency — Conflict of evidence and opinion . 75 9 CHAPTER LXIV. Civil responsibility — Testamentary capacity — "Wills made by the insane — Test of capacity — Evidence of delusion — Eccentricity in wills . . .771 CHAPTER LXV. The plea or defence of insanity— Circumstances under which it is admissible — Homicidal insanity — Moral insanity — Symptoms — Legal tests — Medical tests — Delusion — Tests of irresponsibility — Medical evidence . . . 781 CHAPTER LXYI. Suicidal mania — Suicide not necessarily an indication of insanity — Suicide a felony — In relation to life insurance — Hereditary taint — Puerperal mania — Pyromania — Kleptomania — Dipsomania — Erotomania — Responsibility of drunlcards— Delirium tremens— Somnambulism— Deafness and dumbness . 800 LIFE INSURANCE. CHAPTER LXVII. Principles of Life Insurance — Questions to persons who insure their lives Medical questions — What diseases have, and what have not, a tendency to shorten life '—Legal decisions respecting the meaning of these words— Con- cealment of diseases — What is material concealment? — Concealment of habits— What is intemperance ?— Proximate and remote effects— Delirium tremens — Epilepsy— Phthisis— Abstinence— Vegetarianism — Opium-eating — Inveterate smoking — Insanity — Voidance of policies by suicide — Insurance murders .......... 833 ILLUSTRATIONS. 1 Crystals of oxalic acid 2 Crystals of oxalate of lime 3 Crystals of nitrate of soda 4 Crystals of arsenic from sublimation 5 Metallic sublimates of arsenic 6 Crystals of arsenic from solution . 7 Deposits from Marsh's process 8 Apparatus used for detecting arsenic in the tissues 9 Apparatus for Marsh's process 10 Deposit of metallic arsenic by heat 11 Flask used for Reinsch's process . 13 Crystals of corrosive sublimate by sublimation 13 Crystals of corrosive sublimate by solution in water 14 Crystals of corrosive sublimate by solution in alcohol 15 Sublimate of metallic mercury in globules 16 Sugar of lead crystals from a solution 17 Sugar of lead crystals magnified 80 diameters 18. Crystals of tartar emetic 19 Tips of the leaves of savin 20 Trichina spiralis in its capsule 21 Trichina spiralis in abdominal muscles of ma;n 22 Single trichina spiralis from human muscle 23 Trichina spiralis encysted in pork 24 Crystals of morphia from the hydrochlorate 25 Crystals of cyanide of silver 26 Berry of cocculus indicus . 27 Seeds of henbane . 28 Silky hairs of nux vomica 29 Crystals of strychnia 30 Crystals of strychnia from sulphate 31 Crystals of chromate of strychnia 32 Crystals of sulphate of brucia 33 Seeds of hemlock 34 Seeds of (Enanthe crooata 35 Seeds of ^thusa cynapium 36 Boot of aconite 37 Root of horseradish 38 Seeds of aconite 39 Seeds of belladonna PAOE 123 134 128 145 145 146 148 150 152 152 154 163 164 164 165 171 171 179 187 198 198 303 303 309 314 329 232 236 337 237 238 340 341 344 344 347 347 348 351 XVI LIST OF ILLUSTRATIONS. FIS. 40 Seeds of lobelia 41 Seeds of foxglove 42 Seeds of stramonium 43 Crystals of daturia 44 Fibres of cotton magnified 45 Fibres of linen magnified 46 Fibres of silk magnified 47 Fibres of woollen magnified 48 Fibres of ancient woollen 49 Fibres of ancient linen 50 Blood-corpuscles magnified 51 Corpuscles of blood in linen fibre 52 Human blood-corpuscles with fibrin 53 Human blood-corpuscles dried 64 Hsematin crystals 55 Blood-crystals from blood of man and fish 56 Blood-crystals from dried human blood 57 Section of the ergot of rye 58 Heart with ductus arteriosus in its foetal state 59 Heart with ductus arteriosus contracting 60 Granules of wheat-starch and of arrowroot 61 Oil-globules of human and cow's milk 62 Oil globules of human milk and colostrum 63 Epithelial scales .... 64 Microscopical appearances of meconium . PAGE 254 255 256 256 287 287 287 287 287 287 303 304 305 305 308 308 308 534 581 581 583 584 584 584 588 MEDICAL JURISPRUDENCE. MEDICAL EVIDENCE. CHAPTEE I. THE PRACTICE OF MEDICAL JUEISPRUDENCB. — MEBICAL AND MEDICO- LEGAL DUTIES. — INSPECTION OF BODIES IN DEATH FROM WOUNDS, OR POISONING. — USE OF NOTES. — MEDICO-LEGAL REPORTS. — DYING DECLA- RATIONS. Medical Jurisprudence — or, as it is sometimes called, Forensic, Legal, or State Medicine — may be defined to be that science which teaches the application of every branch of medical knowl- edge to the purposes of the law ; hence its limits are, on the one hand, the requirements of the law, and on the other, the whole range of medicine. Anatomy, physiology, medicine, surgery, chemistry, physics and botany, lend their aid as necessity arises ; arid in some cases all these branches of science are required to enable a court of law to arrive at a proper conclusion on a con- tested question affecting life or property. The purpose of this work is to bring, as far as possible, within a limited compass, those subjects which especially demand inquiry, and which more particularly concern the duties of the educated physician and surgeon. The definition above given necessarily implies that a medical jurist should have a theoretical and practi- cal knowledge of all branches of the profession, a large range of experience and the rare power of adapting his knowledge and experience to emergencies. He should be able to elucidate any difficult medico-legal question which may arise, and be prepared at all times to make a cautious selection of such medical facts, and a proper application of such medical principles, as may be ne- cessary to enable a judge to place the subject in an intelligible light before a jury, and to enable a jury to arrive at a just con- clusion. The variety of subjects of which a medical jurist is required to have knowledge may well alarm a student, and lead him to sup- pose that, as he cannot make himself perfectly acquainted with all, he may well forego the labor of preparing himself in any. 2 18 DUTIES OF PHYSICIANS AND But this would be taking an erroneous view of his position. This description of the qualifications necessary to constitute a normal witness in a court of law must not deter him from entering on the study. It is assuredly beyond the mental power of any individual that he should be at the same time profoundly versed in all the principles of medicine and jurisprudence, and that he should be able to answer all possible questions, and encounter and remove all medical difficulties that may occur during the trial of a civil or criminal case. All that the law expects from a medical man is a fair average knowledge, not merely of his profession, but of that which falls more peculiarly under the province of a medical wit- ness. There can be no doubt that the more perfectly a man has made himself master of his profession, the better will he be fitted to follow the principles and apply himself to the practice of medi- cal jurisprudence ; but he must divest himself of the notion that these principles can be spontaneously acquired, or that they are necessarily derived from the study of those isolated branches of medicine upon which medical jurisprudence is based. The mate- rials for the medical jurist undoubtedly exist in these collateral sciences ; but they require to be assorted, selected, and moulded into shape, before they can be applied to any useful or practical purpose. The duties of a medical jurist are distinct from those of a physi- cian or surgeon ; the latter looks only to the treatment of disease or accident and the saving of life ; but the object of the former, in a large proportion of cases, is, whether in reference to the living or dead, to aid the law in fixing on the perpetrator of a crime, or to rescue an innocent person from a falsely imputed crime. Thus he may be required to determine whether, in a particular case, the cause of death is natural or violent ; and for this puqaose it will be necessary for him to make an entirely new application of his professional knowledge. He has now the difficult task of making a selection from those parts of the medical sciences which bear upon the legal proof and development of crime. Some members of the profession have been inclined to look upon medico-legal practice as an unnecessary addition to their ordinary duties ; but there are few who have been long engaged in practice, who have not found themselves occasionally placed in situations of difficulty from the accidental occurrence of cases demanding medico-legal investigation. A medical man is summoned to attend a person laboring under the effects of poison criminally administered, but at the time he may have no knowledge or even suspicion that poison is the cause of the symptoms. In spite of the best treatment, death ensues ; here the functions of the medi- cal man end, and those of a medical witness begin. It is utterly impossible that he can now avoid giving evidence, or shift the re- sponsibility on another — the law will insist upon his appearance, first in the court of the coroner, and afterwards at the Assizes. It will here be assumed that as a registered member of the profession he is fully competent to answer every question put to him by SURGEONS IN ACTING AS WITNESSES. 19 judge and counsel relative to the general effects of poisons ; the quantity required to destroy life ; and the time within which a poison may prove fatal. It may be objected to his evidence, that fhe deceased had died from the effects of disease, and not from poison, in which case the cross-examination will lead to a searching inquiry into all those diseases which resemble poisoning in their * symptoms and post-mortem appearances as well as the means of making a certain distinction between them ; and the fallacies to which the chemical processes for the detection of poison are liable. On another occasion, a medical man may be called to render assist- ance to one who has been stabbed in a quarrel, and who speedily dies from the wound. The office of the surgeon here ceases, while that of the medical j urist commences. He must now be prepared to answer numerous questions, all bearing upon the legal proof of crime, all necessary in law, although apparently superfluous in surgery. Thus he may be asked to state the precise characters of a wound inflicted upon the body of a man soon after death ; and by what means a particular wound was inflicted ? Was it homi- cidal, or accidental ? The amount of blood lost ? "Whether the person could have moved, or performed any act after receiving it ? Are certain red spots found upon his clothes, or upon a knife be- longing to him, owing to effused blood or other causes ? Whether any, and what statements were made by the dying man, and what were the precise circumstances under which they were made ? It need hardly be observed that questions of this nature are rarely noticed, except in a cursory manner, by professors of chemistry and surgery, and a medical man is not likely to acquire the means of answering them by intuition. On the other hand, regarding our- selves as living in a civilized state, in which the detection and punishment of crimes against life and property are indispensable to the security of all, it is impossible to overrate their importance. Unless a witness is able to return answers to these questions when a public necessity occurs, a guilty man may escape punishment, while an innocent man may be condemned. He may thus most seriously injure his own reputation, for it is certain that his quali- fications as a physician, surgeon, or general practitioner, however great, will not shield him from general reprobation. Thus, then, it is obvious that the duties of a medical jurist are of a highly responsible nature and of great importance to society, while the cases which call them into exercise are of purely acciden- tal occurrence. A medical practitioner who thinks himself secure in the most retired corner of the kingdom, is liable to find himself suddenly summoned as a witness on a trial, to answer questions which perhaps during a long period of practice he had been led to regard as unimportant. Under the circumstances it is scarcely pos- sible that he can avoid exposing his deficiencies, and the final ques- tion will be, Have you ever attended to, or thought of these subjects before ? A negative answer to this question, while it commonly brings with it public censure, will in most instances lead to the acquittal of the accused, in spite of strong presumptions of guilt. - 20 MEDICAL CONTRASTED WITH I have endeavored to avoid overdrawing this picture ; its truth will, I am sure, be felt and acknowledged by those who have been a few years engaged in practice. The records of our courts of law contain many unfortunate exposures, which might have been easily avoided, had the witnesses only availed themselves of the opportu- nities afforded to them while students, of acquiring a knowledge of the subject ; but they had unreflectingly acted on the principle, that medical jurisprudence was a dry, dull, and useless study, and that the practice of it was remote and speculative. This feeling is, however, fast disappearing. Those who have been compelled by circumstances to give their attention to it, have in subsequent cases taken care to prepare themselves for the ordeal through which every medical witness must pass. Some medical men who have treated legal medicine with in- difference have occasionally ventured to act as witnesses, thinking that the subjects on which they were likely, to be examined were so little known to judge and counsel, that even hazardous or rash statements would escape observation : such witnesses, however, have often found to their cost that they were laboring under a fatal delusion. Various circumstances have led, in recent times, to the acquisition of much medico-legal knowledge by lawyers, especially in relation to questions connected with wounds, child-murder and poisoning, and they are not slow in detecting and exposing a mere pretender who attempts to shelter himself by vague or evasive state- ments and technical language. Another fact must be borne in mind : there are few counsel engaged in any civil or criminal case of importance, who do not take care to fortify themselves under medical advice, with a full knowledge of the views of standard medical writers on the subject in dispute ; and with these works before them and with their proverbial acuteness, he must indeed be a clever witness who can succeed in passing off" an erroneous or evasive answer to a medico-legal question. It is a frequent charge against members of the medical profession that they are the worst witnesses on matters of fact and opinion. I believe this to be an unmerited censure. Those who are ready to made this charge overlook the number, complexity and difficulty of the questions which are put to medical men compared with those put to other witnesses. They also forget that medical men are much more frequently summoned as witnesses than the members of the two other learned professions. Their evidence obtains much greater publicity, and is necessarily exposed to a wider circle of criticism. The fact is, that good and bad witnesses are to be met with in every profession, and under equal conditions there is no rea- son to suppose that one would furnish a greater number of incompe- tent witnesses than another. It is certainly the fault of medical men that they are not generally prepared for the questions which are likely to arise in a case on which they know they will be required to give evidence. This want of preparation frequently applies to facts as well as to opinions. Thus, in reference to a case on which a charge of murder or manslaughter may be ultimately founded, a MEDIOO-LEGAL OBSERVATION. 21 medical man who is called in omits to observe many circumstances, because at the time they appear to him to have little importance, although at the subsequent trial he may find, to his dismay, that they_ actually become the turning points of innocence or guilt. Medical observation as a result of professional habits is, on these occasions, in general confined to only one set of circumstances — the recognition and treatment of accident or disease ; but medicp-legal observation should take a much wider range than this, and should be directed to all the surrounding facts and incidents of a case. The essential difference in the two kinds of practice is, that circum- stances which are of no interest in a medical or surgical point of view, are often of the greatest value and importance in legal medi- cine. It is obvious, that, if they are not observed by a medical wit- ness when he is first summoned to the injured person, whether dying or dead, it will be out of his power . to meet many of the questions which must arise in the progress of the case. The non- observance of these facts is a serious evil, and often carries with it, although unjustly, an imputation of professional ignorance. The first duty, therefore, of a medical jurist is to cultivate a faculty of minute observation of medical and moral circumstances. This, when combined with a general knowledge of what the law requires as evidence, will enable him to meet in a satisfactory manner all the scientific questions that may be necessary for the elucidation of a case. The exercise of this faculty is by no means inconsistent with the performance of his duties as a surgeon. A learned judge on one occasion remarked that " a medical man, xohen lie sees a dead body, should notice everything." Undoubtedly he should observe everything which could throw a light upon the production of wounds or other injuries found upon it. It should not be left to policemen to say whether there were any marks of blood on the dress or on the hands of the deceased, or on the furni- ture in the room. The dress of the deceased as well as the body should be always closely examined on the spot by the medical man. The importance of this precaution is well illustrated by a certain case in which a man just escaped committal on what would have proved a false charge of murder, by reason of the examina- tion of an article of dress accidentally produced at the adjourned inquest. There is another point which is frequently omitted on these occasions, and the omission may give rise to great inconvenience, if not to a failure of justice. Thus, in reference to a dead body, no observation is made at the time of the visit whether it or any part of it is cold or warm ; whether the limbs are cold and rigid, or cold and pliant. In a medical and surgical view these condi- tions of the body are of no importance whatever, but medico- legally, if the facts are observed, they may enable a witness to speak with greater or less probability on the time of death : this may make all the difference between the acquittal and conviction of a person charged with murder. The case of Gardner, elsewhere related, will show the importance of observations of this kind. 22 RULES FOR OBSERVING ALLEGED OASES OF HOMICIDE. It may stimulate the attention of a medical practitioner in reference to these inquiries if he is informed that the great art of counsel, who defend persons charged with murder or manslaughter, consists in endeavoring to discover what he omitted to do. Al- though sometimes the omission may be really of no medical im- portance whatever, yet it is usually placed before the jury in such a strong. light that the accused obtains the benefit of a doubt. The omission may be attributed to professional ignorance, or, what is worse, to professional bias — a determination to find proofs of guilt against the " unhappy prisoner at the bar" — when the facts might be innocently explained by a want of experience on the part of the witness in dealing with cases of this nature. Before any inquiry is instituted by a magistrate or coroner, and' before any suspicious circumstances have come to light, a medical man may be summoned to a person dying from the effects of a wound, or from the secret administration of poison. The dying person may make to him a declaration or statement as to the cir- cumstances under which the wound was inflicted or the poison administered: he may also mention the names of the person or persons concerned in the assault or the administration. This dying declaration or statement, according to the circumstances under which it is made, may become of material importance in the prose- cution of a party charged with murder or manslaughter. It is therefore proper that a practitioner should observe and make notes of the exact condition of the patient ; whether, when he makes the statement, he is under the conviction or belief that he is dying. It has been thought that it was also necessary to prove that the wounded man had lost all hope of recovery : but as a learned judge has justly remarked, it is very difficult, if not impossible, to say on these occasions, when, if ever, the feeling of hope completely deserts a man. It is sufficient for all legal purposes, if he expresses his belief that he is dying. Hence, when the case is likely to prove fatal, it is the duty of the medical man to warn the patient in the presence of his rela- tives or friends, of his dangerous condition. If the wound or poison is not likely to prove rapidly fatal, the attendance of a magistrate to take down the statement in due legal form, would relieve the medical man of all responsibility. Should any state- ment, however, be made to him under these circumstances, it is his duty to make, on the spot, a note of the words actually used. There should be no paraphrase or translation of them, but they should be the ipsissiraa verba of the dying man. It is not for the witness, but for the court, to interpret what is thus stated. A medical man on these occasions should not render himself officious in extracting information. He may receive that which is volunta- rily uttered, and, either immediately or on the earliest possible opportunity, write down the statement as it was made. Any question should be simply confined to the purpose of explaining what may appear to him to be ambiguous, or contradictory in the declaration itself. RULES FOR OBSERVING ALLEGED CASES OF^HOMICIDE. 23 In reference to persons who have died from the elFects of wounds, poison, or other violent causes, the initiatory proceedings connected with the inquiry usually take place in the court of the coroner ; and unless the medical man in attendance is supposed to be impli- cated by maltreatment, or otherwise in the death of the person, the duty of making an examination of the dead body devolves upon him. He may not have seen the person while living ; and in this case it will be necessary that he should give his attention to those circumstances which may be of importance in the future inquiry. He should note as far as it can be ascertained : 1. The exact time of death, if known, and thus determine how long a period the person has survived. 2. The attitude, position, and con- dition of the body. 3. The state of the dress. 4. All surrounding objects. Any bottles, paper-packets, weapons, or spilled liquids lying about should be collected and preserved, and their position with regard to the body of deceased should be noted. 5. Any vomited matters near the deceased should be collected. In making a post-mortem examination of the body the following additional points should be attended to : 6. The external appearance of the body, whether the surface is livid or pallid. 7. E"ote the state of the countenance. 8. Note all marks of violence on the person, or discomposure of the dress, marks of blood, etc. 9. The situation, form and direction of all wounds should be accurately noticed. 10. The presence or absence of warmth or coldness in the legs, arms, abdomen, mouth, or armpits. 11. The presence of cadaveric rigidity in any part of^the body. To give any value to the two last-mentioned characters, it is necessary for the practitioner to observe the nature of the floor on which the body is lying, whether the body is clothed or naked, young or old, fat or emaciated. These conditions create a difference, in respect to the cooling of the body and the access of rigidity. 12. If found dead — "When was the deceased last seen living, or known to have been alive ? 13. Jfote all circumstances leading to a suspicion of suicide or murder. 14. The time after death at which the inspection is made. 15. Observe the state of the abdominal viscera. If the stomach and intestines are found inflamed, the seat of imflam- mation should be exactly specified ; also all marks of softening, ulceration, effusion of blood, corrosion, or perforation. The sto- mach should be removed and placed in a separate vessel, ligatures being applied to the two ends. If cut open for examination at this period, this should be performed in a clean dish, and with such care that none of the contents are lost, or are allowed to mix with the contents of the intestines. 16. The contents of the stomach, if this organ is opened during the inspection, should be collected in a clean graduated vessel : notice, a, the quantity ; b, the odor tried by several persons ; c, the color ; d, acid or alkaline reaction ; e, presence of blood, mucus, or bile ; /, presence of undigested food ; and here it may be as well to observe, that the presence of farina- ceous matters (bread) would be indicated by the addition of iodine water, if the contents were not alkaline — of fat, by heat ; g, other 2i RULES FOR OBSERVING ALLEGED CASES OF HOMICIDE. special characters. 17. The contents of the duodeuura should be separately collected, ligatures being applied to it. 18. Observe the state of the largo intestines, especially the rectum, and note the condition of their contents. The discovery of hardened feces in the rectum would prove that purging had not existed recently before death. 19. The state of the windpipe, throat, and gullet, whether there are in these parts any foreign substances, or marks of inflammation and corrosion. This is of essential importance, as it throws a light upon a variety of questions which may arise respecting death by suffocation from mechanical causes, or the nature of a substance swallowed. 20. The state of the lungs and heart ; all morbid changes noted. 21. The state of the brain and spinal marrow. 22. The condition of the uterus, ovaries, and genital organs should be examined, as, in the female, poison has been sometimes introduced into the system by the vagina, or wounds have been inflicted internally. 23. The liver with the gall-bladder should be removed for a chemical examination. 24. The urinary bladder, with any fluid contained in it, should be removed and placed in a separate jar. Such are the points to which, in the greater number of cases of violent death, a medical jurist should give his attention. By means of these data, noted according to the particular case to which they are adapted, he will in general be enabled, without difficulty, to determine the probable time of death, and the actual means by which death was brought about. He may thereby have it in his power, if the case be one of poisoning, to point out the dish or article of food which had contained the poison, and to throw light upon any disputed question of suicide or murder in relation to the, deceased. Many cases of death from wounds or poison are rendered obscure, owing to these points not having been attended to in the first instance. It is not necessary in this place to enter into any details respect- ing the mode of performing an inspection. The ■ only essential points in addition to those above mentioned are, 1. To examine all the important organs for marks of natural disease ; and 2. To note down any unusual pathological appearances, or abnormal de- viations ; although they may at the time appear to have no bearing on the cause of death. It is useful to bear in mind on these occa- sions, that the body is inspected, not merely to shOw that the person has died from poison, but to prove that he has not died from any natural cause. Medical practitioners commonly give their at- tention exclusively to the first point ; while lawyers, who defend accused parties, very properly direct a most searching examination to the last-mentioned- point, i. e. the healthy or unhealthy state of those organs which are essential to life. The usual causes of sud- den death have their seats commonly in the brain, the heart and its great vessels, or in the lungs. Marks of effusion of blood, con- gestion, inflammation, suppuration, or a diseased condition of the valves of the heart, should be sought for and accurately noted. It has also been recommended that an examination of the spinal INSPECTION OF EXHUMED BODIES. 25 marrow should be made. If the cause of death be obscure after the general examination of the body, there is good reason for in- specting the condition of this organ. [In medico-legal cases, involving the question of life and death, the examination of the body of the deceased cannot possibly be too thorough and exhaustive ; the omission of any one organ is a radi- cal defect. This is well illustrated in two leading cases in the United States within the past year (1872),— that of Mrs. E. Gr. Wharton charged with poisoning G-eneral Ketchum, and that of Dr. Paul Schceppe charged with poisoning Miss Steinnecke. In neither ease, was the post-mortem examination sufficiently com- plete. In the first case, where the symptoms of the deceased were certainly more in accordance with disease than with tartar emetic (the alleged) poisoning, and where competent medical authority ascribed it to cerebro spinal meningitis, no examination of the spinal marrow was made. In the latter case, in which the symp- toms were those of apoplexy and of ursemic poisoning, the kidneys and several other organs were entirely overlooked. In certain ob- scure cases, it may even become necessary to institute a microscopic examination, especially of the brain and heart. — E..] Exhumation of bodies. — Sometimes the inspection of a body is required to be made long after interment. So long as the coffin remains entire, there may be the expectation of discovering certain kinds of mineral poison in the organs; but decomposition may have advanced so far as to destroy all pathological evidence. The inspection in such cases is commonly confined to the abdominal viscera. The stomach is often found so thin and collapsed, that the anterior and posterior walls appear to form only one coat. This organ should be removed with the duodenum, and ligatures should be applied to each. The liver, spleen and kidneys should also be removed, in order that they may, if necessary, be separately ana- lyzed. ' If poison is not found in one or more of these parts, it is not likely that it will be discovered in the body. It has been recommended that a portion of earth immediately above and below the coffin should be removed for analysis, as it may contain arsenic ; but this appears to me to be an unnecessary piece of refinement when the coffin is entire, or when the abdominal parietes still cover the viscera. If decomposition has so far advanced as to have led to an admixture of earth with the viscera, and the poison is found in minute quantity in the tissues only, the source of the poison may be regarded as doubtful. The body of a deceased person when exhumed, should be identified by some friend or relative, in the presence of the medical examiner. In one case of murder by poison, the evidence almost failed, owing to this precaution not having been taken. It is important that the viscera taken from a body which has been long in the grave should be sealed up immediately. They should not be allowed to come in contact with any metal, nor with any surface except that of clean glass, porcelain, or wood. It has 26 IDENTITY OF ARTICLES FOR ANALYSIS. been recommended that they should be washed with chloride of lime, or placed in alcohol ; but this is decidedly improper ; the use of any preservative chemical liquid would not only embarrass the future analysis, but would render a special examination of an un- used portion of the liquid necessary, the identity of which would have to be unequivocally established. Preservation from air in clean glass vessels, with well-fitted corks, covei'ed with skin, or, what is still better, sheet-caoutchouc, is all that is required in practice. Identity of substances. — It is necessary to observe, that all legal authorities rigorously insist upon proof being adduced of the identity of the vomited matters or other liquids taken from the body of a deceased person, when poisoning is suspected. Supposing that, during the examination, the stomach and viscera are removed from the body, they should never be placed on any surface, or in any vessel, until we have first ascertained that the surface or ves- sel is perfectly clean. [It is safer and more satisfactory that all the vessels and apparatus used should be perfectly new. — E..] If this point be not attended to, it will be in the power of counsel for the defence to raise a doubt in the minds of the jury, whether the poisonous substance might not have been accidentally present in the vessel used. This may be regarded as a very remote presump- tion ; but, nevertheless, it is upon technical objections of this kind that acquittals follow in spite of the strongest presumptions of guilt. This is a question for which every medical witness should be prepared, whether he is giving his evidence at a coroner's in- quest, or in a court of law. Many might feel disposed to regard matters of this kind as involving unnecessary nicety and care, but if they are neglected it is possible that a case may be at once stopped : so that the care subsequently bestowed upon a chemical analysis will be labor thrown away. Evidence of the presence of poison in the contents of a stomach was once rejected at a trial for murder, because they had been hastily thrown into a jar borrowed from a neighboring grocer's shop ; and it could not be satisfactorily proved that the jar was clean and entirely free from traces of poison (in which the grocer dealt) when used for this purpose. [A case has been communicated to the editor by Prof. R. Bridges, in which the search for arsenic in the body failed to detect that poison, but where zinc in considerable quantities was found. It turned out, on inquiry, that the stomach, etc. had been carelessly thrown into an old tin can, which had been formerly used for hold- ing zinc paint, before being sent to the analyst. — R.] When the life of a human being is at stake, as in a charge of murder by poisoning, the slightest doubt is always very properly interpreted in favor of the accused. E'ot only must clean vessels be used for receiving any liquid de- tained for subsequent chemical analj'sis, but care must be taken that the identity of a substance is preserved, or the most correct analysis, afterwards made, will be inadmissible as evidence. The suspected substance, when once placed in the hands of a medical man, should never be let out of his sight or custody. It should be PRESERVATION OF ARTICLES FOR ANALYSIS. 27 kept sealed under his private seal, and locked up while in his pos- session, in a closet to which no other person has a key. If he has once let it out of his hands, and allowed it to pass through the hands of several other persons, then he complicates the evidence for the prosecution, by rendering it indispensable for these persons to state under what circumstances it was placed while in their possession. The exposure of a suspected substance on a table, or in a closet or room, to which many have access, may be fatal to its identity ; for the chemical evidence, so important in a criminal investigation, will probably be altogether rejected by the court. "When any article (e. g. a stomach or other organ) is reserved for analysis, care should be taken to attach immediately to it, or to the vessel containing it, a parchment or wooden label, upon which is plainly written, in ink, the name of the deceased and the date of removal, including the day of the week and month. This is espe- cially necessary when there are two or more articles for analysis. I have known the greatest inconvenience to result from the neglect of this simple precaution. [This rule in relation to identity cannot be too rigorously enforced. A striking illustration is afforded in a recent case {State of Virginia v. Mrs. E. E. Lloyd, charged with poisoning her daughter with arsenic). At the trial, it was found that the person who had conveyed the stomach to the analyst, had died in the interim. Although several grains of arsenic were said to have been detected, still, as the identity of the stomach could not be positively established, the court very properly ruled out the evidence for want of this single link in the chain. — R.] Preserving articles for analysis. — In removing viscera or liquids from the body, and reserving them for analysis, it is necessary to observe certain precautions. A clean vessel with a wide mouth should be selected ; it should be only sufficiently large to hold the organ, or liquid (the less air remaining in it the better) ; it should be secured by a closely-fitting cork, covered with fine skin or bladder. Another piece of skin should then be tied over the mouth, or, for this, sheet caoutchouc or gutta-percha may be substituted with advantage. It should lastly be covered with tinfoil and a layer of white leather. In this way any loss by evaporation or decomposition is prevented, and the viscera may be preserved (in a cool place) for some time. If the mouth of the vessel be too wide for a cork, the other articles cannot be dipensed with. Paper only should not be used ; I have known the appearances after death of the viscera of an infant, suspected to have died from poi- son, entirely destroyed by drying, from the evaporation which took place through the layers of paper with which the vessel in which they were contained was covered. The practitioner should bear in mind that all these matters are likely to come out in evidence ; and whatever is worth doing at all is worth doing well. For reasons already stated, antiseptic chemical compounds should not be used. The addition of a small quantity of chloroform to the viscera will, without complicating the analysis, tend to preserve them. 28 USE OF NOTES IN EVIDENCE. The articles used for the preservation of viscera should be in all cases scrupulously examined. Some kinds of calico are dressed with arsenic and starch pastes, and many kinds of wrapping-paper- as well as wall-papers are strongly impregnated with this poison. An observation made by Mr. Aickin, of Belfast, shows that this is not an unnecessary caution. This gentleman was engaged in exam- ining the body of a child, in order to determine the cause of death. The organs were healthy, and as no sufficient cause presented itself, he removed the stomach, with a view of making an analysis of its contents. He was suddenly called away ; and, to preserve the stomach, he wrapped it in a piece of paper (used for papering rooms), placing it on the uncolored side, and he locked it in a closet until the following day. Assisted by a friend, he then analyzed the contents, and found a trace of morphia, with a pretty large quan- tity of arsenic. As the symptoms from which the child had died were not those of poisoning with arsenic, and there were no appear- ances of the action of this substance on the body, he came to the conclusion that its presence must have been owing to some extra- neous cause. He examined a portion of the wall-paper in which the stomach had been wrapped, and then found that part of it which was colored yellow was tinted with sulphide of arsenic or orpiment ! It was therefore evident, as orpiment contains white arsenic, that the stomach and its contents had imbibed a portion of the poison during the night. (" Lancet," June 23, 1855, p. 632.) This satisfactorily accounted for the presence of arsenic under circumstances which might have given rise to a false charge of murder. Ifearly all wall-papers having any tinge of green or golden yellow in them, contain arsenic, and this arsenic spreads by imbibition to other parts of the paper not so tinted. It would, of course, be proper to avoid in all cases the use of any wrapper having upon it mineral colors of any description. Mr. Aickin's case shows in a striking point of view the danger of trusting to chemical analysis alone. Unless we look to physiology and pa- thology, a most erroneous opinion may be expressed. The results of an a,nalysis, in the shape of sublimates or precipi- tates, should be preserved as evidence, distinctly labelled in small glass tubes, hermetically sealed. They can then, if asked for, be produced for examination, at the inquest or trial. On the use of Notes. — It has already been recommended, as a rule in these criminal investigations, that a practitioner should make notes of what he observes in regard to symptoms, appearances after death, and the results of a chemical analysis. His own observa- tions should be kept distinct from observation given him by others. He may base his conclusions on the former, but not on the latter. Trom the common forms of law in this country, a person charged with the crime of poisoning may remain imprisoned, if at a dis- tance from the metropolis, for some months before he is brought to trial. It is obvious, however clear the circumstances may at the time appear to a practitioner, that it will require more than ordinary powers of memory to retain, for so long a period, a dis- MEDICO-LEGAL EEPORTS. 29 tinct recollection of all the facts of the case. If he is unprovided with notes, and his memory is defective, then the case will turn in favor of the prisoner, for he will be the person to benefit by the neglect of the witness. In adopting the plan here recommended, such a result may be easily prevented. It may be remarked that the law relative to the admissibility of notes or memoranda is very strict, and in trials for murder is rigorously enforced by the judges. In order to render such notes or memoranda admissible, it is in- dispensably necessary that they should be taken on the spot at the time the observations are made, or as soon afterwards as practica- ble ; and, further, it must be remembered that a witness can refer to them only to refresh his memory. If from indistinctness of writing or other causes, a copy of the notes has been subsequently made, a witness should not destroy the original notes, but have them ready for production. [See on this subject " Greenleaf's Evi- dence," vol. i. §§ 436-439. Also, " Alison's Treatise on the Practice of the Criminal Law," pp. 540-542.— P.] So in reference to all other written memoranda connected with the case as to the medicines prescribed for the deceased, the visits made to him, etc., the witness should be prepared to produce them and explain any alterations or erasures which may be found in his books. Counsel ai'e entitled to look at and examine all documents of this kind which are produced or used by the witness in giving his evidence. Medico-legal Heporis. — One of the duties of a medical jurist is to draw up a report of the results of his examination : 1, in regard to symptoms ; 2, in regard to appearances after death ; and, 8, in regard to the results of an analysis. "With respect to the first two divisions of the report, I must refer the reader to the rules for in- vestigating cases of poisoning (p. 28). It need hardly be observed that the time at which the person was first seen, and the circum- stances under which the attendance of the practitioner was re- quired, as well as the period of death, should be particularly stated. The hour, the day of the week, and the month, should be invariably mentioned. Some medical witnesses merely state the day of the week, without that of the month, or vice versd. At a trial this sometimes creates great confusion, by rendering a reference to almanacs necessary. The words yesterday, next day, etc., should never be used. The facts which it will be necessary to enter in the report are specially stated under the heads of investigation (see p. 24). If these facts are not observed in the order there set down, their value as evidence of the cause of death, or of the criminality or innocence of particular persons, will be entirely lost. In drawing up a report of symptoms and appearances after death, the facts should be in the first instance plainly and concisely stated seriatim, in language easily intelligible to non-professional men. A reporter is not called upon to display his erudition, but to make, himself understood. If technical terms are employed, their mean- ing should be stated in parentheses. When a subject is thoroughly understood, there can be no difficulty in rendering it in simple 30 MEDICO-LEGAL REPORTS. language; and when it is not well understood, the practitioner is not in a position to make any report. Magistrates, coroners, and barristers are very acute, and easily detect ignorance, even when it appears under the mask of erudition. In recording facts, a reporter should not encumber his state- ments with opinions, inferences, or comments. The facts should be first stated, and the conclusions should be reserved until the end of the report. The language in which conclusions' are ex- pressed, should be precise and clear. It must be remembered that these are intended to form a concise summary of the whole report, upon which the judgment of a magistrate, or the decision of a coroner's jury, will be ultimately based. They should be most strictly confined to the matters which are the subject of inquiry, and which have actually fallen under the observation of the wit- ness. Thus, they commonly refer to the following question: What was the cause of death ? What are the medical circumstances which lead you to suppose that death was caused by violence ? What are the circumstances which lead you to suppose that death was not caused by natural disease ? Answers to one or all of these questions comprise, in general, all that a reporter is required to introduce into the conclusions of his report. The reporter must remember that his conclusions are to be based only upon medical facts, not upon moral circumstances, unless he is specially required to express his opinion with regard to them when they are of a medico-moral nature. Further, they must be founded only on what he has himself seen or observed. Any information derived from others should not be made the basis of an opinion either in evidence, or in a medico-legal report. It is scarcely necessary to remark that a conclusion based upon mere probabili- ties is of no value as evidence. In drawing up a report on the results of a chemical analysis, the following rules may be borne in mind. A liquid or solid is re- ceived for analysis : 1. When, and of whom, or how received ? 2. In what state was it received — secured in any way, or exposed ? 3. If more than one substance received, each to be separately and distinctly labelled ; appearance of the vessel, its capacity, and the quantitjr of liquid (by measure) or solid (by weight) contained therein. 4. Where and when did you proceed to inake the analy- sis, and where was the substance kept during the intermediate period ? 5. Did any one assist you, or did you make the analysis yourself? 6. Physical characters of the substance. 7. Processes atid tests employed for determining whether it contained poison. All the steps of these processes need not be described ; a general outline of the analysis will suffice. The magistrate may thus satisfy himself by an appeal to others (if necessary) whether the analysis has or has not been properly made. 8. Supposing the substance to contain poison — is this in a pure state, or mixed with any other body ? 9. The strength of the poison, if an acid, or if it be in solution : in all cases, the quantity of poison found, deter- mined if possible by actuaj weighing. 10. Supposing no poison to MEDICO-LEGAL REPORTS. 31 be contained in it, what was the nature of the substance ? Did it contain anything of a noxious nature, i. e. likely to injure health, or destroy life ? 11. Could the supposed poisonous substance exist naturally, or be produced within the body ? 12. "Was it present in any of the liquids or solids employed in the chemical analysis ? 13. Was it contained in any of the articles of food or medicine taken by the deceased ? 14. Is its presence to be ascribed to the use of any mineral matter employed by injection after death for the preservation of the body of the deceased ? 16. What quantity of poison was actually separated in the free or absorbed state ? 16. How much of the substance found would, under the circumstances, be likely to destroy life ? There are few reports in which answers to some of these ques- tions, although not formally put, will not be required ; and unless the whole of them are borne in mind by the operator at the time an analysis is undertaken, those which are omitted can never re- ceive an answer, however important to the ends of justice that answer may ultimately become. There are frequently defects in these reports which it is desira- ble to point out. The statements are sometimes drawn up in ex- aggerated language ; at others they are overloaded with technical and therefore unintelligible terms, and the writer is seldom suffi- ciently careful to keep his facts distinct fi'om his comments. The former may be useful as evidence ; the latter are inadmissible. With respect to the first of these defects, it is very much the practice of medical men, in drawing up reports of medical cases for professional purposes, to use, unthinkingly, exaggeratedlanguage. Thus, it may be observed in the description of an ordinary post- mortem examination, the lining-membrane of the stomach is de- scribed as being "intensely" inflamed, or some part is "consider- ably" injected, or a cavity is " enormously" distended. Expressions thus loosely employed, convey to the legal mind a widely-different meaning from that intended by the reporter. Let him who is inclined to use them bear in mind that barristers look much more closely to the strict meaning of words than medical men, and that they are always disposed to distrust the judgment of one who cannot speak or write without resorting to the use of the super- lative degree. The free use of technical terms in drawing up reports should be avoided. Putting aside those cases in which a medical man be- lieves that he is displaying his erudition by the selection and use of such terms, there can be no doubt that the greater number of medical practitioners fall into this practice from mere habit. They think they are addressing the report to the president and members of some medical society, instead of a coroner and jury who have never in their reading or experience met with such terms, and to whom therefore they are perfectly unintelligible. In a report on the appearances in the body of a man who had suffered froni chronic insanity, which was submitted to me for explanation, the following passage occurred : " The only morbid appearance in the brain was 62 MEDICO-LEGAL REPORTS. an atheromatous deposit in the pons Varolii, near the situation of the locus niger." In another document, the reporter stated, for the information of a coroner's jury, that the "integuments of the cranium were reflected, and the calvarium was exposed." If a reporter will use such terms as these or others of a similar kind, such as " parietes of the abdomen," " epigastrium," " hypertrophy of the liver," when it would require no more trouble to put what he means in plain English, he must be prepared to have his mean- ing perverted, or wholly misunderstood. Setting aside the men who act as jurors, it may be observed that educated persons, such as coroners and magistrates, do not commonly include professional terms within the range of their studies. There are but few of them who understand the difference between perineum and peri- toneum, or the meaning of the words hemispheres of the brain, pia mater, puncta cruenta, corpora quadrigemina, centrum ovale, etc. They are not likely to know the difference between the cardia and pylorus, nor the nature or situation of the duodenum, jejunum, ileum, or caecum, and are as ready to consider them to be parts of the liver or urinary bladder, as of the intestines. On one occasion, I heard a learned judge ask for an explanation of the meaning of the term " alimentary canal." A slight consideration will show to any medical practitioner that refined professional language is wholly misplaced in a report which is intended to inform and con- vince the minds of ordinary men upon plain matters of fact. The last point' which calls for comment in reference to medical reports, is the loose manner in which facta and comments on facts, as well as hearsay statements, are sometimes found blended. If a reporter takes care to eliminate facts from comment, his report is admissible, and may be read at the inquest or trial as evidence. The facts are for the jury ; the comments upon the facts, introduced by the reporter, may or may not be correct, and are therefore not evidence. Their correctness or relevancy to the case will be elicited in the cross-examination. As a rule, nothing should be entered in a report which is not connected with the subject of inquiry, and which has not actually fallen under the observation of the reporter. The introduction of hearsay statements, i. e. statements made by others, or of circumstances which have come to his knowledge through public rumor, should be carefully avoided. Upon the medical report, and such evidence as may be required to explain it, an accused person may be committed for trial at the Assizes, either by a coroner or a magistrate. In the first stage of the proceedings, under these circumstances, the medical witness goes before the grand jury, and there, after the administration of an oath, he is required to make a general statement of what he knows of the matter. Such questions are put as may be necessary to elucidate the cause of death ; and on the finding of a true bill for murder or manslaughter, the accused is placed upon his trial before one of the learned judges of Assize. According to the variable circumstances attending such cases, the medical evidence DYING DECLARATIONS. 83 is called for at an early, or late stage of the proceedings. When it is at all doubtful whether the cause of death was owing to any criminal act, it is called for at the commencement of the case, in order to lay a foundation for further inquiry. It is necessary that a medical witness should remember that copies of his report and depositions, either before a coroner or magistrate, are usually placed in the hands of counsel as well as of the learned judge, and that his evidence, as it is given at the trial, is compared word for word with that which has been already put on record. There is reason to believe that this is not generally known to members of the medical profession, and thus it happens that either froin failure of memory, want of accurate observation, or carelessness in giving evidence at a coroner's inquest, medical witnesses lay themselves open to severe censure, either by stating matters diflterently at the trial, or by giving a very different com- plexion to the facts. Any serious deviations from what is on record will of course tell unfavorably for the witness, supply mate- rials for a severe cross-examination, and form an excellent ground of defence for the prisoner. The witness's weakness is the prison- er's opportunity, and of course his counsel will not lose the occasion of impressing upon the jury that a man who can on oath give two different accounts of the same transaction, is not to be believed on either. {^Dying declarations. — "The general principle on which this spe- cies of evidence is admitted was stated by Lord Chief Baron Eyre to be this : That they are declarations made in extremity, when the party is at the point of death, and when every hope of this world is gone ; when every motive to falsehood is silenced, and the mind is induced by the most powerful considerations to speak the truth. A situation so solemn and so awful is considered by the law as creating an obligation equal to that which is imposed by a positive oath in a court of justice. " It was at one time held by respectable authorities that this general principle warranted the admission of dying declarations in all cases, civil and criminal ; but it is now well settled that they are admissible, as such, only in cases of homicide, ' where the death of the deceased is the subject of the charge, and the circumstances of the death are the subject of the dying declaration.' " The persons whose declarations are thus admitted are considered as standing in the same situation as if they were sworn; the danger of impending death being equivalent to the sanction of an oath. It follows, therefore, that where the declarant, if living, would have been incompetent to testify, by reason of infamy or the like, his dying declarations are inadmissible ; and, as an oath derives the value of its sanction from the religious sense of 'the party's accountability to his Maker, and the deep impression that he is soon to render to Him the final account; wherever it appears that the declarant was incapable of this religious sense of accountability, whether from infi- delity, imbecility of mind, or tender age, the declarations are alike inadmissible. 3 34 DTING DECLARATIONS. "On the other hand, as the testimony of an accomplice is ad- missible against his fellow, the dying declarations of a particeps criminis in an act which resulted in his own death, are admissible against one indicted for the same murder." lb. § 157. On principle, therefore, the dying declarations of an accomplice should, to justify a conviction, require the same corroboration that is necessary where he testifies as a living witness (see Joy on the Evidence of Accomplices); but as to this the judges in Tinck- ler's case (1 East. PI. Cr. 854-56) were divided, the majority, however, thinking that they were suflScient without corroboration. And as husband and wife may testify against each other in all cases of personal injuries inflicted by either upon the other, the dying declarations of either are admissible where the other party is charged with the murder of the declarant. The People v. Green, 1 Denio R. 614. It is essential to the admissibility of these declarations, and is a preliminary fact, to be proved by the party offering them in evidence, that they were made under a sense of impending death. It is not essential, however, that the consciousness of impending death should be expressed by the dying man himself; it maybe collected either from the circumstances of the case, as the nature of the wound and state of the body, or from expressions used by the deceased. Com. v. Murray, 2 Ash. 41 ; Com. v. Williams, lb, 69; State v. Gillick, 7 Clarke (Iowa) 287; State v. Nash, lb. 347. See also People v. Lee, 17 Cal. 76 ; People v. Ybarra, lb. 166 ; Kil- patrick v. Commonwealth, 7 Casey 198. The length of time which elapses between the declarations and the death furnishes no rule as to the admissibility or rejection of the evidence. In Woodcock's case, 2 Leach's Cr. Cas. 563, the declarations were made forty-eight hours before death; in Tinck- ler's case, 1 East. P. C. 345, ten days, and in Pex v. Mosley, Cr. Cas. 97, eleven days before death ; and all were received. It is the impression of almost immediate dissolution, and not the rapid succession of death in point of fact, that renders the testimoriy admissible. Hence, where declarant at the time believed his death to be impending and certain, the declarations were com- petent, notwithstanding that he subsequently revived, and thought he might recover. State v. Nash, 7 Clarke (Iowa) 347. The language of the text-books, and of the authorities generally, is, that "where it appears that the declarant had 'any hope' of recovery, however slight it may have been, and though death actually ensued shortly afterwards, the declarations are inadmissi- ble." 1 Greenleaf § 158; Phillips on Evidence 200. But in Peginar. Pym ("Law Times," 1846, p. 500), where it appeared that the declarant had a firm belief that death was approaching, although it appeared that he hoped and thought it not impossible that he might recover, Erle, J., in admitting the evidence, said : "It has no doubt been held in some cases that all hope must be given up, but this is now decided not to be necessary. Indeed, if it were so, no declarations could be received, for scarcely a human dyin6 declarations. 85 being could be found, under any circumstances, who would not retain some hope. The law admits these declarations, not because recovery is impossible, but because there is a conviction of approach- ing death." The word hope is used in two senses : first, as implying belief, expectation; and second, wish or desire. In the latter sense it must always exist, and that seems to be the meaning as used in the case last cited. Where it is used as synonymous with belief or expec- tation, its existence would render the declarations inadmissible; since "hoping" in that sense to recover would be wholly incon- sistent with the alleged belief that death was impending. The declarations are admissible only as to those things which declarant would have been competent to testify if sworn in the case, viz., relevant facts, not mere matters of opinion. They are admissible in favor of, no less than against the party charged with the death. It is no objection to their admissibility that they were elicited by leading questions, or by pressing and earnest urgings. They must, however, be complete in themselves: for if it appears that the declarant intended to connect them with or qualify them by, other statements, which he is prevented by any cause from making, they will not be received. 1 Greenleaf, § 159. The circumstances under which the declarations were made are to be shown to the judge: it being his province, and not that of the jury, to determine whether they are admissible. Com. v. Murray, 2 Ash. 41 ; McHiigh v. State, 31 Alabama 317 ; People v. Glenn, 10 Cal. 32 ; State v. Howard, 32 Vermont 380. Still, however, the credibility of the evidence is entirely with the jury, who, if they do not believe that the deceased really was in such circumstances as the other witnesses may have testified to, may give no weight to the declarations. If the statement of the deceased was reduced to writing, and signed by him, it must be produced, if existing, and secondary evidence of the declarations cannot be admitted. State v. Tweedy, 11 Iowa 350. But it is not essential that a subscribing witness thereto should be produced, or his absence accounted for. Me- Hugh V. State, 31 Ala. 317. And where the declarations had been repeated at different times, at one of which they were under oath, and informally reduced to writing by one witness, and at the others they were not, it was held that the latter might be proved by parol, 4f the other could not be produced. Rex v. Reason, 1 Str. 499, 500; State v. Tweedy, supra. So, if the deposition has been taken, and is inadmissible as such for want of compliance with some statutory requirement, it seems it may still be treated as a dying declaration. Great caution, however, is to be observed in the use of this kind of evidence, because it is to be recollected that the accused may not have been confronted with the declarant, nor does he ever have the power of cross-examination, which is quite as essential to the eliciting of all the truth as the obligation of an oath can be. Be- 3-6 DYING DECLARATIONS. sides which, the particulars of the 'evidence, to which the deceased, has spoken, are in general likely to have occurred under circum- stances of confusion and surprise, calculated to prevent their being accurately observed ; and leading both to mistakes as to identity of persons, and to the omission of facts essentially important to the completeness and truth of the narrative. 1 Greenleaf, § 162 ; Evans's Pothier on Obligations 255. In the case of Commonwealth v. Lamb, tried in the Oyer and Terminer of Philadelphia, in March, 1854, the deceased, who died from the effects of blows upon the head inflicted by a gang who attacked him in the dark, had declared positively that the defend-' ant was the person who had struck him. The declarations were not received because of failure in the preliminary proof, and the prosecution was abandoned. The defendant was a very respectable young man, and could have clearly established his innocence, but the case showed how little reliance can be placed on this species of evidence, especially in questions of identity. (See, also, a case men- tioned in the former edition of this work, p. 179.) The objection, that receiving dying declarations was a violation of the article of the Declaration of Eights that every subject shaL have a right to confront the witnesses against him face to face, has been made, but not sustained by the courts. Com. v. Carey, 12 Gush. (Mass.) 246 ; Burrell v. State, 18 Texas 713 ; Peoj)le v. Glenn, 10 Cal. 32 ; State v. Nash, 7 Clarke (Iowa) 347. It is to be observed that while dying declarations are restricted to the case of trial for the homicide of the declarant, this applies only to declarations offered on the sole ground that they were made in extremis; for where they constitute part of the res gestce, or come within the exception of declarations against interest, or the like, they are admissible as in other cases ; irrespective of the fact, that the declarant was under apprehension of death. It is evidently, however, no part of the duty of the medical wit- ness or other person present when declarations are made to deter- mine whether they will be admissible or not. This question is to be left to the judges before whom the case shall be tried ; and the witness should carefully remember what is stated, writing it down immediately, or at the earliest moment possible, stating all that was said, and using the identical language of the declarant, not simply giving what he conceives to be the meaning or substance of it.— P.] coroners' inquests. 37 CHAPTER II. coroners' inquests. — TRIAL AT THE ASSIZES. — SUBPCBNAS. — EXAMI- NATION IN COURT. — DUTIES OE MEDICAL WITNESSES. — RULES FOR THE DELIVERY OP EVIDENCE. Coroners' inquests. — The proceedings at coroners' inquests are treated too lightly by medical men. The ignorant and uneducated class of persons who often constitute the jury, as well as the cir- cumstances under which the inquiry usually takes place, are not calculated to inspire great respect for these initiatory proceedings ; but still by law and custom coroners' inquisitions are and have been for ages in this country, the only tribunals for inquiring into and determining the cause of death in cases of suspected violence ; and they are therefore deserving of more attention than is usually shown to them by medical witnesses. As a rule, in all inquests which are likely to end in a committal of the accused person, a medical man who is giving his evidence before a coroner, in the room of a small country inn, or in a village school-room, is vir- tually delivering it before a judge of assize ; and this fact alone, if not a respect for the court, should induce him to give the evidence guardedly, and with a due consideration to the serious results to which it may ultimately lead. The 4th Edward I. stat. 2, on which coroners profess to act, directs that "upon information," they shall " go to th6 place where any be slain or suddenly dead," and make due inquiry as to the cause, etc., before a jury selected from persons living in the neighborhood. The information upon which a coroner generally acts is, 1. Ifotice from a beadle, or other officer of the parish (whose zeal is sometimes stimulated by a fee or salary), of any death from sudden or supposed unusual causes. 2. I^otice from a medical man who may have attended the de- ceased, and who communicates his suspicion that the cause of death, is not natural. 3. Notice from a registrar of deaths that no cause has been assigned in a particular case, or that there has been a rapid death after a short illness. The conclusion to which ex- perience leads in reference to these inquiries is, that the system affords no certainty for the detection of crime ; that it affords no protection to those who are wrongly charged with crime ; and lastly, that in some cases it screens a criminal by a verdict based upon an imperfect inquiry, in which the important medical facts are either not understood, or are misinterpreted by the jury. Many persons who occupy the office of coroner are neither medically nor judicially qualified for the proper performance of the duties of the office. The system of electing a man to hold such 38 coroners' inquests. an office as this (one demanding spiscial medical knowledge of the_ causes of death, and good legal knowledge of the law of evidence) by freeholders of the lowest degree, is so intrinsically absurd, that it is quite wonderful how, with improved civilization, it has main- tained its ground in such a country as England. The election of a Lord Chancellor, of the judge of our courts of law, or of County Court judges, might be with equal reason left in tbe hands of voters of this class, men who have no knowledge of the duties of the office, or of the skill and learning required in one who is really competent to fill it. The election of a good and capable person as coroner is, therefore, a matter of pure accident. B'o preliminary test of ability or capacity is required. [The same is lamentably true in most parts of the United States ; the office being usually the bestowal of political favoritism, — R.] Under the present system coroners are empowered by the Medi- cal Witnesses' Act (6 and 7 William IV. c. 89) to issue an order for the attendance of any legally-qualified practitioner, " being at the time in actual practice in or near the place where the death has happened ;" a fee of two guineas is the maximum allowed for making a post-mortem examination, and, if considered necessary by the jury, a chemical analysis of the stomach and intestines. A penalty of five pounds is attached to disobedience of this order, except for reasonable cause. Mr. Rumsey has correctly represented the unsatisfactory position in which medical men are placed by such an arrangement. He observes: "It is no discredit to a practitioner engaged in the toilsome routine of ordinary medical duties, if he should feel himself at a loss when called upon for a decisive opinion in some obscure case of poisoning or infanticide. His scanty opportunities for the study of these subjects and for making post-mortem examinations cannot suffice to qualify him for answering the delicate and important questions which he must answer before a jury can find a proper verdict." ..." The custom of indiscriminately summoning medical practitioners of all sorts, and of all degrees of pathological knowledge and forensic skill has sadly depreciated the value of medical evidence in courts of justice. Public confidence in the profession has been shaken, ' and the appearance of a ' doctor' in the witness-box is but too often a signal for sport among gentlemen of the long robe." (" Essays 01^ State Medicine," p. 356.) Under such a loose and imperfect system, the results must necessarily be disastrous. JS"o medical man can be compelled to undertake that which he feels incompetent to perform, and some medical practitioners who have felt this want of experience have properly declined to make chemical analyses involving so serious a responsibility. It is thus that, in many cases of importance, analyses for coroners' inquests are now referred to chemical experts, and the practitioner dis- charges himself of that responsibility which the Medical Witnesses' Act imposes upon him without any adequate remuneration. Before quitting this subject, it is necessary to observe that medi- cal men are too ready to give their opinion of the cause of death TRIAL AT THE ASSIZES. 39 for a coroner's inquest without making an inspection of the body. 'ISTo man is compelled to give an opinion upon insufficient data, and if by the institution of a judicial inquiry there are grounds for believing that a death has not been natural, no medical opinion of the cause should be given in the absence of an inspection. Such an opinion must always be conjectural, and may involve the medi- cal man in an unpleasant responsibility. Trial at the Assizes. — The next stage of the proceedings in a criminal case brings a medical w^itness before a superior court. For this purpose a subpoena is issued. It need hardly be observed that every witness is bound to obey a subpoena, when with it his reasonable expenses for journey, etc., are tendered to him, but he is not bound to attend at the trial except upon a subpcena. [In criminal cases no tender of fees, etc., is in general necessary 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 that 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 pub- lic treasury. In all such cases, the accused is entitled to have compulsory process for obtaining witnesses in his favor. (1 Grreen- leaf s Ev. § 311.)— P.J There are some questions connected with this subject which it will be proper to consider in this place. If a subpoena is served on an ordinary or skilled medical witness, is he bound to obey it ? In Setts V. Clifford (Warwick Lent Assizes, 1858) the late Lord Campbell stated, in answer to a question, that a scientific witness was not bound to attend upon being served with a subpoena, and that he ought not to be subpoenaed. If the witness knew any question of fact, he might be compelled to attend, but he could not be compelled to give his attendance to speak to matters of opinion. In Mich V. Pierpoint, an action for malapraxis. Dr. Lee was sum- moned against his will to give evidence on the part of the plain- tift". He stated that on the evening before the trial a solicitor called on him, and left a subpoena with him. Dr. Lee would not hear any account of the case which the solicitor proposed to give, and expressed his resolution to have nothing to do with the trial. The solicitor informed him that he would be required to pay the usual penalty if he did not attend. He went down to Kingston, and was warned not to leave the court until the trial was over. He heard the evidence on the part of the plaintiff", and upon this and the medical evidence he gave his opinion — not much in favor of the party who summoned him, and not much against him. Dr. Lee considered that he could not avoid attending the trial under these circumstances. ("Medical Times and Gazette," April 12, • 1862, p. 889.) In the case of Webb v. Page ("Carrington's and Kirwan's Reports," p. 23) the late Mr. Justice Maule ruled as follows: "There is a distinction," said his lordship, "between the case of a man who sees a fact and is called to prove it in a court of justice, and that of a man who is selected by a party to give his opinion 40 OBEDIENCE TO A SUBPCENA. on a matter on which he is peculiarly conversant from the nature of his employment in life. The former is bound, as a matter of ^public duty, to speak to a fact which happens to have fallen within his own knowledge — without such testimony the course of justice must be stopped. The latter is under no such obligation ; there is no such necessity for his evidence, and the party who selects him must pay him." In the case referred to by Mr. Justice Maule, a skilled witness had been subpoenaed, but he refused to give evi- dence unless first paid for his services and loss of time. ("Medical Times and Gazette," April 26, 1862, p. 432.) A barrister, who quotes this ruling, goes on to say : " There is one reason why I should not advise any person in the position of a skilled witness totally to disregard a subpoena. It is quite clear that should such a person fail to attend a trial no attachment could issue, even if he were called as is usual upon the subpoena, because the party subpoenaing him could not make the requisite affidavits that he was damnified by the witness's absence, and in what respect. But such party might bring an action for damages ; and although he would recover none, he might not only worry, but might even put the defendant to a considerable expense, as taxed costs by no means include the entire costs in such cases. Although, therefore, I could not advise a total neglect of the subpoena, the safest course would be to obey it, and demand expenses before giving evidence. Such expenses would be only those allowed for a professional witness (not special fees), but if the person so subpoenaed were willing to run the risk of an action, he might safely absent him- self without any fear of an attachment from the court for con- tempt." With regard to the question whether a skilled witness would be permitted to demand a high fee for his attendance under such circumstances, the writer adds : " To permit him legally to demand a high fee would perhaps look somewhat like legally countenancing a bribe." At all events there is no such legal recognition. , Lord Campbell's dictum in reference to the distinction between fact and opinion confers no practical benefit on witnesses. It is at all tin>es difficult in science, and in the medical sciences par- ticularly, to separate them ; and if a man appears to testify to a medical or scientific fact, he cannot avoid giving an opinion arising out of the fact. In a recent action against a druggist for a mistake in compounding medicine, an attempt was made to procure my opinion as a skilled witness at the trial, by reason of facts obtained from the report of a chemical analysis, the real object of which was, at the time, entirely concealed. The suit was fortunately compromised, and my attendance was not neces- sary, but such a case should convey a caution to chemical experts. * They may be employed secretly and under untrue statements to make analyses; these become facts on which they may be sum- moned like .ordinary witnesses to give opinions, as skilled wit- nesses, while the payment of the usual fee for a skilled witness is evaded. MEDICAL WITNESSES.' 41 Medical witnesses. — Assuming that the medical man has obeyed the subpoena, he will now be required to attend before the court, and to state, in the face of adverse counsel, the opinions which he has formed from the medical facts of the case, as well as the grounds for these opinions. He will then, for the first time, undergo the ordeal of a public examination. Before being sworn to deliver his evidence, a medical or scien- tific witness may claim the payment of his customary fees, unless an arrangement has already been made between him and the solicitors who have sent him a subpoena. These fees are generally made a matter of private arrangement between the witness and the attorney. Unless there is such an arrangement, or some written document to show an agreement as to the amount, the witness will be paid according to a tariff which will not even suffice to indemnify him for the expenses necessarily incurred by a journey to, or residence in, an assize town; not to mention the loss occasioned in his practice during this forced absence from it. This is necessarily a source of great dissatisfaction among members of the medical profession. The country impounds their services for the administration of justice, without making a proper remunera- tion to them. In some exceptional cases, a special application made to the Court may have the effect of rectifying this matter. Some medico-legal writers have considered it necessary to lay down rules respecting the manner in which a medical witness should give his evidence; how he is to act on a cross-examination, and in what way he is to recover himself on re-examination. Any advice upon this head appears to me to be quite superfluous ; since experience shows that these rules, like those given to prevent drowning, are invariably forgotten at the very moment when the individual is in the situation in which it is supposed he most requires them. A man who goes to testify to the truth to the best of his ability should bear in mind two points: 1. That he should be well prepared on all parts of the subject on which he is about to give evidence. He should act, on these occasions, upon the advice contained in the Latin motto, ne tentes aut perfice ; 2. That his demeanor should be that of an educated man, and suited to the serious occasion on which he appears, even although he may feel himself provoked, or irritated by the course of examination adopted. A medical witness must not show a testy disposition in having his professional qualifications, his experience, his means of knowledge, or the grounds for his opinions very closely investi- gated : he should rather prepare himself to meet with good humor the attempts of an adverse counsel to involve him in contradiction, and show, by his answers, that he has only a desire to state the truth. Law and custom have long established that a barrister, in defending a prisoner charged with murder, has a right to make use of all fair and even what may appear to the witness unfair means for the defence. Nothing can tend more to lower a witness in the opinion of the court and jury, or diminish the value of his evidence, than the manifestation of a disposition to deal with his 42 MEDICAL SECRETS. examiner as if he were a personal enemy, to evade "the questions put, or to answer them with flippancy or anger. All such exhi- bitions invariably end in the discomfiture of the witness. It has been suggested that medical men, on these occasions, might take a lesson from lawyers, and observe how little they allow forensic differences, which they put on with their professional costume, to influence them in their intercourse with each other or with an adverse judge or jury. Medical men have complained, and on many occasions justly, of the license of counsel. On this subject it may be well to consider what has been said by one of the highest authorities on the bench. Chief Justice Erie: "The law trusts the advocate with a privilege in respect to the liberty of speech, which is, in practice, bounded only by his own sense of duty; and he may have to speak upon subjects concerning the deepest interests of social life, and the innermost feelings of the soul. The law also trusts him with a power of insisting upon answers to the most painful questioning, and this power again is in practice, only controlled by his own view of the interests of truth." (Judgment in Kennedy v. Broun^ 1862.) Thus it will be seen that almost unlimited powers of interrogation are intrusted to counsel by the law, and it is a serious question whether the unrestricted use (which it has been justly re- marked means only the frequent abuse) of these enormous powers is necessary or even favorable to the administration of justice. One of the most severe reprimands on this abuse came from the same learned judge in a case which was before him in 1857; it was addressed to 'a learned sergeant, now deceased, and was to this effect : A question had been put throwing on the witness an imputation for which there was really no foundation. The learned judge then said : " The freedom of question allowed to the bar was a public nuisance, and the barrister who made such an imputation ought to be prosecuted. If a question had relation to the truth, he was most anxious it should be put, but to cast haphazard im- putations at the suggestion of a person (an attorney) who might have no scruples as to what he did, was a degree of mischief that made him wish that a party should be prosecuted. He begged leave to say that in his experience he had seen counsel so abuse their privilege, that he had cordially wished a power could be in- stituted that they might be prosecuted for a misdemeanor." It is the general practice to say that the obnoxious questions are in the instructions, but a barrister can alw^ays exercise a power of putting, or not putting a question which may be found there. But putting it he clearly adopts it, and frequently to the great damage of his own case. This is at present the only check upon the practice, for learned judges seldom interfere unless directly appealed to by the witness. Some medical men have claimed a privilege not to answer cer- tain questions which are put to them, on the ground that the matters have come to their knowledge through private and con- fidential communications with their patients. It is right to state MEDICAL PRIVILEGE. 43 at once that the law concedes no special privilege of this nature to members of the medical profession. N'o man is bound to reply to any question if the answer would tend in any way to incriminate himself — for no man is compelled to be a witness against himself. With this exception all questions must be answered, provided they are relevant to the case, and their irrelevancy is a matter for the consideration of the learned judge who presides. A witness must remember, therefore, that there are no medical secrets. In the case of the Duchess of Kingston this privilege of with- holding statements was claimed by a medical witness, but rejected. In a case in which a female was indicted for the murder of her infant, a surgeon was called to prove certain confessions made to him by the woman during his attendance. He objected, on the ground that he was then attending her as a private patient. The learned judge (Park, J.) said this was not a sufficient reason to prevent a disclosure for the purposes of justice, and he was ordered to answer the questions. (Beck's " Med. Jurisprudence," vol. ii. p. 922.) Any statements therefore which are made to physicians or surgeons while attending persons in a private capacity, although they are not to be volunteered in evidence, must be given in answer to questions, whatever consequences may ensue. Cases of poisoning and wounding, duelling and child-murder, as well as cases which involve questions of life-insurance, divorce, or the legitimacy of offspring, may be materially affected by the answers of the medical man on matters which have been the subject of private communi- cations. A professional man who claims a privilege where none is allowed, is simply endeavoring to set himself above the law. It is absurd to suppose that there is any real breach of confidence under these circumstahces, because, as Dr. Gordon Smith justly observes, " Society in general receives the authority of courts as paramount to all obstacles and private considerations," so that in yielding to such authority, a professional man will be fully ac- quitted even in the opinion of those who may be the sufferers. The expressed opinion of the judge will be a full indemnity for the witness. ("Analysis of Medical Evidence," p. 98.) I was once present at a trial for murder by poison, when in the course of a cross-examination counsel for the prisoner asked the medical wit- ness what remedy or antidote he had employed when he was first called to attend the deceased. He appealed to the judge to know whether he was bound to answer such a question as that. Judge : " Yes, unless you have reason to believe that your antidote killed the deceased. In that case you are not bound to answer it!" The question was immediately answered. Any medical man, however, who voluntarily violated the con- fidence reposed in him by a patient, or who communicated pro- fessional secrets to counsel apart from a public necessity in court, would justly lay himself open to severe censure. In Wright v. Wilkes (June, 1865), a suit involving the validity of the will of a lady, the only question before the Vice-Chancel lor (Kindersley) was as to the costs, occasioned by the refusal of a 44 MEDICAL PRIVILEGE. medical witness to answer a question as to the disease of which the testatrix died. The witness had attended the testatrix, and on being asked of what disease she died, he refused to answer, on the ground of professional privilege, and also that the question was irrelevant. The Vice-Chancellor said, that he could not possibly see the relevancy of the question, and, further, of what use it was to examine witnesses at all in the cause. 'No reason was given for so doing. The question of costs would, primd facie, have been left till the hearing but that it was a dangerous prece- dent to allow a witness to decline answering on such grounds. His honor was clearly of opinion that the witness could not claim professional confidence or irrelevancy as an excuse for not answer- ing the question, and he must pay the costs. From this judgment it will be perceived, that even the refusing to answer an irrelevant question may lead to the infliction of a heavy penalty on a medical practitioner. A man who refuses to answer a question which the court considers to be relevant and proper, may render himself liable to imprisonment for contempt of court. [By the Revised Statutes of New York (vol. ii. p. 652, § 103), and of Missouri (Code of 1835, p. 623, § 17), "No person duly authorized to practise physic or surgery shall be allowed to disclose any information which he may have acquired in attending any patient in a professional cha- racter, and which information was necessary to enable him to pre- scribe for such patient as a physician, or to do any act for him as a surgeon." — P.] This question of medical privilege has presented itself on some recent occasions in a medico-ethical aspect, as where, for instance, during his attendance on a patient, a suspicion arises in the mind of a medical man that the person is undergoing slow poisoning. It has been supposed that when, under these circumstances, the poisoner was in the medical profession, there would be a breach of etiquette in communicating to others the suspicion entertained. There is no code of medical etiquette by which any member of the profession is bound to conceal the fact of poisoning which he be- lieves to be going on before his eyes, whether perpetrated by a medical man or any other person; and at the same time there is a higher code of ethics which makes the prevention of secret mur- der and the safety of society paramount to all other considerations. A medical man nmst take care not to charge another with a serious crime upon loose suspicions. If froni the nature of the symptoms, the absence of any natural cause for the illness, and the ineflSciency of ordinary remedies, he suspects that the patient is under the influence of poison, it is his duty to lose no time in confirming or removing that suspicion by a proper medical and chemical investigation. If his suspicion is confirmed by the dis- covery of poison in the food or urine, then steps must be immedi- ately taken to save the life of the patient. In Meg. v. Wooler (Durham Winter Assizes, 1865); in which the prisoner was charged with the murder of his wife by secretly administering to her arsenic, three medical gentlemen were in attendance. There was MEDICAL PRIVILEGE. 45 a suspicion that arsenic was being administered to the deceased nineteen days before her death, but the fact was not made known because these gentlemen were unable to satisfy themselves con- clusively that arsenic was present in the urine. They appealed to a high authority to aid them, but the advice reached them too late — ■the patient had died, and, as it was clearly proved, from the effects of arsenic. The learned judge who tried this case said, " When the idea of poisoning struck them they ought to have communicated their suspicion to the husband if they did not sus- pect him, and if they did suspect him, they ought to have gone before a magistrate, and not have gone on from the 8th to the 27th of June seeing the woman murdered before their eyes." Dr. Christison, in commenting upon this case, very properly takes exception to this advice, and there can be no doubt that any man acting upon it would expose himself to an action for slander. " Ideas" of poisoning often arise in cases of disease where the symp- toms deviate a little from the ordinary course, but they are dis- missed on further observation. If, in the absence of the means or knowledge of applying chemical tests, or of taking the opinion of othei's experienced in toxicology, a medical man charged the hus- band of a lady with secret poisoning, or went before a magistrate and charged him publicly, he would be acting with rashness, ruin his own practice and reputation, and be mulct in heavy damages for the irreparable injury done by a false accusation. Such a step should be taken upon something more than an idea or a suspicion. A prudent and conscientious man will always await the result of a chemical analysis before giving publicity to a suspicion which may, after all, turn out to be quite unfounded ; and he will lose no time in obtaining this necessary confirmation or a removal of his doubts. [Unquestionably, it is the first and paramount duty of the medi- cal attendant to protect his patient, in a case of suspected poison- ing ; but he should be equally careful not to raise the suspicion against another — very possibly an innocent person — without the fullest and most unequivocal proofs. The practice of some medi- cal " experts" in shearing to the presence of poison, not only when, in the language of Dr. Christison, " the symptoms deviate a little from the ordinary course," but even when they are perfectly recon- cilable with those of ordinary disease, cannot be too severely re- probated ; especially when such " expert" opinions are maintained in non-fatol cases, in the absence of all chemical tests on the food and drinks, and on the urine and other excreta of the patient. — E.] When the suspicion is confirmed, there is some difterence of opinion as to the course to be pursued. Dr. Christison advises that when the medical man is satisfied of the fact of poisoning he should communicate his conviction to the patient himself, and that he ought not to be deterred by the chance of injury to his patient from making even so dreadful a disclosure. He will have thus taken the surest preparative step to prevent a repetition of the poisoning. Whether this communication be made to the pa- 46 EXAMINATION-IN-CHIEF. tient or not, the proper course will be to place the matter imme- diately in the hands of a magistrate for investigation. Some years since I was consulted in a case of supposed slow poisoning. The symptoms suffered by a lady, taken as a whole, were not recon- cilable with any disease. The medical gentleman had an " idea" that poison might possibly be the cause, but before acting upon this idea he sent to me a portion of urine for examination. Anti- mony was found in it, and the cause of the symptoms was at once explained. He communicated the result of the analysis to the members of the family, and the symptoms of poisoning ceased from that time ! The error committed by medical men even on these occasions is not in claiming a privilege of concealment, but in allowing a doubt upon so serious a question to remain in their minds for days or weeks. This question was again brought into prominence at the trial of Dr. Pritchard, at Edinburgh (July, 1865), on the charge of poi- soning his wife with antimony. One of the medical witnesses, who saw the deceased a fortnight before her death and at other times, stated in his evidence at the trial, that he suspected she was suffering from the effects of antimony when he first saw her; but it seems that there the matter was allowed to remain. No one was accused, but no step was taken to prevent the continuance of the poisoning, the suspicion of which turned out to be well founded. The Lord Justice Clerk, who tried this case, is reported to have said that no notions of medical etiquette should be permitted to interfere with those higher duties which every right-minded man owes to his neighbor, and which are to be expected in a tenfold degree from every medical man, because his life is solemnly de- voted to the preservation of life, and the prevention of its destruc- tion. Examination-in-chief. — The ordinary course of proceeding in a criminal case is thus concisely stated by Mr. Fitzjames Stephen (" Criminal Law of England," pp. 168, 282). After opening the case the counsel for the crown calls the witnesses, and examines them according to the rules of evidence — that is, he brings out, by questions which do not suggest their answers, the facts relevant to the issue to be tried which are within his personal knowledge. Those questions which suggest the answers are called " leading" questions. With one exception it is not the practice to allow these to be put in this part of the examination. The exception according to Mr. Stephen is : " When the judge is satisfied, either by a witness's demeanor, or by contradictions between the evi- dence and the depositions, that he is trying to keep back the truth and favor the prisoner, he may, in his discretion, allow the counsel for the crown to ask leading questions, and, as the phrase is, to treat the witness as hostile." When the examination-in-chief is closed, the next step is the cross-examination. Cross-examination. — In this, the second stage, the counsel for the prisoner extracts from the medical witness, by questions which may suggest the answers in the strongest form, any facts that may appear CEOSS-EXAMINATIOK. 47 to be favorable to the client, and which he believes to be within the witness's knowledge. Leading questions are not only allowable in this part of the examination, but, according to good authority, a counsel for the defence can hardly lead to much. The theory of the law is that the witness is unfavorable to the prisoner and has come to bear evidence against him. The more he has shown him- self by conduct or conversation a partisan in the case, the more severely will he be treated. Anything which he may have said in the hearing of others, or published in journals, or even written in private letters (if the contents transpire) in reference to the case or the guilt of the prisoner, is now brought to light, although he may have supposed that what he did say was in perfect confidence. It is at this stage of the case that any exaggerations which may have been most favorably received by the counsel for the prosecution are reduced to their true proportions. Any bias by which the mind of a witness may have been influenced, or any imperfection or confusion of memory as to facts, is here brought out. (Stephen, p. 177.) It is in this part of his examination that the witness will be closely questioned as to his qualifications, the time during which he has been engaged in practice, the accuracy of his judgment, his general professional knowledge, and his special experience in refer- ence to the matter in issue, the number of cases he has seen, etc. Straightforward answers should be given to all questions. No harm can be done to the witness by the answers unless they are given, evasively, since it is not to be supposed that the witness wishes to represent himself difterently from what he is. If he does make the attempt, he will assuredly fail. - The most striking distinction between the examination-in-chief and cross-examination is in reference to leading questions. It rests upon the assumption that there is a danger that a witness will say Avhatever is suggested to him by the one side, and conceal every- thing that is not extorted from him on the other. It need scarcely be observed that witnesses whose evidence is of little importance in the case, are rarely cross-examined. This is reserved in its most stringent form for those whose facts and opinions are likely to aft'ect the fate of a prisoner in a criminal trial. In dealing with a skilled witness whose evidence may be of importance, the questions in cross-examination are usually put by the counsel for the prisoner with great caution, or the answers brought out may be more ad- verse to his own case than those elicited in the examination-in- chief. Re-examination. — The cross-examination is usually followed by a re-examination on the part of the counsel for the crown, or of the counsel by whom the witness has been called. The object of this is to clear up or explain any portion of the evidence which may have been rendered obscure or doubtful by the cross-examination. It is sometimes unnecessary to put a question, and if the witness has given his evidence consistently and fairly, no questions may be asked. As a rule, the re-examination must be confined to those matters which have arisen out of the cross-examination. Any 48 QUOTATIONS FROM BOOKS. questions upon new subjects may render a further cross-examina- tion on them necessary. In reference to facts, a medical witness must bear in mind that he should not allow his testimony to be influenced by the consequences which may follow from his state- ment of them, or their probable effect on any case which is under trial. In reference to opinions, their possible influence on the fate of a prisoner should inspire caution in forming them, but when once formed they should be honestly and candidly stated without regard to consequences. It will be well to remember, in reference to each stage of the examination, what a great medical authority has said : " To make a show and appear learned and ingenious in natural knowledge may flatter vanity. To know facts, to separate them from supposition, to arrange and connect them, to make them plain to ordinary capacities, and, above all, to point out their useful applications, should be the chief object of ambition." (William Hunter.) Quotations from hooks. — It is a not unfrequent custom with coun- sel to refer to medical works during the examination of a witness. He is expected to have a fair knowledge of the writings of pro- fessional men on the subject of inquiry. The authority is men- tioned, the passage is quoted, and the witness may be then asked whether he agrees with the views of the author, or whether he differs, and if so, his reasons. In cases connected with medical treatment, the views of the profession are and have been so various, that a barrister would have no great difficulty in finding some book to oppose to the opinions of a witness. Standard works of recent date are so well known to the profession that there are few medical men engaged in practice who are not well acquainted with, and able to explain the views of the writers, and how far they agree or conflict with his own. The witness must be on his guard that the question is fairly put, and that it is properly taken with the context, or he may unexpectedly find himself involved in a diffi- culty. On one occasion, I found that a learned, gentleman stopped in his quotation at a comma, and on another occasion the quota- tion ended at a colon — the remainder of the sentence in each case materially weakening the inference which it was intended to draw with the apparent sanction of the witness. "When a quotation from a standard work is thus opposed to the evidence of a medical witness, he should take care by reference to the work itself to see that the passage is correctly quoted. A re- markable instance of the importance of this caution has been com- municated to me by a former pupil. At the Swansea Lent Assizes 1869, an action was brought against a railway company for com- pensation for personal injury. Plaintiff" was proved to have had pneumonia shortly after the accident, and the counsel for the com- pany wished to show that the pneumonia had not arisen from any physical injury. In cross-examining the medical witness he asked, " Cannot pneumonia be produced by shock V Witness : " I do not^ believe it to be possible." Counsel : " What ! do you mean to say. you do not believe what is asserted in fact by no less an authority EXAMINATION" OF WITNESSES. 49 than Professor Taylor? Have you read Dr. Taylor's work on 'Medical Jurisprudence?'" Witness: "Yes." Counsel: "Have you seen the last edition ?" Witness: "No." Counsel: "I have it here (turning over the leaves of a book), and a case is given of pneumonia being caused by shock." (Witness in confusion.) It was subsequently discovered on referring to the work, that the case in question was one in which the lung had been wounded by a fractured rib. The cause of the pneumonia was thus sufficiently explained ; it was proved to have been a result of physical injury and not of shock ! A reference at the time to the work which is quoted is always necessary, if any use is to be made of a quotation. Without suggesting that there is intentional misrepresentation to bear out a particular view of the case, a barrister, in dealing with the medical facts, may wholly misunderstand the author's views and statements, and in some instances wrongly assign to the au- thor opinions which he has merely quoted from other authorities for comment or illustration. Presence in court. — In England, medical and scientific witnesses, except under special circumstances, are allowed to be present in court and hear the whole of the evidence in the case. This is in some instances absolutely necessary if the court requires medical opinions, for unless the witnesses are fully a-cquainted with the facts they can give no opinions, and they can only become fully acquainted with the facts by being allowed to be present and hearing the evidence in court. If excluded, the judge or counsel will be compelled to read to the witness notes of the evidence be- fore an opinion can be given, and it may then appear that some small point which counsel did not think of importance is omitted ; this if known to the witness might, however, materially affect his opinion. A failure of justice is likely to occur when medical wit- nesses are excluded, and it is generally when there is no defence, or a false defence, that the right of excluding them is exercised. The rule in Scotland is similar : medical and scientific witnesses are allowed to be in court during the trial. The examination of the witnesses for the crown is followed by the defence of the prisoner, either in person or by his counsel, who acts throughout the part of an advocate, simply securing for his client every advantage the facts or the law may afford him. In other words, he sees that his client is strictly tried according to law, and not condemned contrary to law. A key to some of the difficulties which medical witnesses must be prepared to encounter will be found in the exposition given by Mr. Stephen of the tacit rules which regulate the duties of counsel for the prosecution and defence. " In practice it is universally admitted that the counsel for the prosecution is morally and professionally bound always to keep in sight the ultimate object — namely, the discovery of truth ; whereas no such obligation is laid upon the prisoner and those who represent him, because it is too much to expect of human nature that they should discharge it, and it is better not to impose an obligation which is sure to be systematically violated. Both sides, 4 50 RULES BESPECTIXG THE on the other hand, are bound in the strongest way not to do arty- thing to propagate falsehood. The counsel for the crown is bound not to suppress any fact within his knowledge favorable to the prisoner ; and, on the other hand, the counsel for the prisoner is bound not to bring to light facts within his knowledge unfavor- able to the prisoner." " The counsel for the crown may not use arguments to prove the guilt of the prisoner which he does not himself believe to be just, and he is bound to warn the jury of objections which may diminish the weight of his arguments ; in short, as far as regards the evidence which he brings forward, his speech should as much as possible resemble the summing-up of the judge. He should contend not for the success of his cause at all events, but for the full recognition by the judge and jury of that side of the truth which makes in favor of it. On the other hand, the counsel for the prisoner may use arguments which he does not believe to be just. It is the business of the jury, after hearing the judge, to say whether they are or are not just." (Op. cit., pp. 160 and 168.) The last remark shows what appears to be a serious defect. in the administration of the criminal law. While in a case of misdemeanor, a prisoner may be tried by a special jury, in a case of felony, involving an analysis of important questions of medical science in reference to murder or manslaughter, the trial takes place before a common and comparatively ignorant jury. Such a jury is hardly in a position to cope with an ingenious counsel, who has it in his power to misrepresent and distort medical facts and opinions in any manner that he pleases. The defences made are frequently such as no barrister would venture to place before a jury of educated men. These " powerful" or " forcible" addresses, as they are termed by the press, full of burning eloquence and im- passioned logic, have frequently withdrawn the attention of the jury from the real facts, and have procured verdicts of acquittal contrary to the evidence and all the medical circumstances of the case. Another observation made by Mr. Stephen more nearly concerns the medical witness : " There are many obligations which effect each side equally, !N"either is at liberty to attempt to browbeat, intimidate, or confuse a witness, although they may expose any real confusion which exists in his mind, or test, by the strictest cross-examination, the accuracy of his statements. Neither is at liberty wilfully to misunderstand a witness, or to misstate, in his address to the jury, the eflect of what he has said, either by distor- tion or suppression. The neglect or observation of these and other rules of the same kind practically establishes a wide distinc- tion, and one which is easily recognized, between those who exer- cise a noble profession and those who disgrace it." (Op. cit., p. 168.) The treatment of a medical witness, in passing through the ordeal of an examination at a criminal trial, will depend, therefore, very much upon the class of counsel who is opposed to him. As- suming that he is properly prepared for the discharge of his duties, and that the questions put to him are answered fairly and truly, EXAMINATION OF WITNESSES. 51 according to his knowledge and experience, without exaggeration or concealment, he has no reason to fear any attempt at intimida- tion. Barristers, for the most part, know that by this line of conduct they lose more with the jury than they gain by the at- tempt to confuse the witness ; and as their ultimate and sole object is a favorable verdict, they will generally avoid conduct which must necessarily place this verdict in jeopardy. The normal barrister, as depicted by Mr. Fitzjames Stephen, is not at liberty in his address to the jury, to misrepresent, either by distortion or suppression, the medical facts or opinions given in a case. According to mj experience, however, misrepresentation is a not unfrequent practice, and one of which medical witnesses have very strong reason to complain. Whether such misstate- ments are wilful or not it may be difficult to determine, but their effect on the jury is well known to those who employ them, and they frequently escape the observation of the counsel on the other side, and even of the learned judge, unless he is well versed in medical subjects. It is also worthy of remark, that if a misstate- ment is thus made, it is by a remarkable coincidence always in favor of the view of the counsel who makes it, when a proper examination of his notes would, in general, show him that he was wrong. Then as to the question of intimidation, this is sometimes carried very far. On a trial for murder by poisoning, I have heard a re- spectable country practitioner, who had given his evidence for the crown in a feir and proper manner, thus addressed in cross-exami- nation by a learned counsel, notv deceased : " Ou your oath, sir, and in the face of the whole profession, will you venture to persist in that statement ?" etc. A public writer in commenting on this subject, says: "But the hardest and most unfair part of the sys- tem (of cross-examination) is when witnesses have to bear a loud | and insulting tone or gesture without remonstrance or retaliation. V A counsel may very plainly imply that a respectable witness is a person of doubtful character, and not to be believed on his oath, or that he is ignorant, and a bungler in his profession ; but if the witness retorts that the barrister's eloquence and sympathies are hired, or if he gives vent to any other words of retaliation in his natural indignation, the court is against him." "Whatever may be the importance of a case to a prisoner, nothing can justify the putting of questions in a loud and insulting tone to a skilled, pro- \ fessional witness. I quite agree with the writer whose opinion I have already quoted, that " every contemptuous and even uncourteous expres- sion, every query leading nowhere, except to the end of confusing the mind or irritating the temper of a witness, ought surely to be reckoned as overpassing the legitimate limits of the counsel's office, ./ and as such be regarded with universal disapprobation." It may be that criminal cases fall more into the hands of the second class of barristers to whom Mr. Stephen alludes — namely, those who disgrace a noble profession. But it is a widely spread opinion in 52 . EXAMINATION OF WITNESSES. the medical profession, that this style of examining educated men, who are perhaps compelled most unwillingly to appear on a sub- poena to testify to facts, is certainly not adapted to elicit the truth, but rather to favor the escape of criminals and give impunity to crime. It may be fairly admitted that a man who puts himself forward as a witness, and attempts to elucidate what he only succeeds in rendering more obscure, should receive no favor at the hands of the bar. Dr. Elwell, a member of the legal as well as of the medical profession, observes that " No witness is ever compelled to appear and testify to what he does not know. He may be compelled to attend in court in obedience to a subpoena, but if he attempts to testify upon a subject requiring opinions' upon which he has no well-settled or well-defined ideas, it is his own fault, and he alone is to blame ; for no one but himself can know so well as he, until he has exposed himself, how unfit he is for the occasion." (Medico- legal Treatise on " Malpractice and Medical Evidence," by J. J. Ewell, M.D., 'Member of the Cleveland Bar, New York, 1860, p. 302.) But let us take the case of a practitioner, who, in a country district, has gone through twenty years of practice with honor and credit in his neighborhood, and who is suddenly called to a case in which a man is found dead from a wound in his throat. Under the Medical "Witnesses' Act he is compelled to make an examina- tion of the body for a coroner's inquest. At a great loss of time, and for no adequate remuneration, he attends the inquest and gives his evidence ; he is bound over, nolens volens, to appear for the first time as a witness at a criminal trial, and to testify, Ist, to the throat being cut, and 2dly, to give his opinion to the court on the cause of death, and whether the wound was inflicted by the deceased on himself, or by another person. A medical man who limited himself to the statement of the bare fact that the deceased's throat was cut need not appear at all, for this evidence might be supplied by a constable or policeman ; but the law presumes from his profession, that the medical man made a proper examination of the wound, with a view to determine to the best of his ability, whether it was the cause of death and whether it was or was not self-inflicted. It is difficult to understand how a medical man, although before this occurrence he may never have seen a case of cut-throat, could excuse himself from giving an answer to these questions, both of which involve purely matters of opinion. If he excused himself altogether from giving answers, there would be a failure of justice, and no conviction for such a common form of murder could ever take place. If, on the other hand, he answers these questions to the best of his ability, he may reasonably com- plain that while thus compelled to appear as a witness to testify to what he does know, his evidence should, by rules of law, be made the subject of abuse and ridicule before his neighbors, when he expresses his opinion from the facts; and that the counsel who examines him legally possesses an unlimited power of misrepre- senting his views. A medical man is certainly not benefited by RULES FOR THE DELIVERY OF EVIDENCE. 53 being described as an ignoramus or a blunderer in his profession, whom nO one ought to trust. The truth is, in medical evidence facts and opinions cannot be separated, and if medical practitioners were restricted in their evidence only to those facts which they had observed in a case, in which no other professional man saw the person living or dead, it is difficult to understand how crime could be detected and punished. These remarks of course do not apply to cases in which the opinions of medical experts can be taken. Here it would be desirable that one who has not had ex- perience on the subject should avoid giving any opinion ; he might simply state the facts, and decline from want of experience to give an opinion on the conclusions to which they lead. In pursuing any other course, he will find that the whole weight of the cross- examination will fall upon him. There are other remarks on this subject made by Dr. Elwell, which those who are compelled to attend as witnesses in a court of law will do well to bear in mind : " However anxious an incom- petent witness may be to appear learned, and however hard he may labor to show it, he will ever find it a difficult business to make the court and counsel believe that he is really so. To appear really learned he must be able to make the subject on which he gives an opinion clear, and to give satisfactory reasons for this opinion. He must be not only a thinker, but must satisfy others that he is master of his subject. Take almost any one of the im- portant scientific questions upon which a professional witness is called to pass an opinion, and unless he has looked at the subject before with a purpose to understand it — comprehending its extent, weight, and relations — he will find it to have suddenly assumed an importance he had not suspected, just at the time when the discovery will add to his confusion. It is better to make this dis- covery in the quiet stillness and security of solitude, than under the eye of a judge and the severe scrutiny of counsel. A man, whether learned or not — whether in court or out of court — will talk; clearly upon a subject he well understands, whether it is scientific or otherwise, but unless it is clear in his own mind his account of it will be confused and unsatisfactory." (Op. eit., p. 303.) This is undoubtedly the test to which every man should rigorously submit himself before entering the witness-box. Hules for the delivery of evidence. — There are a few rules bearing upon medical evidence which, if observed, may save the witness from interruption or reproof and place him in a favorable position with the court : — 1. The questions put on either side should receive direct answers, and the manner of the witness should not be perceptibly different whether he is replying to a question put by the counsel for the prosecution or for the defence. For reasons elsewhere assigned (p. 47), most of the questions put by counsel in cross-examination will admit of an answer " yes," or " no." If, from the ingenious or casuistical mode in which the question is framed, the witness should feel that the simple affima- 54 EULES FOE DELIVEEY OF MEDICAL EVIDENCE. tive or negative might mislead the court, then, after giving the answer, he can appeal to the judge to allow him to qualify it, or add to it any matter within his ovm knowledge and which is at the same time relevant to the case. The witness must remember that he takes an oath to state the truth, the whole truth, and nothing but the truth. On the other hand, while the counsel for the de- fence is bound not to introduce falsehood, his object is not the dis- covery^ or development of truth. Unless the witness is on his guard, he may find, when the learned counsel who has cross-examined him addresses the jury, that his afiirmatives and negatives may be worked into a shape representing the reverse of what he intended. Some counsel adopt the ingenious plan of compressing two or three questions into one. A witness unthinkingly answers the last, or that which most fixes his attention. The same answer may not be strictly applicable to all, but the witness may find, when too late, that it is made so in the defence. lu this ease he should ask for a severance of the questions, and give separate replies. Direct answers are necessary, because it is only by them that the case can be brought clearly before the court and jury in all its details. Medical witnesses sometimes forget this, and fall into answers to questions floating in their own minds, or which they think are likely to be put to them. They are also sometimes dis- posed to anticipate many questions by one general answer. This simply creates confusion, and the witness will be told' by counsel to keep to the question, and that he is coming to the other matters presently. Care should be taken by the medical witness not to argue with the learned counsel. Argument is not evidence, and the entering into it disturbs the order of the proceedings. Arguments between counsel and witnesses, and even between medical witnesses them- selves, are freely allowed in the French courts, but in England such a practice is not recognized. The mode in which questions are put by counsel in cross-examination sometimes tends to the introduction of argument, but the witness should avoid the temp- tation to enter into it. What he says under such circumstances is not evidence, except in the form of answers to questions, and he is there only for the purpose of stating what is relevant in the case. There is a difference between evidence and testimony. A medi- cal witness sometimes gives much in the form of testimony which amounts to very little as evidence. When he does not attend to the questions, he testifies to a variety of subjects which have no bearing on the case, and do not constitute evidence. The decision on what is and what is not evidence lies with the judge. 2. The replies should be concise, distinct, and audible, and, ex- cept where explanation may be necessary, they should be confined strictly to the terms of the questions. The learned judge who tries the case, generally takes full notes of the medical evidence — hence the necessity for a slow and distinct delivery of the evidence. Some witnesses have a singular habit of not answering the ques- tion which is asked but one which is not asked. Others give an RULES FOB DELIVERY OF MEDICAL EVIDENCE. 55 answer in such a voluble form, in the shape of a small speech or lecture, that there is great difficulty in reducing it to its proper proportions. A witness who is so profuse of information generally supplies abundant matter for a long and troublesome cross-exami- nation. It has been a question whether a witness 'should volunteer evi- dence, assuming that the examination-in-chief and cross-examina- tion have failed to bring out all that he knows of the case. If that which he has to state is some matter of fact within his own knowledge, or an opinion based on facts within his knowledge, he will be allowed, on application to the judge, to make the statement in spite of the efforts of counsel on either side to shut it out. It is scarcely necessary to observe, that the language in which the answers are returned should be plain and simple. Counsel who are unacquainted with medical terms frequently misapply them, or use them in a wrong sense. There are few barristers who are aware that the term " symptom" is confined to the living body, and " appearance" to the dead ; and the witness may thus find himself questioned on the " appearances" when he first saw the patient, or the " symptoms" which he observed on the post-mortem examina- tion of the stomach and bowels. On a trial for murder, in which one of the questions at issue was whether dysentery or poison was the cause of death, the learned counsel puzzled one of the medical witnesses by asking him whether during his attendance he found any traces of '■'■dysuria" in the feces ! There is no doubt he intended to refer to a state of the feces, like that met with in dysentery, but the professional term employed by him signified a " difficulty in passing urine." A judicious witness will avoid anything like a triumph over his examiner under such circumstances, and simply put him right. 3. Answers to questions should be neither ambiguous, undecided, nor evasive. An ambiguous answer necessarily leaves the witness's meaning doubtful, and calls for an explanation. An undecided answer — indicated by the words " I believe," or " I think," or " It might be," — is not sufficient for evidence. Did the wound cause death ? "Was death caused by loss of blood or poison ? If, by a proper consideration of all the medical facts, the witness has come to a conclusion on the subject, his answer should be expressed in plain and decided language, either in the affirmative or negative. A man who has formed no conclusion is not in a position to give evidence. ISo opinion should be given for which the witness is not prepared to assign reasons, and except by permission of the court, no medical opinion should be expressed on facts or circumstances observed by others. A hesitating witness will be met with the question, Have you any doubt about it? or, Was it so or not ? — to which a reply in the affirmative or negative must be given. If the witness fairly entertains doubts about the matter at issue, it is his duty to express them, and not allow them to be extorted from him piecemeal by a series of questions. 56 EULES FOE DELIVEEY OF MEDICAL EVIDENCE. Chemical witnesses have occasionally certified to the discovery of " imperceptible," " unmistakable," or " undoubted" traces of poison in the liver, etc. Such terms naturally convey to the shrewd mind of an examiner that the witness has some lurking doubt or suspicion of mistake in his mind, for that of which we are sure requires no such terms to express our meaning. If poison has been discovered, the statement of fact is sufficient. 4. The replies should be made in simple language, free from technicality. Some remarks have been elsewhere made in reference to the use of technical terms in drawing up medico-legal reports (p. 31). If medical men could be made aware of the ridicule which they thus bring on their evidence otherwise good, they would at once strive to dispense with such language. A witness is perhaps unconsciously led to speak as if he were addressing a medical assembly, instead of plain men like the members of a common jury who are wholly ignorant of the meaning of medical terms, and barristers who are but imperfectly acquainted with them. There are few Assizes which do not afford many illustrations of the injury done to scientific evidence and the clear understanding of a case, by the technical language in which it is given. A court may be told that the " integuments were reflected from the thorax, and the costal cartilages laid bare, when a wound was found which had penetrated through the anterior mediastinum" and had involved the arch of the aorta, etc. A simple cut in the skin is described as " an incision in the integuments." In a case of alleged child- murder, a medical witness being asked for a plain opinion of the cause of death, said that it was owing " to atelectasis and a general engorgement of the pulmonary tissue." On a trial for an assault which took place at . the Assizes, some years since, a surgeon, in giving his evidence, informed the court that on examining the prosecutor, he found him suffering from a severe contusion of the integuments under the left orbit, with great extravasation of blood and ecchymosis in the surrounding cellular tissue, which was in a tumefied state. There was also considerable abrasion of the cuticle." ^'- Judge: You mean, I suppose, that the man had a bad black eye. Witness: Yes. Jtt^^^e; Then why not say so at once?" It would be easy to multiply examples of this kind. This is not science, but pedantry, and if such language is em- ployed by a witness with a view of impressing the court with some idea of his learning, it wholly fails of its effect. Barristers and reporters put down their pens in despair, and the time of the court is wasted until the witness has condescended to translate his ideas into ordinary language. CAUSES OF DEATH. 57 CHAPTER III. CAUSES OF DEATH. — SUDDEN DEATH. — SYNCOPE, ASPHYXIA, COMA. — SIGNS OR INDICATIONS OF DEATH. — CESSATION OF CIRCULATION AND RESPIRATION. — COOLING OF THE BODY. — CADAVERIC RIGIDITY. — THE EYES. — THE SKIN. — COAGULATION OF THE BLOOD. — PUTREFACTION. — CADAVERIC LIVIDITY. — ADIPOCBRE. Medical jurisprudence takes cognizance of all violent causes of death, and is only indirectly involved in those cases of natural death which simulate the effects of violence. Thus all causes which operate to produce death suddenly, as by syncoipe, asphyxia, or coma, especially demand the attention of a medical jurist. These may be either natural, or violent ; and the distinction between them is of importance, since the guilt or innocence of a person charged with crime may depend on a correct determination of the cause. The continuance of life depends upon the proper and regulated action of the heart, the lungs, and the brain, and the interdepend- ence of these organs is such tlaat the arrest of the functions of one of them is speedily followed by the arrest of the functions of the others. Hence, these three organs have been called the tripod of life. When the suspension of the motions of the heart is the pri- mary cause of death; the person is said to die by syncope. The term asphyxia is applied to death whicb begins by the lungs ; and coma to that which arises from a primary disturbance of the functions of the brain. Syncope (avyxoittoi). — In order that the action of the heart should be maintained, it is necessary, first, that the blood supplied to it should be in sufficient quantity, and, secondly, that this blood should be of proper quality. . In death from hemorrhage we have an in- stance of deficiency, and in death from certain poisons as well as diseases, an illustration of defect of blood. In ordinary syncope (fainting or swooning) there is simply a deficiency in the quantity of blood which passes through the heart, although there is no actual loss of this fiuid from the circulation. Certain diseases which aflect the muscular structure of the heart, as well as its membranous valves and bloodvessels, may also lead to a sudden arrest of its functions. These morbid conditions produce a me- chanical impediment to the motions of the organ by which the blood is propelled, and death by syncope is the necessary result. "When death takes place by the heart, the right and left cavities of this organ are found to contain blood in the normal proportion in which that fluid is ordinarily circulated. This retention of blood in these cavities arises from the sudden stoppage of the heart's 58 DEATH FROM SYNCOPE. contractions. Blood is found in the large .veins (venfe cavse), as well as in the arterial trunks. There is no congestion or accumu- lation of blood in the lungs or the brain. Asphyxia (i priv. and u^ultj pulse) signifying pulselessness. This state is induced by any cause which arrests the function of respi- ration. The term apnoea (from a priv. and Ttvsu I respire) is more appropriate ; for the state of syncope might equally be called asphyxia. The various forms of death by suffocation, as in the obstruction of the air-passages from mechanical causes, in drown- ing, hanging, and strangulation, furnish illustrations of death commencing by the lungs, or asphyxia. The effect of cutting off air from the lungs is that the blood is not aerated, and it is there- fore circulated in a state unfitted to support the nutrition of the heart and brain, without which life cannot continue beyond a few minutes. It is necessarily distributed with the impurities derived from the waste of tissue, and thus acts as a poison in all the organs. It is incapable of sustaining nerve-force or muscular irritability. It stagnates in the capillary vessels of the lungs, produces a languid action of the heart by its circulation through the muscular struc- ture of this organ, and it causes insensibility by its distribution through the bloodvessels of the brain. The lungs are essential to the circulation by purifying the blood ; the brain from the neces- sity of supplying the proper stimulus — nerve-force. Death from asphyxia may be therefore regarded as death from defect of blood. The observations of the late Sir B. Brodie (" Lectures on Pa- thology," 66) and others have clearly proved that in spite of the impurity of the blood, the heart will continue to act, and the cir- culation to Ije maintained for two or three minutes or longer after breathing has entirely ceased. This may be proved by hanging Or strangling an animal, and observing the condition of the heart during the stage of insensibility. As the action of this organ con- tinues after the animal has ceased to breathe, life is not actually extinct ; and under favorable circumstances, it may be restored, if no injury be done to the air-cells of the lungs, so long as this action continues. Supposing that the suspension of respiration is com- plete, the action of the heart gradually slackens and finally stops. It is at this period of the complete arrest of the motions of the heart, that asphyxia passes into death. Apnoea is determined by the time at which respiration is completely arrested. The circula- tion of the unaerated blood through the brain appears to annihilate sensibility, so that no consciousness or feeling exists ; the person is, to all appearances, dead. There are many diseases which operate fatally by arresting the functions of the lungs, and these may be regarded as furnishing the natural causes of asphyxia. The violent causes, including not only the ordinary modes of suffocation, but the effects of certain poisons, are not difficult to appreciate, provided a true history of the case can be obtained. In death by the lungs, as the circulation of the blood is primarily arrested in these organs, the pulmonary artery, the right cavities of the heart and the venae cavse are found gorged with blood. The DEATH FROM COMA. 59 pulmonary veins, the left cavities of the heart and the aorta, are either empty or contain but little blood. In certain cases of as- phyxia, the right cavities of the heart, as well as the left, have been found empty. When the access of air to the lungs is suddenly and completely cut off, the circulation of the blood is very speedily arrested ; but supposing the occl usion of the air-passages to be par- tial or gradual, the circulation of the blood may continue for a time, and thus cause congestion of certain organs. Hence, the appearances in asphyxia differ greatly. A mixed condition under the name of syncopal asphyxia has been described by some patholo- gists. In this, the cavities of the heart are found empty. Coma. — Besides a due supply of properly aerated blood, the brain requires for the exercise of its functions a proper quantity of blood, so that either by the sudden withdrawal of this fluid, or by a distribution of impure blood, these are arrested. A person thus affected falls into a state of complete insensibility (coma), so that it is impossible to rouse him. The functions of the heart and lungs are not suddenly arrested under these circumstances. They appear to be less dependent on the brain than the brain is upon them ; but this is rather a question of degree. A due supply of nerve-force is required for the action of the muscles, whether of the heart or of the chest ; and when this is withdrawn, the heart ceases to pulsate, and the respiratory muscles cease to act: circulation and respiration are thus arrested by the absence of innervation. This is sometimes described as death by paralysis of the heart and lungs. The blood is neither aerated nor circulated. Sudden death from apoplexy is an illustration of death by the brain. Coma may also be a result of the introduction of certain poisons into the blood, and of fractures of the skull leading to compression of the brain or destruction of its substance. In death by the brain, the appear- ances observed consist chiefly in a congested state of the cerebral membi'anes and substance of the brain. As, before death, the breathing is affected, the lungs are congested, and blood accumu- lates in the cavities of the heart, more on the right than on the left side. The appearances described as characteristic of the different modes of death by the heart, lungs and brain, are liable to variation by reason of the intimate relations of these organs. Thus, there may be a mixed condition of syncope and asphyxia, or of asphyxia with cerebral congestion. With regard to the interruption of the functions of the brain as a result of pressure by the effusion of blood or serum, it is to be observed that a very small quantity effused at the base or in the substance of the medulla oblongata, is sufficient to cause death ; while generally speaking a larger quantity is required to be effused in the membranes, ventricles, or substance of the brain, in order to produce a fatal result. [In some cases of violent death by fracture of the skull, the supervention of coma is very gradual, in conse- quence of the slow effusion of blood into the brain from the rup- tured vessel. — R.] In cases of chronic hydrocephalus, in which the 60 INDICATIONS OF DEATH. brain has resisted the pressure of a large accumulation of serum for many years, a slight and sudden increase in the quantity at any period of life may lead to coma and death by apoplexy. This con- dition may be mistaken for narcotic poisoning. All causes of death, whether from disease or violence, are refer- able to an effect produced primarily on the heart, the lungs, or the brain ; but, as it has been elsewhere stated, death does not take place until the action of the heart has entirely ceased. The arrest of the circulation produces an immediate impression upon the func- tions of the brain and lungs ; while the lungs and brain are aifected, and can only affect each other indirectly through the medium of the circulation ; hence, systemic death, or the death of the body, is resolvable into death by syncope or a failure of the action of the heart, and this depends* in all cases either upon defect or deficiency of blood. The natural causes of sudden death may be generally traced to some injury or impediment to the action of the heart, lungs, or brain. It would be foreign to the objects of this manual to give a description of them. The violent causes are those which demand the especial attention of a medical jurist; they will be considered hereafter. In its relations to medicine and medical jurisprudence the subject of sudden death has been most fully treated by Herrich and Kopp (" Der plotzliche Tod aus ineren Ursachen," Regensburg, 1848) ; as well as M. Devergie (" Ann. d'Hyg.," 1838, 2, 145). To these works I must refer the reader for further information on the causes, as well as on the appearances met with in the bodies of persons dying suddenly from natural causes. The violent causes of death, whether sudden or protracted, which chiefly require the skill of a medical jurist for their elucidation, are poisoning, wounds, and personal injuries, such as burns and scalds, as well as those forms of death which commence by the lungs, including drowning, hanging, strangulation and suffocation. In nearly all cases, the body of the deceased is produced, and a medical opinion can be based upon a careful examination. Signs or Indications of Death. — The verification of death is occa- sionally a duty thrown on the medical jurist. Certain signs or in- dications have been pointed out as proving that death is real, and not apparent. These are taken in the order of their importance. 1. The cessation of circulation and respiration. — The heart is con- sidered to be the organ in which life begins and ends — the primum vivens and ultimum moriens — the first to live and the last to die. The proof of death is the proof of cessation of the heart's action for a certain period. The more visible indication of death is the cessa- tion of breathing, and in the opinion of the late Sir B. Brodie, the entire cessation of breathing alone may be regarded as a decisive test of the extinction of life. The movements of respiration cannot be overlooked by any one who does not choose to overlook them, and the heart never continues to act for more than four or five minutes after respiration has ceased. The proofs of the continued action of this organ are, however, less obvious to the unskilled INDICATIONS OP DEATH. 61 observer, than the movements of the chest ; hence the visible ces- sation of these movements, i. e., of breathing, for a period of five minutes furnishes a certain proof that the person is really dead. But the skilled observer would apply the test of auscultation, and before giving an opinion would satisfy himself of the permanent cessation of the heart's action. It is impossible to admit that the heart can remain for even half an hour in a state of inaction in a human being, and then spontaneously recover its activity. [The case of Colonel Townshend, mentioned by Dr. Cheyne, is an apparent exception to this rule. He possessed the remarkable power of a seeming voluntary death, i. e., of suspending the action of the heart and lungs for the period of half an hour. His condi- tion most probably resembled that of an animal in a state of hyber- nation, during which the heart-beats are reduced to an extremely low figure, and it appears to be actually dead ; but unquestionably, the functions of both heart and lungs are going on, though in a very feeble degree. — R.] There are some forms of the disease afi'ecting the nervous system, as, for example, hysteria accompanied by tetanus, or coma and cata- lepsy, the symptoms of which are occasionally such as closely to simulate death. Respiration and circulation appear either to cease entirely, or to be carried on so feebly, that, to uninformed obser- vers, the persons affected may seem to be really dead. Catalepsy, or, as it is vulgarly called, trance, in which the person lies in an unconscious state, may thus assume the appearance of death ; but the warmth of the body is retained, the limbs are flexible, and the heart and lungs continue to act, although less vigorously than natural. (For a remarkable case of this kind, see " Medical Times and Gazette," 1870, 1, 495.) Cases of prolonged and profound sleep of a natural kind, which have also been described as cases of trance, cannot be mistaken for death. Dr. Cousins met with a re- markable instance which may be taken as the type of others. A man of healthy habits, forty-three years of age, was at intervals subject to attacks of long and persistent sleep. He would retire to bed at his usual hour, and, without any warning symptoms, sud- denly and almost immediately fall into a profound sleep, from which all the usual means would fail to arouse him. In this state, his face and ears were pale ; the skin was pale and generally warm, but his feet were cold and livid, and the limbs quite relaxed. His pulse was soft, slow, and feeble ; his respirations almost impercep- tible, amounting to about eight or nine in a minute. He appeared like a person in a refreshing, tranquil slumber. There was no stertor or snoring. The longest period he ever passed in profound sleep was five days and five nights. He frequently slept three days and occasionally four days without waking, but his average period was two days. His secretions were suppressed, and no food was required. He commonly awoke suddenly, had no conscious- ness of the lapse of time, and retained a good remembrance of the last occurrences before he fell into . this state. He had no dreams. (" Medical Times and Gazette," April 18, 1863, p. 396.) 62 COOLING OF THE BODY. 2. Cooling of the body. — The average temperature of the interior of the living body in health varies from 98° to 100°, and this it re- tains so long as life continues, whether the temperature of the air is below zero or above 140°. It is liable to be increased in some diseases, and to be diminished in others. In a case of typhoid fever, the blood was found to have a temperature of 113°. When life is extinguished, the body gradually loses the heat which it possessed at the moment of death, just like so much inert organic matter artificially raised to the same temperature, and it cools down to the temperature of the air to which it is exposed. The time usually assigned for the cooling of the dead human body is irovaffteen to twenty hours, but it varies according to the condition of the body at the time of death, the mode of death, and the cir- cumstances under which it has been placed. Thus, if exposed naked to a cold atmosphere, the cooling is very rapid. If the body is well covered, the cooling takes place slowly. When death has taken place suddenly, from accident, apoplexy, or acute disease, a body has been observed to retain its heat for a long period. Can the warmth of the human body be retained in its normal state for any length of time after death ? We might suppose, cL ■priori, that this question should be at once answered in the nega- tive ; but there are numerous authentic observations which show that heat may be sometimes long retained by the dead body, both on the surface as well as in the cavities ; and it has been noticed, in certain fatal diseases, that the temperature has actually risen in the body after death. This exceptional retention of heat has given rise to the erroneous suspicion that the person was still living. Doubts were entertained for several days respecting the death of the well-known Professor Dieft'enbach, of Berlin. The unusual re- tention of heat, and the delaj' of the putrefactive process, led to the supposition that he was only in a state of apparent death. It can scarcely be imagined that the production of heat should continue in a really dead body ; and yet certain facts connected with the malignant cholera, yellow fever, and other diseases, appear to establish the possibility of this. In some cases of death from malignant cholera, when epidemic in this country, in 1832-3, the body, which had become moderately cold, was observed sud- denly to resume its warmth, so that the temperature is stated to have risen some time after death as high as 87°, although circula- tion and respiration had entirely ceased. In another instance the temperature was observed to rise from 79° to 92° after death. This singular phenomenon, like numerous others connected with that disease, has received no adequate explanation. According to Valentin the occurrence of post-mortem heat is common to all dead bodies, the difference being only in degree. It is said to be most rapidly developed after death from injuries to the nervous centres, especially the brain. In cerebro-spinal meningitis the temperature has risen after death from 104° to 111° Pahrenheit, and in a fatal case of smallpox, attended with much delirium, Simon observed that the thermometer rose at death from 104° to 113° (" Lancet," CADAVERIC RIGIDITY. 63 1870, vol. 1. p. 21). This production of heat after the cessation of breathing must be taken as positive evidence of some latent vital power or chemical force still lingering about the circulating system ; for in real death, the animal body, when it has once become cold, is no more capable of spontaneously generating heat within itself, than any of the inert and lifeless solids by which it is surrounded. In a case of death from Asiatic cholera, Mr. Rumsey observed that half an hour after the complete cessation of respiration and circulation, the muscles of the arms underwent spontaneously vari- ous motions of contraction and relaxation, continuing for upwards of an hour, and that although previously cold, they then became evidently warmer. The restoration of warmth after the body has become cold in such cases, can only be explained by supposing that there still remains about it some lingering trace of vital action ; although this may not be indicated by the presence of the ordinary signs of active life. The facts connected with the production of heat in the dead body have not received much attention from physiologists. Dr. John Davy met with some very high temperatures in the dead body. In a case of rheumatism, after the viscera had been exposed for nearly ten minutes, the mercury of a theremometer, placed under the left ventricle, rose to 113°, and when in contact with the lobulus Spigelii of the liver, to 112°. In a second sub- ject, examined six hours after death, the thermometer under the left ventricle indicated a temperature of 108°, and when in contact with the lobulus Spigelii 107°. In these cases, the patients were ill but a short time, and died suddenly ; and the temperature of the apartment in which the observations were made, was 86°. This increase of temperature after death has been referred to putre- faction ; but Dr. Dowler has shown that it takes place soon after death, and before rigidity sets in. Some of the cases reported by Dr. Wilks and myself also show that it- may take place independ- ently of putrefaction. (" Guy's Hosp. Rep." Oct. 1863, cases 4, 26, 30, p. 184.) Dr. Dowler has called this condition post-mortem calori- city ; he has noticed it as a common occurrence, in a warm climate, in the bodies of persons who have died from yellow fever. The heat of the body, according to him, continues to increase for several hours after death. The alleged effect of loss of blood in accelerating the cooling of the human body when death has occurred suddenly from hemorrhage, has no foundation in fact. The only physical difterence which it would be likely to create, would be by simply reducing the amount of fluids in the body to undergo the cooling process. In a well-marked case, the loss of four pounds made no appreciable difference in the rate of cooling. 3. Cadaveric rigidity. Bigor mortis. — In from five to six hours after death, and generally while the body is in the act of cooling, the muscles of the limbs are observed to become hard and contracted in the attitude in which the body is placed ; the joints are stiff, and the trunk firm and unyielding. This peculiar condition is known under the name of cadaveric rigidity. The first effect of 64 CADAVERIC RIGIDITY. death from any cause is in most cases a general relaxation of the whole of the muscular system. The lower jaw drops, the eyelids lose their tension, the limbs are soft and flabby, and the joints are quite flexible. The muscular tissue may be considered as passing through three stages in a dead body. 1. It is, at first, flaccid but contractile, although it may be remarked that muscles contracted by living force in the act of dying, do not necessarily become re- laxed in death ; 2. It becomes rigid and incapable of contraction ; and 3. It is once more relaxed, and does not regain its power of contractility. The body now passes into the first stage of putre- faction. The first stage defines the duration of muscular irri- tability ; the second stage, that of cadaveric rigidity ; and the third, that of the commencement of chemical changes, or putre- faction. The time at which rigidity occurs after death, as well as its dura- tion, is affected by various circumstances. It generally commences within _^z;e or six hours, and lasts from sixteen to twenty-four hours. Experiment shows that the seat of this phenomenon is in the mus- cular system, for the rigidity disappears immediately on the re- moval or division of the muscles. According to the experiments of Beclard and others, the rigid condition of the muscles is wholly independent of the integrity of the nervous system : for a division of the nerves leading to the particular muscles, or even the entire removal of the brain, has not been found to prevent it, or to retard its occurrence. It has also been observed, that when death has taken place from paralysis, hemiplegia, or apoplexy, the rigidity has been as strongly manifested by the muscles of the paralytic or hemiplegic, as by those on the healthy side, provided they are well nourished and retain some irritability. The muscles of shattered limbs in death from comminuted factures, do not take on this con- dition. It is probable that the rigidity is due to a vital action in the muscular fibre ; and possibly, as John Hunter imagined, it may be the last eflect'of the vital force on the muscular system. Ac- cording to Kussmaul the living metamorphosis of the muscle has ceased ; the muscle becoming rigid is a dying — ^the perfectly rigid, is a dead muscle. Rigidity is in general observed to take place simultaneously with the coagulation of the blood throughout the body. Some have considered it to depend upon this ; but not to mention that the alleged cause appears to be wholly inadequate to the eft'ect produced, the rigidity sometimes occurs while the body is warm and the blood fluid, therefore this cannot be the true ex- planation : moreover, it closely resembles the rigidity of syncope and asphyxia, which can have no reference to the coagulation of the blood. Cceteris paribus, rigidity is always more strongly manifested and continues for a longer period, in those bodies in which the mus- cular system is healthy and fully developed. It has been observed that the time at which it appears after death in muscular subjects, is longer than in other cases. In a case of death from hemorrhage, in which four pounds of CADAVERIC RIGIDITY. - 65 blood were suddenly lost from the axillary artery, it was observed that eight hours after death the arms and legs were pliant ; and it was not until twelve hours after death, when the body was becom- ing cold, that rigidity manifested itself. Death by hemorrhage, therefore, does not accelerate this condition ; it appears to have no more influence upon the period of its occurrence than it has upon the cooling of the body. So with regard to irritant poisoning in an acute form ; no difference was observed in reference to the rate of cooling or the commencement of rigidity in a well-marked case of death from arsenic, in eleven hours. In a case of suffocation by charcoal vapor, Nysten observed that rigidity did not make its ap- pearance until sixteen hours after death, and it is stated to have lasted for the long period of seven days. In other instances of suf- focation, this protraction of cadaveric rigidity has not been noticed. In these cases, the slow access of this state depends less on the mode of death than on the irritability of the muscles at the time of death. This is always great when the nutrition of the muscles is perfect, a condition which exists in cases of violent death, as from decapitation, sudden hemorrhage, or isome form of asphyxia. Dr. Symonds has seen a body in a state of rigidity eight days after death by hanging. Nysten found that there was muscular irritability in the body of a decapitated man twenty-six hours after the head had been severed from the body ; and Brown S^quard states as the gene- ral result of his experience, that in the bodies of healthy persons decapitated or asphyxiated, cadaveric rigidity did not appear sooner than ten or twelve hours after death, and that it lasted more than a week, even when the weather was warm. He has found in the muscles of the limbs of two decapitated men some degree of irrita- bility, thirteen and fourteen hours after death. According to K'ysten, cadaveric rigidity first appears in the mus- cles of the trunk and neck ; it then takes place in the muscles of the upper extremities, and lastly, in those of the lower. In regard to its disappearance, the muscles of the lower extremities will often be found rigid while those of the trunk and upper extremities are again in a state of relaxation. In the^articular limbs, it commonly proceeds from above downwards, and it generally passes oft" in the same order. It always sets in, increases, and decreases imper- ceptibly and gradually, in which respect it differs strikingly from the rigidity of muscles as a result of disease. (" Kiissmaul, Viertel- jahrschrift fiir die praktische Heilkunde, 1856," B. 2, s. 67. See also a translation by Dr. Moore, " Dublin Quar. Jour. Med. Sei." 1856, vol. 22, p. 490.) A more recent observer, M. Larcher, who states that he has examined more than six hundred dead human bodies, as well as the bodies of a great number of animals, assigns the following course, unless convulsions may have been present at the time of the death. It commences in the lower jaw; — afteets the lower limbs — and afterwards the neck and the upper limbs. Those muscles which are the first to become rigid are the longest tO' retain rigidity. ("Ann. d'Hyg." 1869, 1, 469.) It will now be necessary to consider whether a living body ever- 5 66 CADAVERIC RIGIDITY. assumes a condition analogous to that of cadavei'icsrigidity. Te- tanus, apoplexy, catalepsy, hj'steria, syncope^ and asphyxia have been stated to present symptoms which might lead to doubt re- specting the reality of death from this sign. There are, however, these striking diflerences : in rigidity from any of these diseases, the warmth of the body is commonly in great part preserved, if not on the surface, in the rectum and flexures of the joints ; the rigidity of disease takes place simultaneously with the apparent suspension of life from the attack ; and lastly, the whole of the body becomes equally rigid at the same moment, owing to the ex- istence of a universal muscular spasm. The observations of M. Brown S^quard have furnished an expla- nation of many of the difiiculties connected with the occurrence, and disappearance of cadaveric rigidity. (" On the Relations be- tween Muscular Irritability, Cadaveric Rigidity, and Putrefaction." " Proc. R. S." May 1861, p. 204.) This physiologist agrees with Nysten and others that the greater the degree of. muscular irrita- bility at the time of death, the later cadaveric rigidity sets in, and the longer it lasts ; and the later also putrefaction appears, and the more slowly it progresses. Miiller and Gierlichs had already shown rigidity does not occur until the muscles have lost their irritability, or their power of contracting on the application of ordinary stimuli ; that in irogs, in which, as in other reptiles, muscular irritability is very persistent, rigidity is often not established until three or four days after death ; that in birds, on the other hand, in which mus- cular irritability remains but a short time after death, rigidity ensues quickly. Further, all circumstances which cause a speedy exhaustion of muscular irritability during life, induce an early occurrence of cadaveric rigidity, while those conditions by which the appearance of irritability is delayed, retard its access. (" Baly and Kirke's Physiology," 1848, p. 9.) M. Brown S^quard observed as a result of his experiments on animals, that when the tempera- ture of the muscles was diminished before death, their irritability lasted long after death ; cadaveric rigidity set in late, and lasted long ; and putrefaction appeared late and proceeded slowly. What- ever exhausts muscular irritability, such as violent exercise or ex- ertion, accelerates rigidity in the dead, and, in an equal degree, putrefaction ; this applies to observations on man, as well as on animals. Rigidity takes place rapidly in the dead bodies of cattle that have been overdriven, or of animals that have been hunted to death. The bodies of soldiers killed in the early part of a battle become rigid slowly, while the bodies of those who are killed at the close, after many hours of violent muscular exertion, become rigid almost immediately. This may explain the singular fact recorded by military men, that the dead bodies are sometimes found on the field of battle stiffened in the attitude of kneeling or sitting, with their weapons clenched firmly in their hands. There has been no relaxation in death, but the muscles appear to have at once passed from a living contraction into a rigid condition. This also throws light upon a fact to be presently noticed, that suicides CADAVERIC RIGIDITY. 67 are sometimes found with weapons grasped in their hands, and their bodies stiffened' in the attitudes in which they have died. It may be inferred in these cases that from some cause operating during life, the muscular irritability was exhausted at the time of death. Hence the greatest differences are observed to exist in regard to the commencement of cadaveric rigidity and putrefaction, in consequence of the variable degree of muscular irritability at the time of death. Dr. Brinton, IL S., has recorded his experience in this curious subject during the American war. In many who had died instantaneously from brain and heart wounds, the body was rigid throughout, and the position was that of the last mo- ment of life. He has called this instantaneous rigor. After the battle of Antietam in 1862, he counted within a small space forty dead bodies, mostly with chest wounds. There were some with their armes raised rigidly in the air, and others with their legs drawn up and fixed. In not a few the body was curved forwards and fixed. These attitudes were not those of the relaxation of death, but were rather of a seemingly active character, and the muscles remaining rigid and inflexible as the result of spasmodic muscular action in the last moment of life. (" Amer. Jour. Med. Sci.," Jan. 1870, p. 87. Also "Lancet," 1870, 1, 276.) In refer- ence to deaths from malignant cholera. Brown S^quard observed, that cadaveric rigidity appeared late and lasted long in those patients who died quickly, that is, before a prolonged alteration of nutrition, and that those muscles which had been attacked with violent and frequent cramps, became rigid very soon after death, and remained so only for a short time. M. Ollivier found that the bodies of cholera patients were frequently rigid in from six to eight hours after death, while the muscles which were the seat of this rigidity were still warm, and on making an incision into them, the blood readily flowed out. A similar error has arisen respecting the bodies of persons killed by lightning. John Hunter thought that cadaveric rigidity did not occur in this mode of violent death ; but the late Sir. B. Brodie found that the body of an animal killed by electricity became, as usual, rigid after death. In an accident which occurred in France, in August, 1846, a group of laborers was struck by the electric fluid : four were killed on the spot, and five or six severely wounded. It was remarked that the person whose body bore the most extensive marks of injury had worn a goat-skin. There were several lacerations about this body, and in three hours after death it became perfectly rigid. (*' Med. Gaz.," vol. 38, p. 351.) In a case of death from lightning, commu- nicated to the " Medical Gazette," by Dr. F. J. Brown, rigidity was strongly marked in the limbs about twenty-eight hours after death (vol. 47, p. 844). In May, 1854, during a storm, a man was struck by the electric fluid. He' made a short exclamation, and immediately expired. It was observed in this case that the body became rigid after death. Facts are now sufficiently numerous- to 68 THE EYES. enable us to say that the old opinion of the non-occurrence of rigidity in the bodies of persons killed by lightning is unfounded. At a certain period after death, the heart is found rigid and firmly contracted. If examined at this time, it may appear to be in a state of spasm, and to have its walls thickened, while the cavity of the left ventricle may be described as being much smaller than in the normal state. Sir James Paget has pointed out that this natural condition of the heart after death has led to pathological mistakes, the walls being described as thickened, and the' cavities diminished in size, and the heart itself as being in a state of con- centric hypertrophy from disease. On the other hand, the perfect relaxation of the heart which follows at a later period after death, has been mistaken for, and described as a morbid flabbiness and flaccidity. Spasm and paralysis cannot be inferred to have existed when we discover these conditions of the heart in the recently dead body. Under the action of poisons like strychnia, and those alkaloids which cause death by convulsions, the more violent and frequent the convulsions, the sooner cadaveric rigidity sets in. 4. The Eyes.- — Shortly after death, the cornea becomes dull, its brightness and prominence disappear, the globe becomes collapsed, and, after a time, the surface of the membrane is wrinkled. Louis long since observed, that the eyes of the dead became flaccid and soft in a very few hours after dissolution, and that a film was formed over them ; this condition he considered to be characteristic of death. It is necessary to observe, however, that while this ap- pearance is not always met with in the dead body, it is sometimes found in the living. In those who have died from apoplexy, or from the inhalation of carbonic acid gas, the eyes have often pre- served their brilliancy and prominence for a length of time. This has also been observed in those who have been poisoned by prussic acid, cyanide of potassium, or the essential oil of bitter almonds. Incipient putrefactive changes may, by forcing the blood towards the head, cause a prominence and brilliancy of these organs, in those bodies in which they were dull and collapsed soon after death. On the other hand, the film over the eye and the collapse of the globe have been observed in cases of malignant, cholera several hours before death, and while the heart was still beating. (" Ann. d'Hygi^ne," 1848, 1, 104.)] M. Larcher has pointed out a new sign which he calls cadaveric imbibition of the globe of the eye. This appears in the shape of a blackish stain on the sclerotic coat on the outer side. This is at first slight, but becomes gradually deeper. It is followed by a similar patch or spot on the sclerotic in the inner side. They ex- tend towards the centre of the eye, approaching each other, and forming the segment of an ellipse. This appearance is probably due to the sclerotic becoming thinner in these parts by evaporation and the dark pigment showing itself through it, M. Larcher de- scribes this mark as the forerunner of putrefaction, following rigidity, but preceding even the green tint which is seen in the THE SKIN — COAGULATION OF THE BLOOD. 69 skin of the abdomen at the commencement of this process. (" Ann. ^'Hyg., "1869, 1, 468.) Kiissmaul states that no conclusion can be drawn from the width of the pupils in death, as to the diameter which they presented at the latest period of life. This statement is of some practical importance in reference to post-mortem appear- ances, in cases of alleged narcotic poisoning. M. Ripault noticed that in real death, the iris is perfectly flaccid. This is seen when the globe is compressed in two opposite directions at the same time. If the person is living, the pupil retains its circular form, notwith- standing the compression. If dead, the circular form is lost, and the aperture becomes irregular. Dr. Fleming has noticed that a solution of atropia, which by causing dilatation of the pupil would in a few minutes reduce the living iris to a mere line, has no action on the iris of the dead eye ; but this result probably depends on the time after death at which the liquid is applied. Jobst and Hesse found that two drops of an aqueous solution of physostigniia (the poisonous alkaloid of the Calabar bean) applied to the eye of a rabbit an hour after death from natural causes, caused the pupil to contract to one-fourth, compared with the other eye, and it re- mained in this condition. (" Chem. Ifews," March 5, 1864, p. 109.) In cases of catalepsy or trance simulating death, the pupil retains its contractile power. It contracts under a strong light, and dilates when the light is withdrawn. In real death, the pupil is not af- fected by light. 5. The Skin. — After dissolution, the skin is observed to become extremely pallid and waxy-looking, owing to the absence of all cir- culation. In some parts it becomes covered, as the body cools, by livid discolorations (cadaveric ecchymosis) ; this is especially the case in those instances where death has taken place by sudden vio- lence. One of the most striking changes in the skin is its entire loss of elasticity. In the living body, if any part of the surface be compressed, the skin will readily return to its original form on re- moving the pressure. Thus, in a doubtful case, a flatness of those parts which have been allowed to lie upon an even surface may be regarded as a sign of real death, provided the other concomitant changes are observed. 6. Coagulation of the blood has been enumerated among the signs of death. M. Donnd suggested that, in order to determine the reality of death before the access of putrefaction, a small portion of blood should be drawn from a vessel, and it should then be observed whether it coagulated or not. If instead of a red homogeneous coagulable liquid, we obtain only a reddish colored uncoagulable serum, from which the particles speedily subsided as a red sediment, we shall be justified in inferring that life has ceased — a conclusion at which we could not arrive if even the smallest portion of coagu- lum should be formed. This appears to be a fair physiological test, and easy of application. When the blood has once coagulated, there must be an arrest of circulation ; and although it might be- come again fluid, this would be only under the influence of putre- faction, and it would not thereby recover a coagulating power. 70 PUTEEFACTION. One of the great characters of blood efi'used from a living body is, that it coagulates speedily after its effusion. Blood sprinlded from- a dead body is more liquid ; it has less coagulating property. The blood coagulates in most cases after death, but at a variable time after the cessation of the heart's action. "When blood is re- moved from the living body, coagulation commences in from five to ten minutes. In the dead body, it probably does not commence until it begins to cool. Hence the fact of coagulation does not prove that the person is living. Dr. Wilks has observed that when a body is examined eight or ten hours after death, it is not unusual to find the blood which may have flowed fi-om it as a liquid, form- ing a firm clot on the table ; and that which is effused into the chest during the examination often forms after some time a very firm coagulum. (" Guy's Hospital Eeports," Oct. 1863, p. 183.) It has been stated that the blood of persons killed by lightning does not coagulate, but this statement is erroneous. Certain diseases appear to influence the coagulation of the blood. Mr. Savoiy has observed that coagulation has been partial or imperfect in cases of death from delirium tremens ; and it is well known that in rapid death from certain vegetable poisons the blood is found fluid and of a darker color than natural, even when the examination is made soon after death. If we allow a proper interval to elapse after the supposed death of a person, there can be no difficulty in solving the question, whether the body is really dead, even before any of those changes which arise from putrefaction have manifested themselves. The circumstances on which we may rely as furnishing conclusive evi- dence of death, are the following: 1. The absence of circulation and respiration for at least an hour, the stethoscope being employed if necessary ; 2. The gradual cooling of the bpdy to the temperature of the air, the trunk remaining warm while the members are cold; and 3. As the body cools, a gradual supervention of a rigid state of the muscles, successively attacking the limbs and trunk, and ultimately spreading through the whole muscular system. When these conditions are observed, the proofs of death are conclusive ; it is unnecessary to wait for any sign of putrefaction. These changes are as certainly the forerunners of putrefaction as the pro- cess of putrefaction is .itself the forerunner of the entire destruction of the body. I believe it may be safely said that there has not been a single instance of resuscitation after rigidity had once commenced in a body. During the raging of epidemics, if additional evidence be required for early burial, it might be obtained by exposing a superficial muscle to the galvanic, stimulus. If the fibres do not contract, death is certain. If they do, this is no proof that the person can be restored to active life; but further time may be allowed before the body is committed to the grave. Putrefaction. — By putrefaction we are to understand those chemi- cal changes which spontaneously take place in dead animal matter, during which offensive gases are evolved. The ultimate effect of these changes is, after a longer or shorter period, to reduce the or- PUTREFACTION. 71 ganic to the condition of inorganic compounds, consisting chiefly of water, ammonia, and carbonic acid. It is in the stage of transi- tion that noxious effluvia are evolved from which the process derives its name. These consist of compounds of nitrogen, sulphur, phosphorus, and carbon with liydrogen. This process does not begin to manifest itself in the dead body until after the cessation of cadaveric rigidity, and generally about the third day. It is then observed, if the body has been exposed to the atmosphere in an apartment of mean temperature (60°), that the limbs and trunk become supple and pliant, and yield a faint odor. The skin covering the abdomen becomes of a pale greenish color, which gradually deepens. A similar discoloration slowly makes its appearance in the chest, between the ribs, in the face, the neck, the legs, and lastly, in the arms. The color appears to depend on the decomposition and infiltration of the animal fluids, especially the blood, into the skin. In the neck and limbs it is observed to be more marked in the situation of the large venous trunks ; and sometimes, indeed, the course of the superficial veins is accurately traced out by greenish-blue or dark lines, which have been mistaken for marks of violence. Gaseous products are formed, not only in the hollow organs of the abdomen, but beneath the skin generally, so that on making an incision, the edges of the skin are rapidly forced apart or everted. The reaction of this confined gas accounts for the occasional escape of alimentary and fecal matter from the outlets ; as also for the escape of blood some days after death from wounds involving any of the large veins. Putrefaction takes place with variable rapidity. It commonly shows itself about the second or third day in warm weather, and about the fifth or sixth day in cold weather. In some instances, however, the body has been found in an advanced state of putre- faction in the short period of sixteen hours after death, and in others the process has been greatly protracted. The time of its appear- ance is dependent on the duration of cadaveric rigidity, and the condition of the body at the time of death. It never begins until cadaveric rigidity has ceased, and therefore not until the muscles of the body have entirely lost their irrita- bility. Whatever conditions of the body during life or after death may operate to cause the disappearance of muscular irritability, will pari passu accelerate rigidity and putrefaction, and vice versa. There are three primary conditions which are indispensable to the establishment of this process in a dead body. These are: 1st, a certain temperature ; 2d, the presence of moisture ; and 3d, the free access of air. Temperature. — The process is found to go on most favorably in a temperature varying from 70° to' 100°. It will commence, other circumstances concurring, at any temperature above 50° ; but at 32° it appears to be wholly arrested. The dead body may thus be preserved a considerable time in snow, ice; or in a frozen soil ; but if, after removal, it is exposed to a temperature between 70° and 100°, the ordinary putrefactive changes are stated to take place 72 PUTREFACTION. with more than their usual rapidity. At a high temperature, again, i. e., about 212°, putrefaction is arrested. The soft animal solids lose their water, become hard and brittle masses, and may now be exposed to the atmosphere without undergoing any further change. A heat between 100° and 212° may also speedily put a stop to the process, by causing a rapid evaporation of the water contained within the solids. They become thereby dried and coagulated. Thus it is that bodies buried in the hot and arid sands of Egypt are dug up, many years after interment, in the state of desiccated mummies, putrefactive decomposition having been long since arrested. The effect of temperature on this process is strikingly seen in the influence of season. A dead body exposed to air during summer, when the thermometer is above 60° or 70°, may undergo more marked putrefactive changes in twenty-four hours than a similar body exposed for a M'eek or ten days in winter. This is a fact which demands consideration, when an opinion is required to be formed respecting the date of death of a body concerning which nothing is known. The presence of moisture. — ^Unless the animal substance is im- pregnated with water or moisture, it is impossible that putrefac- tion can take place. The animal solids commonly contain sufficient water for the spontaneous establishment of the process. In a human body weighing 150 lbs., there are about 100 lbs. of water (" Brande and Taylor's Chemistry," p. 831). The soft organs differ much from each other in respect to the quantity of liquid contained in them, and therefore in the degree in which they are prone to putrefaction. Thus the brain and the eye are in this respect con- trasted with the teeth, bones, hair and nails. The fluids of the eye are rapidly decomposed, while the teeth and hair may remain for centuries unchanged. Influence of air. — Putrefaction may take place to a slight extent independently of air, but the process is soon arrested ; and hence bodies sealed permanently in leaden coffins are found perfect and may be identified after very long periods of time. The, products in all cases in which air is excluded, are chiefly of an ammoniacal nature. Air operates by its free oxygen combining with the ani- mal elements, and forming gaseous and liquid products. [Besides these external causes, there are others, subjective or in- herent in the body, such as age, sex, state of the body, manner of death, influence of disease, etc. Aged bodies decompose slowly, pro- bably on account of their comparative want of moisture, whilst the bodies of new-born children rapidly putrefy, for the opposite reason. Fat and flabby bodies undergo decomposition more rapidly than lean ones, because they contain more fluids ; the same is said to be true of the bodies of women dying in childbed. In cases of very sud- den death in persons of previously sound health, putrefaction -is more rapid than when it has resulted from an exhausting disease. When the blood has been impoverished, as in typhus, and when the body has previously been much contused (provided it has not been protected from the influence of the air, as when buried under CADAVERIC LIVIDITY AND ECCHYMOSIS. 73 rubbish), the process of decomposition is accelerated. It is also rapid after death from suffocation by smoke, coal-gas, or sulphur- etted hydrogen ; also by strangulation, drowning, and asphyxia generally ; also after narcotic poisoning ; but it is slower after death from phosphorus, alcohol, sulphuric acid and arsenic. The order of decomposition of the internal organs, according to Prof. Casper, is as follows: Trachea and larynx, brain of young infants, stomach and intestines, spleen, omentum and mesentery, liver, brain of adults, heart and lungs, kidney, bladder and oesopha- gus, pancreas, diaphragm, large vessels (especially the arteries) and last of all, the uterus. — E,.] Cadaveric lividity and ecchymosis. — There are certain external changes which take place in a dead body before the access of, or during putrefaction, to which it is necessary that a medical jurist should attend. There is what is called cadaveric lividity^ which comes on during the act of cooling. At a still more advanced period, dark livid spots or patches are met with in the skin, to which the name of suggillation or post-mortem ecchymosis has been given (see "Henke Zeitschrift der S. A.," vol. i. p. 199). These appearances have often been mistaken for the effects of violence applied during life, and serious mistakes have thence arisen. Inno- cent persons have been accused of murder or manslaughter, and have been tried on charges afterwards proved to be groundless. Sir R. Christison -refers to two cases, in one of which two persons were convicted, and in the other, three narrowly escaped convic- tion, upon a mistake of this kind. These spontaneous changes in the dead body must, therefore, be attended to by the surgeon. They may be considered by dividing them into those which take place before putrefaction, and those which take place afterwards. The first form (before putrefaction) is dependent on a stagnation of blood in the capillary vessels. So long as there is life, the capil- lary circulation continues. This may be ascertained by puncturing the skin or lip with a fine needle ; if the capillary circulation is going on, a drop of blood will escape, otherwise not. When after death the capillaries have lost their contractility, the blood appears to stagnate in them in an irregular manner, producing lividity. The skin of the body, although pale at the time of death, becomes covered during the actof cooling by extensive patches of a bluish or slate color, diffusing themselves over the greater part of the trunk and limbs. The color is sometimes of a deep purple, often mottled, but generally abruptly terminating in the white skin. This kind of ecchymosis is chiefly seen on the bodies of those who have died suddenly in full health, or by a violent death, as in apo- plexy, hanging, drowning, suffocation from charcoal vapor, and other causes. In the latter case, it has been found in some instances to be especially developed. It is rarely seen in the bodies of those who have died from loss of blood ; the skin is in these cases com- monly pallid. When the skin in which the lividity is seated is divided, it is seen that the color is confined to the upper layer of 74 CADAVERIC LIVIDITY AND ECCHyMOSIS. the true skin (cutis), or to the space between the cuticle and cutis^ and never to extend through the latter. There is no sanguineous efi'usion, but apparently a simple congestion iii the minute capillary vessels. Sometimes this lividity is disposed in a peculiar form over the body. If a stout and muscular person has died suddenly, and the body, wrapped closely in a sheet, is allowed to cool, the lividity may be sometimes disposed in the form of a number of stripes or bands over the whole surface — the congestion of the vessels taking place in the interstices of the folds, while the parts actually com- pressed remain white. The appearance of the body is such that we can hardly divest our minds of the idea that the person must have been flogged. The unbroken state of the cuticle, with the other characters just now mentioned, are, however, sufficient to distin- guish this appearance from the effects of violence. This kind of lividity is known under the name of vibices. It is often seen on the backs of subjects that have been allowed to cool either in their clothes or on any rough and uneven surfaces. A few years since I saw a well-marked case of vibices, in which the suspicion was so strong that violence had been used to the deceased, that a coroner's inquest took place. The forepart of the body was covered with stripes, which were of a red and livid color : they appeared to cor- respond exactly to the folds of a sheet drawn tightly across the chest ; and it was subsequentl}'^ ascertained that the body of the deceased had been treated in this manner after death. The blood was superficially diffused, and the cuticle uninjured. The circum- stance above mentioned at once . satisfactorily explained the cause of the appearance. These vibices or weals, like the cadaveric livi- dity already described, are commonly seen in plethoric persons ; they indicate great vigor of circulation at the moment of death. But lividity in the dead body occasionally presents itself under a more deceptive form than in either of the instances just mentioned. This is well shown in the case of a man who died in ]S"ovember, 1837, on board of the Dreadnought hospital ship. The subject of this case, set. 33, died suddenly from disease of the heart. Just before death the deceased had been auscultated, and no marks then existed on the skin. The body, after about eighteen hours, was examined, and then it was found to present, in detached places, patches of discoloration or ecchymosis, varying in size from small spots to several inches in diameter. Although closely simulating bruises or marks of violence dui-ing life, a slight examination showed that they were owing to simple lividity, because those parts of the back and limbs which were not compressed by the sur- face on which the body of the deceased was lying, were the only parts discolored. The calves of the legs, the loins, and the back, which bore the pressure, were white. On cutting into these patches, the layers of the skin, as well as the tissues beneath, were through- out reddened by congested blood, and small rounded semi-coagu- lated masses oozed out from the cellular membrane on slight pressure. ADIPOCEEE. 75 These characters somewhat resembled those produced by violence on the living body ; but there was another, and, I believe, an unex- ampled circumstance, in which the resemblance to vital ecchymosis existed. Around many of the patches there was a wide border, or zone, of a pale straw color, with various shades of green and blue, precisely similar to those which are seen in the gradual disappear- ance of an ecchymosis from the living body. By most medical jurists it has been hitherto considered that the zones of color are peculiar to vital ecchymosis, and are never seen in the ecchymosis produced after death. The occurrence of this case shows with what caution general rules should be franried for medico-legal prac- tice. Had the body of this person been found lying dead and exposed on a high road, and had it beeh proved that another man had been seen quarrelling with him, what might have been the opinion expressed? We can scarcely hesitate to say, unfavorable to the accused person. This kind of ecchymosis could have been distinguished from that of violence during life only by the unruffled state of the skin, and the slight efl'usion of blood, compared with the extent of discolored surface. It is worthy of note, also, that the chief seat of ecchymosis was in those parts which were recum- bent or depending. The formation of the colored zones around some of the patches of lividity was fully explained by the fact of the man having labored under general dropsy. The serum effused in the cells here acted upon and diluted the liquid blood, as it exuded from the vessels, and diffused it around, much in the same manner as the serous exhalation of the cellular membrane acts on the blood effused in the living body. Adipocere.—Th.e substance called adipocere was first observed and described by Fourcroy during the removal of vast numbers of bodies from the Cimetiere des Innocens in Paris. He gave to it this name, owing to its properties being intermediate between those of wax and fat. He considered it to be constituted of fatty matter and ammonia. From an analysis by Chevreul, the substance de- scribed by Fourcroy was proved to be a real ammoniacal soap with some extraneous coloring matter, which gave it a yellowish or brown color. It contained, besides, a bitter substance not defined, and an odoriferous principle, to which it owed its smell. Chevreul also detected in some specimens, lime, potash and salts. The composition of adipocere does not appear to be uniform : it is liable to vary according to the nature of the medium to which the body has been exposed. Thus, in hard or river water, the white sub- stance so called, discovered in the dead body, is formed of a base of lime ; so, in bodies laid in graves or vaults which are traversed by springs of water containing sulphate or carbonate of lime, an adi- pocere of stearate and oleate of lime is found as a hard white solid. It is not improbable, as Orfila has suggested, that in the first instance an ammoniacal soap is produced, and that this is subse- quently converted into a calcareous soap by contact with calcareous water. Any part of the human, body may undergo this change, but all 76 ADIPOCERB. parts are not equally susceptible of it. In order that the adipoeere described by Pourcroy should be found, it is indispensable that the animal fat should be in contact with substances containing nitro- gen. Experiment has clearly established that neither pure fat, nor pure fibrin, when kept apart, will become saponified. Orfila found by comparative experiments, that the skin deprived of all fat did not undergo this change ; but when the fat was allowed to adhere to it, it became saponified. Upon the knowledge of these facts, the following theory of the production of adipoeere was founded. The fat, containing no nitrogen, could not furnish ammonia ; conse- quently it could not spontaneously change into this substance. The fibrin of the muscular system was therefore supposed to pro- duce ammonia by giving oil" hydrogen and nitrogen ; and this alkali combined with the fatty acids of the body to form a soap (see " lire's Dictionary," art. Adipoeere). As the fat of the body is contained in a cellular membrane (a nitrogenous compound), and is traversed by the blood and other nitrogenous fluids, the nitrogen is as readily furnished by these as by the fibrin of the muscles. So again, the skin and fat, separated from the muscles, will become converted into adipoeere. The fibrin of muscles, therefore, although unquestionably it may be one source of the ammonia, is not the sole source. Oil or fat exists throughout the soft organs and tissues of the whole body ; hence every part may undergo this transforma- tion. When the change is complete, the body maintains its con- dition for many years. Thus, in one instance, after seventeen years' burial in a grave, an exhumed body was found to be con- verted into this substance, and many of the organs could still be identified (;' Phil. Med. Exam.," April, 1847, p. 247). The period required for saponification to take place varies according to circumstances. Devergie states that the body of a newly-born child in the soil of water-closets may become 'entirely saponified in from six weeks to two months ; while in a drowned subject in water, saponification may be partially met with in three or four months ; and in one buried in a damp grave, from two to three years may sometimes elapse before saponification is complete. There is no doubt, however, that the process may take place par- tially in the dead body within much shorter periods than these. A body floating in water has been found converted into this adipo- cerous state in a little more than five weeks ; and with regard to the period in an ordinary grave, I may refer to the case of a female, exhumed at Bristol, in 1835, after fourteen months' interment. The lower part of the body was here found adipocerous. It appears that the grave was very damp, and the line of adipocerous trans- formation in the deceased was bounded by the level to which the water had reached. These facts are of more importance than may at first sight appear, since a legal question of survivorship, in at least two cases, has turned upon the shortest period required for the production of true adipoeere in the dead body. Properties of adipoeere. — Fourcroy and other French chemists describe adipoeere as an unctuous, soapy substance, varying in INSPECTIONS. 77 color from a pale white to various shades of yellow or brown. In the first instance it is soft, but becomes harder and lighter in color when dried. It melts at 200°, and when strongly heated in air gives off an ammoniacal odor, inflames, and burns. It is easily suspended in cold water, and forms an opaque mixture on boiling. Acids decompose the solution by combining with the bases, forming salts. When heated with lime, ammonia is evolved. It is only partly dissolved by boiling alcohol. Adipocere with a calcareous base is harder and whiter than that which contains ammonia. There is no trace of organic structure in either. Inspections. — The necessity for appointing a skilled independent inspector of bodies in all suspected cases demanding inquiry, will be apparent from other considerations. Under the present sj'stem, a person who has destroyed the life of another by poison may be present at the post-mortem inspection of the body of his victim, and may use his efforts to defeat the objects of the inquiry. Wil- liam Palmer, a medical man, was thua allowed to be present at the inspection of the body of Cook. He nominated the persons, one of them an inexperienced young man who had never before inspected a body in a case of death from poison, and he stood over them while they were engaged in the office. The stomach of the deceased when received for analysis was cut open throughout its length. The injury to this organ, by which at least a portion of the contents was lost, occurred during the inspection, and is said to have arisen from Palmer having accidentally (as it was alleged) pushed against the youth who was making the inspection ! After the vicera had been placed in a jar and secured with a bladder. Palmer found an opportunity of cutting the bladder with a knife and inverting the jar, and this probably led to a further loss of the contents. In a case of exhumation in which I was consulted, the viscera had been carefully removed and placed (as it was supposed) in separate jars, which were properly secured and labelled. When the jar labelled " Stomach and Contents" was opened by the analyst to whom it had been sent, it was found empty. From inquiries subsequently made, there was but little doubt that a person who was interested in preventing an analysis was permitted to be present at the inspec- tion, and that he had taken the opportunity, when the inspectors were otherwise occupied, of removing the stomach from the jar and again secretly returning it into the abdomen before the body was sewn up, or otherwise disposing of it. Acts of this kind should be impossible in the present day, and the best security against their occurrence would be the appointment of a skilled inspector in a district, to conduct all post-mortem examinations for coroner's inquests. A charge of malapraxis is sometimes raised against a medical man, in consequence of the death of a patient. The examination of the body may, by order of a coroner, be unknowingly placed in the hands either of a professional rival, or of a friend of the person in- culpated. This is not just, either to the practitioner or the public. There is nothing more easy, medically speaking, than to exaggerate 78 INSPECTIONS. appearances in a body, or to assign to the action of medicines, or to the use of surgical instruments, post-mortem conditions to which an independent and experienced anatomical inspector would* pro- bably attach no importance. Supposing the question to be that a patient has died from an overdose of opium, said to have been found, in the stomach — if the analysis has been intrusted by a coroner to any professional rival, or to an incompetent analyst selected by him, the injury done may be irreparable. These are not imaginary cases ; they have occurred and must occur until special inspectors arid analysts are appointed in place of men who are now taken by chance, by the fact of their living in the vicinity, or of their being called to see the person while dying. [In cases involving the all-important issues of life and death, we cannot but regard it as a serious error to commit the responsible duty of the exhumation of a body, and its subsequent anatomical and chemical examination exclusively to the State's experts, where no opportunity is allowed to the experts for the defence to be pre- sent. To say the least, such a procedure has very much of an ex •parte look, and must necessarily subject the persons thus profession- ally employed to a suspicion of prejudice. In the " Review" of the Wharton-Ketchum trial (" Amer. Journ. of Med. Sei.," April, 1872) we took occasion to condemn this practice as unfair both to the accused and to the cause of j iistice. In this case, the body of the deceased was thrice examined, and exclusively by the State's expert witnesses ; and, on one of these occasions, secretly — without even the knowledge of the counsel for the defence 1 — -R.] DEFINITION OF A POISON". 79 POISONING. CHAPTER IV. DEFINITION OF THE TERM POISON. — -DEADLY POISONS. — MECHANICAL IRRITANTS. LAW IN RELATION TO THE ADMINISTERING OF POISONS. INFLUENCE OF HABIT AND IDIOSYNCRASY. — CLASSIFICATION.— SPECIAL CHARACTERS OF IRRITANT, CORROSIVE AND NEUROTIC POISONS. Definition. — A Poison is commonly defined to be a substance, which, when administered or taken in small quantity, is capable of acting deleteriously on the body; in popular language, this term is applied only to those substances which destroy life in small doses. This popular view of the nature of a poison is too restricted for the purposes of medical jurisprudence. It would obviously exclude numerous compounds, the poisonous properties of which cannot be disputed — as, for example, the salts of copper, tin, zinc, lead, and antimon}^ ; these, generally speaking, act as poisons only when administered in large doses. Some substances, such as nitre, have not been observed to have a noxious action except when taken in large quantity, while arsenic acts as a poison in a small dose ; but in a medico-legal view, whether a man dies from the effects of an ounce of nitre, or two grains of arsenic, the responsibility of the person who criminally administers the substance, is the same. Each may be regarded as a poison, differing from the other only in its degree of activity, and in its mode of operation. The result is the same ; death is caused by the substance taken, and the quantity required to destroy life, even if it could be always accurately deter- mined, cannot enable us to distinguish a poisonous from a non- poisonous substance. If, then, a medical witness be asked " what is a poison ?" he must beware of adopting this popular definition, or of confining the term poison to a substance which is capable of operating as such in a small dose taken at once. In legal medicine, it is difficult to give such a definition of a poison as shall be entirely free from objection. Perhaps the most comprehensive which can be suggested is this: " A poison is a sub- stance which, when absorbed into the blood, is capable of seriously affecting health, or of destroying life." There are various chan- nels by which poisons enter the blood ; some are in the form of gases or vapors ; these operate rapidly through the lungs ; others are liquid or solid, and these may reach the blood either through the 80 MEDICINES AND POISONS. skin or through a wound ; but more commonly through the lining membrane of the stomach or bowels, as when thej are taken or administered in the ordinary maimer. The latter chiefly give rise to medico-legal investigations. Some substances act as poisons, by any one of these channels ; thus arsenic is a poison whether it enters the blood through the lungs, the skin, or the stomach and bowels ; but such poisons as those of the viper, of rabies, and of glan- ders, appear to affect the body only through a wound in the skin. When introduced into the stomach, these animal poisons have been found to be inert. In adopting the above definition of a poison in a medical sense, it is proper to remark that there are some substances which are regarded as poisons, although absorption into the blood does not appear to be necessary to their action. The mineral acids and alkalies belong to this class of bodies. They are corrosive poisons ; they operate injuriously by causing the destruction of living parts: and whether applied to the skin, the stomach, or (in the form of vapor) to the air-cells of the Inngs, they destroy life by the local changes to which they give rise, and the inflammation which is a consequence of their action. It is not easy to define the boundary between a medicine and a poison. It is usually considered that a medicine in a large dose is a poison, and a poison in a small dose is a medicine ; but a medi- cine such as tartarized antimony may be easily converted into a poison, by giving it in small doses at short intervals, either under states of the body not adapted to receive it, or in cases in which it exerts an injuriously depressing effect. Some deaths have been lately occasioned by this wilful misuse of antimony in doses which might be described as medicinal, although in the cases referred to, no other intention could have existed, in the secret administration of this substance, than that of destroying life. A person may die either from a large dose of a substance given at once, or from a number of small doses given at such intervals that the system can- not recover from the eft'ects of one before another is administered. This remark applies to a great number of medicines which are not commonly included in a list' of poisons. In reference to the medical definition of a poison, it is necessary to observe that the law does not regard the manner in which the sub- stance administered acts. If it be capable of destroying life or of injuring health, it is of little importance, so far as the responsibility of a prisoner is concerned, whether its action on the body is of a mechanical or chemical nature, and whether it operates fatally by absorption into the blood or not. Thus a substance which simply acts mechanically on the stomach or bowels may, if wilfully admin- istered with intent to injure, involve a person in a criminal charge, as much as if he had administered arsenic or any of the ordinary poisons. It is then, necessary that we should consider wKat the law strictly means by the act of poisoning. If the substance cri- minally administered destroys life, whatever may be its nature or mode of operation, the accused is tried on a charge of murder or manslaughter, and the duty of a medical witness consists in showing LAW IN RELATION TO POISONS. 81 that the suhstance taken was the certain cause of death. If, how- ever, death he not the consequence, then the accused may be tried for the attempt to murder by poison (24 and '2o Vict., c. 100, s. 11, Aug. 1861). The words of this statute are general, and embrace all kinds of substances whether they are popularly or professionally regarded as poisons or not. Thus it is laid down that — " Whosoever shall administer, or cause to be administered to or taken by any person, any poison, or other destructive thing, with intent to commit murder, shall be guilty of felony." "Whether the administering be followed by any bodily injury or not, the act is still a felony, provided the intent has been to commit murder. The attempt to administer or the attempt to cause to be administered to, or to be taken by any person, any poison or other destructive thing, with the like intent, although no bodily injury be effected, is also a felony (s. 14). If any doubt formerly existed whether the external application of poisons, e. g., by wounds or ulcerated surfaces, would be included in the words " administering or taking," they are now entirely removed by the Criminal Law Consolidation Act (Aug. 1861). The 22d section specially applies to such an ofl'ence, and the 15th section provides that "Whosoever shall, by any means other than those specified in any of the pre- ceding sections of this act, attempt to commit murder, shall be guilty of felony." Mr. Greaves justly remarks, with regard to this important addition to the statute law, that " the malicious may now rest satisfied that every attempt to murder which their perverted ingenuity may devise, or their fiendish malignity suggest, will fall within some clause of this act, and may be visited with penal servi- tude for life." (" l^otes on Crim. Law Consolidation," p. 49.) Under section 22 of this statute, in reference to attempted poisoning, some offences are comprised, which formerly escaped punishment : " Whosoever shall unlawfully apply or administer to, or cause to be taken by, or attempt to apply or administer to, or attempt to cause to be administered to or taken by any person, any chloroform, lau- danum, or other stupefying or overpowering drug, matter, or thing, with intent, in any of such cases, thereby to enable himself or any other person to commit, or with intent, etc., to assist any other person in committing any indictable offence, shall be guilty of felony." A case under this section of the new statute was referred to me in September, 1863. A medical gentleman was charged with " attempting to cause to be administered" to an infant a poisonous dose of laudanum. It was stated by a woman who nursed the child that the accused delivered to her two bottles containing a brown liquid, labelled " one teaspoonful every three hours," and directed her to give it to the child. INone was given. Some months after the death of the child from natural causes, this charge was raised, and the bottles, still full of liquid, were produced as evidence against the accused. On analysis I found that the prescribed dose contained about five minims of laudanum, or nearly one-half grain of opium — a dose likely to prove fatal to an infant only a month old. Assuming the statement of the nurse who made the charge 6 82 LAW IN RELATION TO POISONS. to be true, the only inference to be drawn from the prescription of such a dose for an infant by a medical man, would be that he intended to destroy the life of the child. The charge fell to the ground, as clear proof was given that the woman who made it was not to be believed on her oath, and that it had originated in a desire to extort money. [The Revised Criminal Code of Pennsylvania, passed March 31, 1860, contains various provisions upon the subject of the use of poisons, which are substantially the same as the provisions of the English statutes mentioned in the text. (See §§ 81-83.) Section 70 forbids the sale of morphia, strychnia, arsenic, prussic acid, or corrosive sublimate, except upon the prescription of a physician or on the personal application of some respectable inhabitant of full age. In all cases, the word " poison" to be legibly marked on the label of the vessel in which it is contained. A memorandum of all sales other than under prescription of a physician to be kept in a register, with name and residence of purchaser, quantity sold, and date. Penalty for breach, a fine not exceeding $50. — P.] Poison is not always administered with intent to murder. Qn many occasions it has been mixed with food, and thus administered with a view to injure or annoy a person. Cantharides have been thus frequently given, and in one instance (Nov. 1859) eight mem- bers of a family suffered from severe symptoms of poisoning by reason of the wanton administration of this drug. In April, 1860, several members of a family suffered from severe sickness, as a result of tobacco having been put into water contained in a tea- kettle ; and tartar emetic has been in some cases dissolved in beer or other liquids as a mere frolic, without any proved or probable intention on the part of the offender to destroy life. The case of McMullen (Liverpool Autumn Assizes, 1856) revealed an extensive system of poisoning in the northern counties, in which tartar emetic Avas the substance employed. This drug, mixed with cream of tartar, was openly sold by druggists under the name of " quiet- ness powders," and the evidence established that women gave these powders to their husbands with a view to cure them of habits of drunkenness. Hitherto, when the intent of murder was not proved, the offender has escaped, although great bodily injury may have been done by his wanton or malicious act. Sections 23, 24, and 25 of Consolidation Act, c. 100, provide for this omission: — " 23. Whosoever shall unlawfully and maliciously administer to, or cause to be administered to or taken by any other person, any poison or othe?- destructive or noxious thing, so as thereby to endanger the life of such a person, or so as thereby to inflict upon such per- son any grievous bodily harm, shall be guilty of felony." " 24. "Whosoever shall unlawfully and maliciously administer to, or cause to be administered to or taken by any other person, any poison or other destructive or noxious thing, with intent to injure, aggrieve, or annoy such person, shall be guilty of a misdemeanor." " 25. If, upon the trial of any person charged with the felony above mentioned, the jury shall not be satisfied that such person is MECHANICAL IRRITANTS. 83 guilty thereof, but shall be satisfied that he is guilty of the misde- meanor above mentioned, then and in every other such case the jury may acquit the accused of such felony, and find him guilty of such misdemeanor." It will be perceived that the words of the statute leave the ques- tion " What is a poison ?" to depend upon the medical evidence adduced : and inorderto include all substances of an injurious nature, although they may not be strictly speaking poisons, the words " de- structive or noxious thing" are employed. Hence, on these occasions, a medical witness must be prepared to prove that the substance was either a poison or a destructive or noxious thing. In a trial which took place at the Essex Lent Assizes, 1850 {Beg. v. liai/ward), a woman was charged with administering white precipitate to her hus- band with intent to kill. She was acquitted on the ground that there was no evidence to show that white precipitate was either a poison or a destructive thing. It is, however, placed beyond doubt that this substance is not only capable of producing all the efliects of an irritant poison, but of destroying human life ; hence, this acquittal was based on a pure mistake. White hellebore. Lobelia in- flata., and Oil of turpentine have been erroneously pronounced not to be poisons under similar circumstances ; in fact, when this question is raised, unless the medical evidence received by a court be very closely investigated, great mistakes may arise, owing, perhaps to want of experience, or want of reflection on the part of those to whom the question is put. The quantity of a poisonous substance found in an article of food, or in a dead body, does not affect the culpability of a person indicted for administering it. In the case of Hartley (0. C. C. May 12, 1850), in which an attempt was made to administer sulphuric acid mixed with coffee, Cresswell J., stated — if poison be administered with intent to murder, it is not necessary there should be enough in the article administered to cause death. If any poison be there, and the intent be proved, the crime of attempting to administer poison is complete. Erie, J., ruled to the same effect, in reference to the discovery of a small quantity of arsenic in a dead body, in Heg. v. JBacon (Lincoln Summer Assizes, 1857). In Heg. v. Southgate (Chelmsford Lent Assizes), Parke B., said, in reply to an objection taken, it was quite immaterial to define or prove in what vehicle a poison was given, or whether it was administered in a solid or liquid state. Mechanical irritants. — The substance administered may not be a poison in the medical signification of the term, and it may not be popularly considered as such : yet, when taken, it may be noxious to health or destructive to life. We have examples of substances of this description iia iron-filings, powdered glass, sponge, pins and needles, and such like bodies, which have been administered with the wilful design of injuring, and have on various occasions given rise to criminal charges. In cases of this kind, the legal guilt of a prisoner may often depend on the meaning assigned by a medical witness to the words destructive thing. Thus, to take an example, Hi INFLUENCE OF HABIT ON POISONS. liquid mercury might be poured down the throat of an infant, with the deliberate intention to destroy it. A question of a purely medical nature will then arise whether mercury be a " destructive thing" or not ; and the conviction of a prisoner will probably depend on the answer. Should a difference of opinion exist, an occurrence by no means unusual in medical evidence, the prisoner will, accord- ing to the humane principle of our law, receive the benefit of the doubt. Influence of Habit on Poisons. — Habit, it is well known, diminishes the effects of certain poisons : thus it is that opium, when frequently taken by a person, loses its effects for a time, and requires to be administered, in a much larger dose. Indeed, confirmed opium- eaters have been enabled to take at once, a quantity of the drug which would have infallibly killed them, had they commenced with it in the first instance. Evan infants and children, who are well known to be especially susceptible of the effects of opium, and are liable to be poisoned by small doses, may, b^' the influence of habit, be brought to take the drug in very large quantities. This is well illustrated by a statement made by Mr. Grainger, in the " Report of the Children's Employment Commission." It appears that the system of drugging children with opium in the factory districts, commences as soon after birth as possible ; and the dose is gradually increased until the child takes from fifteen to twenty drops of laudanum at once ! This has the effect of throwing it into a leth- argic stupor. Healthy children of the same age would be killed by a dose of five drops. The same influence of habit is manifested more or less in the use of tobacco, alcohol, ether, chloroform, morphia, strychnia, and other alkaloids. Dr. Christison has remarked that this influence is chiefly confined to poisons derived from the organic kingdom : it is so limited with regard to mineral substances that it can scarcely be said to exist. It is stated on respectable authority that certain peasants in Styria are addicted to the practice of arsenic- eating, and that they carry it on for many years without suffering from the usual effects of this poison. Dr. Roscoe has published a case in which, according to information supplied to him, a Styrian peasant took in one day four grains and a half, and on the day fol- lowing five grains and a half of arsenic, crushing the mineral be- tween his teeth and swallowing it. The day after he had swallowed the second dose, the man left the place in his usual health and there is no further record of him. Dr. C. Maclagan states that he saw a Styrian peasant, set. 26, swallow between four and five grains of white arsenic in powder. In two hours, some urine which he passed contained arsenic. This man suffered no ill effects ; he stated that he had taken arsenic for a year and a half without any injury to his health. He took at first rather less than a grain every fortnight. In another case, a man, set. 46, swallowed six grains. In three quarters of an hour, it was found that arsenic was eliminated with the urine. ("Ed. Med. Journ.," Sept. 1864, p. 200.) Dr. Knapp informed Dr. Maclagan, that a man once took in his presence seven and a half grains of arsenic, and no injurious effects were produced. INFLUENCE OF IDIOSYNCRASY. 85 (" Ed. Med. Journ.," Jan. 1865, p. 669.) Such cases as these admit of no explanation on English experience. Hahit appears to have so little influence on arsenic, under the most careful medicinal use of it in this country, that I laelieve no medical practitioner has ever succeeded in causing a patient to take hoo grains at a dose, the smallest quantity yet known to have destroyed life. Mr. Hunt, who has had a large experience in the use of this mineral, fixes the maximum dose to be given with safety, at one grain. The following case, reported in the same journal (August, 1864, p. 116), by Dr. Parkes, of Halifax, shows the danger incurred by this practice. A man who had taken arsenic for a period of three or four years died under the usual symptoms of chronic poisoning. As far as it could be ascertained, the daily dose taken by deceased for the last five months of his life, was from two to three grains. From the beginning of the practice he had suffered from symptoms of poisoning with arsenic, which gradually assumed the form of arsenical cachexia ; but he referred the symptoms to other causes, and concealed the practice from his friends. His system never be- came habituated to the poison. This is a result which may be gen- erally expected. If the exceptional cases observed in Styria are supposed to prove that arsenic may be taken in large doses with impunity they would lead to error. Such cases have no practical bearing in legal medicine. If the practice of arsenic-eating pro- duces no symptoms, then no question of poisoning can arise. If, as in the above case, it does produce symptoms, then it falls within the range of ordinary experience. The alleged impunitj'^ of the Styrians, in the habitual use of arsenic, may be occasionally quoted to explain the detection of the poison in a dead body, or a motive for its purchase ; but no scien- tific witness who has seen anything of the operation of arsenic in this country can allow these statements to influence his opinion of its effects on human beings. Those who profess to believe in this practice, would be among the last to make a trial of it either on their own persons, or amon^ their friends. The only form in which I have known the question of habit to be seriously raised in medical jurisprudence is this: whether, while the more prominent effects of poison are thereby diminished, the insidious or latent effects on the constitution are at the same time counteracted. The answer is of some importance in relation to the subject of life insurance ; for the concealment of the practice of opium-eating by a person whose life was insured, has already given rise to an action, in which medical evidence on this subject was rendered necessary. As a general principle, we must admit that habit cannot altogether counteract the insidious effects of poisons; and that the practice of taking them is liable to give rise to disease or to impair the constitution. Influence of Idiosyncrasy. — Idiosyncrasy differs from habit: it does not, like habit,' diminish the efteet of a poison ; for it is not commonly found that any particular state of body is a safeguard against the effects of these powerful agents. Some constitutions 86 CLASSIFICATION OF POISONS. are observed to be much more affected than others by certain poisons: thus opium, arsenic, mercury, lead, and antimony are substances of this description, and this difference in their effect is ascribed to idiosyncrasy. Dr. Christison mentions a remarkable instance in which a gentleman unaccustomed to the use of opium, took nearly an ounce of laudanum without any effect. (" On Poisons," 33.) This form of idiosyncrasy is very rare. Certain substances generally reputed harmless, and indeed, used as articles of food, are observed to affect some persons like poisons. This is the case with pork, certain kinds of shell-fish and mushrooms. There may be nothing poisonous in the food itself; but it acts as a poison in particular constitutions — ^whether from its being in these cases a poison ^er se,'or rendered so by changes during the process of digestion, it is difficult to say. The subject of idiosyncrasy is of importance in a medico-legal view, when symptoms resembling those of poisoning follow a meal consisting of a particular kind of food. In such a case, without a knowledge of this peculiar condi- tion, we might hastily attribute to poison, effects which were really due to another cause. It would appear that in some instances idio- syncrasy may be acquii'ed— 2. e. a person who, at one period of his life, had been in the habit of partaking of a particular kind of food without injury, may find at another period that it will dis- agree with him. When pork has been disused as an article of diet for many years it cannot alwaj's be resumed with impunity. In cases in which the powers of life have become enfeebled 'by age, the susceptibility of the system to poisons is increased : thus aged persons may be killed by comparatively small doses of arsenic and opium. Cases of acquired idiosyncrasy are very rare : it appears to be, if we may so apply the term, a congenital condition. There are, however, certain diseases which appear to confer a power of supporting large and even poisonous doses of some substances. Very large doses of opium have been taken without producing dangerous symptoms by persons laboring under tetanus and hydro- phobia. This condition is called tolerance. It has been witnessed in diseases of the lungs in reference to the use of antimonial medicines. Classihcation or Poisons. — Poisons have been divided into three classes, according to their mode of action on the system ; namely, Irritants, Narcotics, and Narcotico-Irritants. This classification is a modification of that originally proposed by Orfila. The Nar- cotics and ISTarcotico-irritants may, however, be regarded as consti- tuting one large class — the Neurotics, as their special action is to affect directly one or more parts of the nervous system. The Neu- I'otic poisons admit of a subdivision into Cerebral, Spinal, and Cebro-spinal, according to whether the poisonous substance affects directly the brain, the spinal marrow, or both of these organs. Irritants. — The irritants are possessed of these common char- acters : When taken in ordinary doses, they occasion speedily violent vomiting and purging. The sj^mptoms are either accom- panied or followed by pain in the stomach and bowels. The pecu- NEUROTIC POISONS. 87 liar effects of the poison are manifested chiefly on these organs, which, as their name implies, they irritate and inflame. Many substances belonging to this class of poisons possess corrosive pro- perties ; such as the strong mineral acids, caustic alkalies, bromine, corrosive sublimate, and others. These, in the act of swallowing, are commonly accompanied by an acrid or burning taste, extending from the mouth down the gullet to the stomach. Some irritants do not possess any corrosive action — of which we have examples in arsenic, the poisonous salts of baryta, carbonate of lead and can- tharides ; these are often called pure irritants. They exert no destructive chemical action on the tissues with which they come in contact ; they simply irritate and inflame them. Difference, between Corrosive and Irritant Poisons. — -As a result of the action of corrosive poisons, symptoms are commonly manifested immediately, because mere contact produces the destruction of a part. In the action of the purely irritant poisons, the symptoms are generally more slowly manifested, rarelj'^ showing themselves until at least half an hour has elapsed from the time of swallowing the substance. Of course, there are exceptions to this remark ; for sometimes irritants act speedily, though rarely with the rapidity of corrosive poisons. It is important in a practical view, to ascertain whether, in an unknown case, the poison which a person, requiring immediate treatment, may have swallowed, is irritant or corrosive. This may be commonly determined by a knowledge of the time at which* the symptoms appeared after the suspected substance was taken. We may thus often easily distinguish betwe.en a case of poisoning from arsenic and one from corrosive sublimate. There is also another point which may be noticed. As the corrosive sub- stance exerts a decidedly chemical action, an examination of the mouth and throat may enable us in some cases to solve the question. It has already been stated that there are many irritant poisons which have no corrosive properties, but every corrosive may act as an irritant. Thus the action of corrosive sublimate is that of an irritant poison, as, while it destroys some parts of the coats of the stomach and intestines, it irritates and inflames others. So again most corrosive poisons may lose their corrosive properties by dilu- tion with water, and then they act simply as irritants. This is the case with the mineral acids and bromine. In some instances, it is not easy to say whether an irritant poison possesses corrosive pro- perties or not. Thus oxalic acid acts immediately, and blanches and softens the mucous membrane of the mouth and throat, but I have not met with any decided marks of chemical corrosion pro- duced by it in the stomach or viscera. Irritant poisons, for the most part, belong to the mineral kingdom ; and they may be divided into the Non-metallic and Metallic irritants. There are a few derived from the animal and vegetable kingdoms; but these, if we except cantharides, are not often employed criminally. Some of the gases likewise belong to the class of irritant poisons. ]!^EUROTics. — Neurotic poisons act upon the nervous system, and their operation is confined chiefly to the brain and spinal marrow. 88 NEUROTIC POISONS. Either immediately or some time after the poison has been swallowed, the patient suffers from headache, giddiness, numbness, paralysis, stupor, and in some instances, convulsions. They have not an acrid burning taste like the corrosive irritants; and they rarely give rise to vomiting or purging. "When these symptoms follow the ingestion of the poison into the stomach, the effect may be generally ascribed either to the form or quantity in which it has been taken, and the mechanical effect on the stomach thereby produced, or to the poison being combined with some irritating substance, such as alcohol. The pure narcotics, or Cerebral poisons, are not found to irritate or inflame the stomach and bowels. ISTotwithstanding the well-defined boundary thus apparently ex- isting between these two classes of poisons, it must not be supposed that the substances arranged in each class always act in the manner indicated. Some irritants have been observed to affect the brain or the spinal marrow, and this may be either a primary or a secondary consequence of their action. Arsenic and oxalic acid, although classed as irritants, have in some instances given rise to symptoms closely resembling those of narcotic poisoning, — namely, coma, pa- ralysis and tetanic convulsions. In a case of poisoning by arsenic, which occurred to Dr. Morehead, of Bombay, the symptoms of nar- cotism were so strongly marked, that it was believed at first the man had taken a narcotic. (" Med. Gaz." vol. 43, p. 1055.) I have met with a case of poisoning by arsenic in which there was paralysis of the limbs, with an entire absence of purging, during the eight days that the deceased survived. On the other hand, in a case of poison- ing by a large dose of opium, there was an absence of the usual symptoms of cerebral disturbance, and the presence of others resem- bling those of irritant poisoning — namely, pain and vomiting. Thus, then, we must not allow ourselves to be misled by the idea that the symptoms are always clearly indicative of the kind of poison taken. The narcotic or cerebral poisons ai-e few in number, and belong to the vegetable kingdom. Some of the poisonous gases possess a narcotic action. Narcotico-irritants. {Spinal and Cerebrospinal Foisons.) — Poisons belonging to this class have, as the name implies, a compound action. They are chiefly derived from the vegetable kingdom. At variable periods after they have been swallowed, they give rise to vomiting and purging, like irritants, and sooner or later produce stupor, coma, paralysis and convulsions, owing to their eftects on the brain and spinal marrow. In the state of vegetables, as leaves, seeds, or roots, they possess the property, like irritants, of irritating and inflaming the stomach and bowels. As familiar examples we may point to nux vomica, monkshood, hemlock and poisonous mushrooms. This class of 'poisons is very numerous, embracing a large variety of well-known vegetable substances ; but they rarely form a subject of difficulty to a medical practitioner. The fact of the symptoms occurring after a meal at which some suspicious vegetables may have been eaten, coupled with the nature of the symptoms themselves, will commonly indicate the class to which EVIDENCE OP POISONING IN THE LIVING. 89 the poison belongs. Some of these poisons have a hot acrid taste ; others, like aconite or monkshood, produce a sense of numbness or tingling, while others again have an intensely bitter taste, as nux vomica, strychnia, veratria and picrotoxia. Strychnia may be regarded as a pure spinal poison. CHAPTEE V. EVIDENCE OF POISONING IN THE LIVING BODY. — ACTION OP POISONS IN- CREASED OR DIMINISHED BY DISEASE. — SYMPTOMS CONNECTED WITH FOOD OR MEDICINE. — SEVERAL PERSONS ATTACKED SIMULTANEOUSLY. — EVIDENCE FROM THE DETECTION OF POISON IN THE FOOD, ETC. "We now proceed to consider the evidence of poisoning in the liv- ing body. To the practitioner, the diagnosis of a case of poisoning is of great importance, as by mistaking the symptoms produced by a poison for those arising from natural disease, he may omit to employ the remedial measures which have been found efficacious in counteracting its effects, and thus lead to the certain death of the patient. To a medical jurist, a correct knowledge of the symptoms furnishes the chief evidence of poisoning, in those cases in which persons ai-e charged with the malicious and unlawful administration of poison. The symptoms produced during life, constitute also an important part of the evidence in those instances in which a poison proves fatal. At present, however, we will suppose the case to be, that poison has been taken, and the patient survives. Most toxico- logical writei-s have laid down certain characters whereby it is said symptoms of poisoning may be distinguished from those of disease. 1. Ill poisoning, the symptoms appear suddenly, while the individual is in health. — It is the common character of most poisons, when taken in the large doses in which they are usually administered with criminal intent, to produce serious symptoms, either immedi- ately or within a very short period after they have been swallowed. Their operation, under such circumstances, cannot be suspended, and then manifest itself after an indefinite interval ; although this was formerly a matter of universal belief, and gave rise to many absurd accounts of what was termed slow poisoning. The symptoms of poisoning by nicotina, prussic acid, oxalic acid, or the salts of strychnia, appear immediately, or generally within a very few minutes after the poison has been swallowed. In an exceptional case, in which the dose of prussic acid was small, and insufficient to pi-oduce death, the poison was supposed by the patient not to have begun to act until after the lapse of fifteen minutes. ("Ed. Med. and Surg. Journ." vol. 59, p. 72.) The symptoms caused by arsenic and other irritants, and, indeed, by all poisons generally, are commonly manifested in from half an 90 INFLUENCE OF DISEASE. hour to an hour. It is rare that the appearance of symptoms is protracted for two hours, except under certain peculiar states of the system. It is said that some narcotic poisons, such as the poi- sonous mushrooms, may remain in the stomach twelve or twenty- four hours without giving rise to symptoms ; and this is also affirmed to be the case with some animal irritants, such as decayed meat ; but with regard to the first point, it has been shown by Dr. Peddie that mushrooms have produced symptoms in half an hour ; and a ease has fallen under my own observation, in which the symptoms from noxious animal food came on within as short a time after the meal, as is commonly observed in irritant poisoning by mineral substances. In some cases of poisoning by phosphorus, DO symptoms have occurred until after the lapse of several hours. Influence of Disease. — A diseased state of the body may render a person comparatively unsusceptible of the action of certain poisons, while in other instances it may increase their action, and render them fatal in small doses. In dysentery and tetanus a person may take, without being materially afiected, a quantity of opium suffi- cient to kill an adult in average health. In mania, cholera, hysteria, and delirium tremens, large doses of opium may be borne with comparative impunity (p. 86). In a case of hemiplegia, a woman ist. 29, took for six days, three grains of strychnia daily without injurious consequences — the dose having been gradually raised (" G-az. Med." Mai, 1845) ; — while one grain of strychnia is commonly regarded as a fatal dose to a healthy adult. In a case of tetanus, Dupuytren gave as much as two ounces of opium at a dose (60 grammes), without serious consequences. '(I^landin " Traite des Poisons," vol. 1, p. 231.) It has also been remarked that per- sons affected with tetanus are not easily salivated by mercury. The morbid state appears to create the power of resisting the ordinary effects of poisons. ("Colles's Lectures," vol. 1, p. 77.) The effiect of certain diseases of the nervous system, as well as of habit,'either in retarding the appearance of symptoms, or in blunt- ing the operations of a poison, it is not difficult to appreciate ; they are cases which can present no practical difl3.culty to a medical jurist. On the other hand, in certain diseased states of the system, there may be an increased susceptibility of the action of poison. Thus, in those persons who have a disposition to apoplexy, a small dose of opium may act more quickly and prove fatal. In a person laboring under inflammation of the stomach or bowels, there would be an increased susceptibility of the effects of arsenic, antimony, or other irritants. In debility from any cause these mineral sub- stances would also act injuriously even in ordinary doses. Anti- mony is a most powerful depressant, and might, by its effect on the heart, cause death by syncope. The influence of disease in increasing the operation of poison, has been noticed in cases of diseased kidney (granular degenera- tion), in which small doses of mercury have produced severe sali- vation, leading to exhaustion and death. In diseases of the lungs afffecting aged persons, opium in medicinal doses, has been observed SYMPTOMS APPEARING DURING HEALTH. 91 to exert a poisonous action. The effect of the drug appears to be intensified by the disease. This observation applies equally to morphia. Chloroform vapor in ordinary quantity has been found to produce fatal effects, in cases in which there was latent disease of the heart, or of the coronary arteries of this organ. A fatty condition of the musc\ilar tissue leading to great feebleness of the heart's action, appears to be highly favorable to death by syncope, under the use of chloroform. A knowledge of these facts is of importance in reference to charges of malapraxis when death has arisen from ordinai-y or extraordinary doses of medicines, administered to persons laboring under disease. In sucb cases, another mode of treatment should be substituted, or a smaller dose than usual given, and its effects carefully watched. In some instances, however, full and large doses of powerful drugs have been recklessly given, and when a fatal result has followed, there has been a strong disposition to refer death to the supposed disease, of which, however, sometimes no trace could be found in the body. An experienced physician, well acquainted with pathological anatomy, informs me that since the use of chloroform has become general, and deaths under its use are not unfrequent, a fattiness and flabbiness of the muscular structure of the heart has been sought for and almost universally found ! The fatal result has not been attributed to its real cause, the imprudent or careless administration of chloroform, but to some minute structural changes revealed by the microscope in the substance of the organ. Symptoms appear during^ a state of health. — Symptoms of poisoning may manifest themselves in a person while in a state o£ perfect health, without any apparent cause. This rule is, of course open to nume- rous exceptions, because the person on whose life an attempt has been made, may be actually laboring under disease; and under these circumstances the symptoms may be so obscure as to disarm all suspicion. When poison is secretly exhibited in medicine, a practitioner is very liable to be deceived, especially if the disease under which the person is laboring is of an acute nature, and is attended by symptoms of disorder in the alimentary canal. Several cases of poisoning have occurred in which arsenic was criminally substituted for medicine, and given to the parties while laboring under a disorder of the bowels. We are, however, justified in saying, with respect to this character of poisoning, that when in a pi'eviously healthy person, violent vomiting and purging occur suddenly and without any assignable cause, such as pregnancy, disease, or indiscretion in diet, to account for them, there is strong reason to suspect that irritant poison has been taken. When the person is already laboring under disease, we must be especially watchful on the occurrence of any sudden change in the character or violence of the symptoms, unless such change can be easily accounted for on common or well-known medical principles. In most cases of criminal poisoning, we meet with alarming symptoms without any obvious or sufficient natural causes to explain them. 92 EVIDENCE OP POISONING. The practitioner will, of course, be aware that there are certain diseases which are liable to occar suddenly in healthy people, the exact cause of which may not at first sight be apparent ; therefore this criterion is only one out of many on which a medical opinion should be founded. 2. In poisoning the symptoms appear soon after a meal, or soon after some kind of food or medicine has been taken. — This is by far the most important character of poisoning in the living body. It has been already stated that most poisons begin to operate within an hour after they have been swallowed ; and although there are few excep- tions to this remark, yet they occur under circumstances easily to be appreciated by a practitioner. Thus, then, it follows that, sup- posing the symptoms under which a person is laboring, to depend on poison, the substance has most probably been swallowed, either in food or medicine, from half an hour to an hour previously. It must be observed, however, that causes may occur in which the poison has not been introduced by the mouth. Oil of vitriol and other corrosive liquids have been thrown up the rectum in injec- tions, and have thus caused death ; the external application of arsenic, corrosive sublimate and cantharides to ulcerated surfaces has destroyed life. In one case, arsenic was introduced into the vagina of a female, and she died in five days under all the symp- toms of arsenical poisoning. (Schneider, " Ann. der. ges. Staatsarz- neikunde," i. 299.) Such cases ar,e rare, but, nevertheless, the certainty that they have occurred, where their occurrence could hardly have been anticipated, shows that in a suspicious case a practitioner should not deny the fact of poisoning, merely because it may be proved that the person could not have taken the poison in the usual way, by the mouth. Again, persons may be destroyed by the vapors of ether, chloroform, prussic acid, or other powerful volatile poisons, introduced into the body through the lungs. Such a mode of suicide, or murder, might disarm suspicion, from the fact of no noxious material being found in the stomach. Let us suppose, however, the circumstances to have been such that these secret means of destruction could not have been resorted to, and that the poison is one of those most commonly selected by a murderer, such as arsenic, tartar emetic, oxalic acid, or corrosive sublimate, then we may expect that this character of poisoning will be made evident to us, and that something must have been swal- lowed by the patient shortly before the alarming symptoms appeared. By observations attentively made, it may be in our power to con- nect the appearance of the symptoms with the use of a particular article of food, and thus indirectly lead to the detection of a crim- inal. Supposing that many hours have passed since food or medicine was taken by the patient, without any effect ensuing— it is probable that the symptoms are due to natural causes, and not to poison. When symptoms resembling those of poisoning speedily follow the ingestion of food or medicine, there is, however, reasonable ground for suspicion ; but caution should be observed in drawing TIME OF OOOUERENCE OF SYMPTOMS. 93 inferences, since the most extraordinary coincidences sometimes present themselves. In the case of Sir Theodosius Boughton, who ■was poisoned by his brother-in-law Donellan, in 1781, the fact of alarming symptoms coming on in two minutes after the deceased had swallowed what was supposed to be a simple medical draught, was a most important part of the evidence against the prisoner. There is no doubt that laurel-water had been substituted for the medicine by the prisoner, and that this had caused the symptoms which preceded death. The practice of substituting poisonous mixtures for medical draughts or' powders is by no means unusual, although it might be supposed to indicate a degree of refinement and knoAvledge not commonly to be found among criminals. Medical practitioners are thus apt to be imposed upon, and the fol- lowing case, related by a deceased judge, will serve as a caution : An apothecary prepared a draught, into which another person put poison, intending thereby to destroy the life of the patient for whom the medicine was prescribed. The patient, not liking the taste of the draught, and thinking there was something suspicious about it, sent it back to the apothecary, who, knowing the ingredi- ents of which he had composed it, and wishing to prove to his patient that he had done nothing wrong, drank it himself, and died from the efteets. He was thus the unconscious agent of his own death ; and although the draught was intended for another, the party who poisoned it was held guilty of murder. This case contains a warning to medical witnesses. It is not unusual, on trials for poisoning, when the poison is conveyed through medicine, to find a medical witness offering to swallow his own draught in a court of law, in order to furnish a convincing practical illustra- tion of the innocence of the inedicine ! It need hardly be observed that an exhibition of this kind is never required of a medical wit- ness. If any doubt be raised of the innocent properties of a draught or powder, a chemical analysis of its contents will be far more satisfactory, and attended with no kind of risk to the practitioner. On the other hand, the occurrence of symptoms resembling those produced by poisoning, soon after food or medicine has been taken, may be a pure coincidence. In such a case, poison is always sus- pected by the vulgar ; and it will be the duty of a medical jurist to guard against the encouragement of such a suspicion, until he has strong gi'ounds to believe it to be well founded. ISTo public retrac- tation or apology can ever make amends for the injury which may in this way be inflicted on the reputation of another ; for those who hear the accusation may never hear the defence. In all such cases, a practitioner may entertain a suspicion, but, until confirmed by facts, he should avoid expressing it, or giving it publicity. When death is not a consequence, it is difficult to clear up such cases, except by the aid of a chemical analysis ; but this, as we know, is not always applicable. If death ensue, the real cause is usually apparent, and a suspicion of poisoning is thus often removed by an examination of the body. 94 EVIDENCE or POISONING FROM SYMPTOMS, 3. In poisoning, when several partake at the same time of the same food or medicine {mixed with poison) all suffer from similar symptoms. ■ — This character of poisoning cannot always be procured: but it furnishes good evidence of the fact when it exists. Thus, suppos- ing that after a meal made by several persons from the same dish, only one sufters, the suspicion of poisoning is considerably weakened. The poisoned article of food, may be detected by observing whether they who suffer under any symptoms of poisoning have partaken of one particular solid or liquid in common. In a case of accidental poisoning at a dinner-party, a medical man who was present ob- served that those who suffered had taken port-wine only ; the con- tents of the bottle were examined, and found to be a saturated solution of arsenic in wine. In general, considerable reliance may be placed upon this character, because it is improbable that any common cause of disease should suddenly attack with violent symp- toms of a similar character, many healthy persons at the same time, and within a short period after having partaken of food together. We must beware of supposing that, when poison is really present, all will be attacked with precisely similar symptoms ; because there are many circumstances which may modify their nature and pro- gress. In general, that person who has partaken most freely of the poisoned dish will suffer most severely ; but even this does not always follow. There is a well-known case, recorded by Bonnet, where, among several persons who partook of a dish poisoned with arsenic, they who had eaten little and did not vomit, speedily died ; while others, who had partaken largely of the dish, and had in conse- quence vomited freely, recovered. It was just now remarked, that there was no disease resembling poisoning which is likely to attack several healthy persons at the same time and in the same manner. This is undoubtedly true as a general principle, but the following case will show that mistakes may occasionally arise even under these circumstances. It occurred in London during the prevalence of the malignant cholera in 1832. Four of the members of a family, living in a state of great domes- tic unhappiness, sat down to dinner in apparently good health : some time after the meal, the father, mother and daughter were suddenly seized with violent vomiting and purging. The evacua- tions were tinged with blood, while the blueness of the skin, ob- served in cases of malignant cholera, was absent. Two of these persons died. The son, who was known to have borne ill-will against his father and mother, and who suffered no symptoms on this occasion, was accused of having poisoned them. At the in- quest, however, it was clearly shown by the medical attendant, that the diseased persons had really died of malignant cholera, and there was no reason to suspect that any poison had been adminis- tered to them. In this instance, it will be perceived that symptoms resembling those of irritant poison, appeared suddenly in several individuals in perfect health, and shortly after a meal. We hereby learn that the utility of any rules for investigating cases of poison- DISCOVERY OF POISON IN FOOD, ETC. 95 ing, depends entirely on the judgment and discretion with which thej' are applied to particular cases. It is well to bear in mind, in conducting these inquiries, that symptoms resembling those produced by irritant poison, may be sometimes traced to food. Meat, rendered unwholesome by disease or decay, pork, bacon, sausages, cheese and bread, as well as certain kinds of shell-fish, may ^ive rise to symptoms of poisoning, and even cause death. Such cases maj' be regarded as poisoning by animal or vegetable irritants. All the characters above described as indicative of poisoning, may be observed, and the difficulty of forming an opinion is often increased by the fact that some of the persons attacked, may have previously partaken of the same kind of food without inconvenience. ■4. The discovery of poison in the food taken, or in the matters vomited. — One of the strongest proofs of poisoning in the living subject, is the detection of poison by chemical analysis, or, if of a vegetable nature, b}'^ a microscopical examination, either in the. food taken by the person laboring under its effects, or in the matters vomited, or, after the lapse of a few hours, in the urine. The evidence is of course more satisfactory when the poison is detected in the matters vomited, or in the urine, than in the food ; because this will show that it has really been taken, and it will readily account for the symptoms. If the vomited matters have been thrown away, we must examine the food of which the patient may have partaken. Should the results in both cases be negative, and no trace of poison be found in the urine, it is probable that the symptoms w^ere due to disease. [On no account should a chemical examination of the food, vomited matters and urine be neglected, as without it, the evidence of poison is altogether inconclusive.^R.] In investigating a case of poisoning in a living subject, a medi- cal jurist must remember, that poisoning is sometimes /ej^/iei^, and at others imputed. It is easy for an artful person to put poison into food, as well as to introduce it into the matters vomited or dis- charged from the bowels, and to accuse another of having adminis- tered it. There are few of these accusers who go so far as to swal- low poison under such circumstances, as there is a great dread of poisonous substances among this class of criminals ; and it will be at once apparent, that it would require a person well versed in tox- icology, to feign a series of symptoms which would impose upon a practitioner at all acquainted with the subject. In short, the difliculty reduces itself to this : "What inference can be drawn from a chemical detection of poison in food ? All that a medical man can say is, whether poison is or is not present in a particular article of food : he must leave it to the authorities of the law to develop the alleged attempt at administration. If the poison has been actually administered or taken, then we should expect to find that the person had suffered from the usual symptoms. The absence of these symptoms would be a strong fact against the alleged admin- istration. The detection of poison in the matters vomited, affords 96 FEIGNED AND IMPUTED POISONING. no decisive proof that it has been swallowed, except under two circumstances: 1. When the accuser has previously labored under the usual symptoms of poisoning, in which case there can be no feigning, and the question of imputation is a matter to be estab- lished by general evidence. 2. "When the matters are actually vomited into a dean vessel, in the presence of the medical attendant himself, or of some person on whose testimony perfect reliance can be placed. The detection of absorbed poison in the urine fur- nishes a clear proof that poison has been taken, that it has passed into the blood, and has been subsequently eliminated. When a medical man is called to a case of suspected poisoning, it is necessary that he should know to what points he ought to give his attention. It is very proper that every effort should be made by him to save life when the individual is living : but while en- gaged in one duty, it is also in his power to perform another (sup- posing the case to be one of suspected criminal poisoning), namely, to note down many circumstances which may tend to detect the perpetrator of a crime. There is no person so well fitted to ob- serve these points as a medica^ man ; but it unfortunately happens, that many facts important as evidence are often overlooked. The necessity for observing and recording them is not perhaps generally known. A medical man need not make himself officious on such occasions, but he would be unmindful of his duty as a member of society, if he did not aid the cause of justice by extending his scientific knowledge to the detection of crime. It is much to the credit of the medical profession, that the crime of murder by poi- soning — a form of death from which no caution or foresight can protect a person, is so frequently brought to light, by the announce- ment of suspicious facts of a medical nature to magistrates and coroners ; and on several occasions the highest compliments have been passed by judges on medical men who have been thus indi- rectly the means of bringing atrocious criminals to the bar of justice. The following appear to me to be the principal points which demand the attention of a medical jurjst in all cases of suspected poisoning : 1. With respect to Symptoms. — 1. The time of their occurrence — their nature. 2. The exact period at which they were observed to take place after a meal, or after food or medicine had been taken. 3. The order of their occurrence. 4. Whether there was any remission or inter- mission in their progress, or, whether they continued to become more and more aggravated until death. 5. Whether the patient had labored under any previous illness. 6. Whether the symptoms were observed to recur more violently after a particular meal, or after any particular kind of food or medicine. 7. Whether the patient has vomited : — the vomited matters, if any (especially those first ejected), should be procured : their odor, color, and acid or alkaline reaction noted, as well as their quantity. 8. If none be procurable, and the vomiting has taken place on the dress, furniture, or floor of the room — then a portion of the clothing, sheet, or carpet, CONSIDERATIONS IN SUSPECTED POISONING. 97 may be cut out and reserved for analysis : — if the vomiting has occurred on a deal floor, a portion of the wood may be scraped or cut put : — or if on a stone pavement, then a clean sponge soaked in distilled water may be used to remove any traces of the substance. The vessel in which vomited matters have been contained will often furnish valuable evidence, since heavy mineral poisons fall to the bottom, or adhere to the sides. 9. Endeavor to ascertain the probable nature of the food or medicine last taken, and the exact time at which it was taken. 10. Ascertain the nature of all the different articles of food used at a meal. 11. Any suspected articles of food, as well as the vomited matters, should be sealed up as soon as possible in clean glass vessels, labelled, and reserved for analysis. 12. Note down in their own words, all explanations voluntarily made by persons present, or who are supposed to be concerned in the suspected poisoning. 13. Whether more than one person partook of the food or medicine : — if so, whether all these persons were affected, and how ? 14. Whether the same kind of food or medicine had been taken before by the patient or other persons, without ill effects following. [As has been shown by the author, it is not possible from the symptoms alone to do more than merely infer the probability of a poison, inasmuch as there is no poison that possesses absolutely characteristic symptoms ; (if so, there would be no necessity for a chemical analysis.) The great uncertainty on this point should suggest extreme caution to " experts" in testifying to the presence of poison from the symptoms alone. In the late (second) trial of Mrs. Wharton, 1873, at Annapolis, on the charge of attempting to poison Eugene Van Ness, the State's medical witnesses under- took to testify to the presence of tartar-emetic, among the various alleged poisons, merely from certain symptoms — nausea, vomiting and general debility — which were quite the reverse of the symp- toms that these same " experts," along with others, swore to in the former Wharton trial, as constituting a main ground for their opinion as to the presence of antimony in the stomach of Gren. Ketchum ! In this second case, all the symptoms were shown by the defence to be logically ascribable to disease. Moreover, no antidotes were administered, and no means employed to get rid of the alleged poison ; no examination was made of the suspected food or drinks, and no search for it either in the vomited matters, or in the urine ! — R.] 98 EVIDENCE OF POISONING IN THE DEAD BODY. CHAPTER VI. ON THE EVIDENCE OP POISONING IN THE DEAD BODY. — PERIOD AT WHICH POISONS PROVE FATAL. — CHRONIC POISONING. — APPEARANCE PRODUCED BY THE DIFFERENT CLASSES OF POISONS. — REDNESS OF THE MUCOUS MEMBRANE MISTAKEN FOR INFLAMMATION. — ULCERATION AND COR- ROSION.— SOFTENING. — PERFORATION OF THE STOMACH FROM POISON AND DISEASE. Supposing that the person is dead, and we are required to deter- mine whether the case is one of poisoning or not, we must, in the first instance, endeavor to ascertain all the particulars which have been considered in the last chapter, as indicative of poisoning in the living body. Should the deceased have died from poison, the circumstances of the attack, and the symptoms preceding death ought to correspond with the characters already described ; and in these investigations, it ,is well to bear in mind the following rule : There is no one symptom or pathological condition which is pecu- liar to poisoning; but at the same time there is probably no disease which presents aU those characters which are met with in a special case of poisoning. The additional evidence to be derived from the death of a person, may be considered under the following heads : — 1. The time at which death takes 'place after the first occurrence of symptoms. — This question requires examination, because the more common poisons, when taken in fatal doses, generally cause death within definite periods of time. By an attention to this point, we may, in some instances, be enabled to negative a charge of poison- ing, and in others to form an opinion of the kind of poison which has been taken. In a court of law, a medical practitioner is often required to state the usual period of time within which poisons prove fatal. It is to be observed that, not only do poisons differ from each other in this respect, but the same substance, according to the form or quantity in which it has been taken, may differ in the rapidity of its action. A large dose of prussic acid, i. e. from half an ounce to an ounce, may destroy life in less than two minutes. In ordinary cases of poisoning by this substance a person dies, i, e. all signs of life have commonly ceased, in from ten to twenty minutes : if he survives half an hour, there is some hope of re- covery. In the cases of seven epileptics, accidentally poisoned by a similar dose of this acid in one of the Parisian hospitals, the first died in about twenty minutes, the seventh survived three-quarters of an hour. Oxalic acid, one of the most energetic of the common poisons, when taken in a dose of from half an ounce to an ounce, may destroy life in from ten minutes to an hour: if the poison is TIME IN WHICH POISONS PEOVE FATAL. 99 not perfectly dissolved when swallowed, it is a longer time iu proving fatal. The strong mineral acids, in poisonous doses, des- troy life in about eighteen or twenty-four hours. Arsenic, under the form of arsenious acid (white arsenic), operates fatally in from eighteen hours to three or four days. ' It has, however, in more than one instance, killed a person in two hours. Opium, either as a solid or under the form of laudanum, commonly proves fatal in from six to twelve hours ; but it has been known, in several in- stances, to destroy life in less than three hours : they who survive the effects of this poison for twelve hours, are considered to have a fair chance of recovery. This must be understood to be merely a statement of the average results, as nearly as we are warranted in giving an opinion ; but the medical jurist will of course be aware that the fatal period may be protracted or shortened, according to all those circumstances which have been elsewhere stated to affect the actions of poisons. There are various forms which this question may assume. It may be said that the death of a person, alleged to have taken poison, has occurred either too rapidly or too slowly to justify a suspicion of poisoning. The following case will serve as an illustration : A Avoman of the name of Russell vsras tried and convicted at the Lewes Summer Assizes, in 1826, for the murder of her husband, by poison- ing him with arsenic. The poison was detected in the stomach ; but the fact of poisoning was disputed by some medical witnesses, for this among other reasons, that the deceased had died three hours after the only meal at which the poison cquld have been adminis- tered to him. The authority of Sir A. Cooper and others was cited to show that, according to their experience, they had never known a case of poisoning by arsenic to have proved fatal in less than seven hours. This nxixy be admitted, but, at the same time, there was suffi- cient authority on the other side to establish that some cases had actually proved fatal in three or four hours. So far as this objec- tion was concerned, the prisoner was properly convicted. In refer- ence to the medical question raised at this trial, I may observe that two distinct cases have since occurred in which the individuals- died certainly within tivo hours after taking arsenic ; and several instances have been reported, in which death has taken place in from three to four hours after the administration of this poison. It seems extraordinary in the present day, that any attempt should have been made by a professional man to negative a charge of criminal poisoning upon so weak a ground as this ; but this opinion was expressed many years ago, when the facts connected with poison- ing were but little known. It is quite obvious that there is nothing,, so far as we know, to prevent arsenic from destroying life in an hour, or even within a shorter period. A case will be hereafter related, in which death took place from arsenic probably within twenty minutes. These matters can be settled only by a careful observation of numerous cases, and not by any d priori reasoning,, or by a limited individual experience. In all instances of sudden death there is generally a strong ten- 100 SLOW OR CHEONIC POISONING. dency on the part of the public to suspect poisoniug. They never can be brought to consider that persons may die a natural death suddenly, as well as slowly ; or, as we shall presently see, that death may really take place slowly, and yet be due to poison. This pre- judice continually gives rise to the most unfounded suspicions of poisoning, and, at the same time, leads to cases of chronic or slow poison being frequently mistaken for natural disease. One of the means recommended for distinguishing narcotic poisoning from apoplexy or disease of the heart, is the diflerence in the rapidity with which death takes place. Thus, apoplexy or disease of the heart may prove fatal either instantly, or within an hour. The only poisons likely to operate with such fatal rapidity are prussic acid or nicotina. Poisoning by opium is commonly protracted for Mve or six hours. This poison has never been known to destroy life instantaneously, or within a few minutes. Thus, then, it may happen that death will occur with such rapidity as to render it im- possible, under the circumstances, to attribute it to narcotic poison. Chronic poisoning. — When a poison destroys life rapidly, it is called a case of acute poisoning, to distinguish it from the chronic form, i. e., in which death takes place slowly. Chronic poisoning is a subject which has of late frequently required medico-legal in- vestigation. Most poisons, when their effects are not rapidly mani- fested, owing either to the smallness of the dose or to timely treat- ment, are capable of slowly undermining the powers of life, and killing the j)atient by producing emaciation and exhaustion. This is sometimes observed in the action of arsenic, corrosive sublimate, and tartarized antimony, but it has been remarked also in cases of poisoning by the mineral acids and caustic alkalies. Death is here an indirect consequence: in poisoning by the acids or alkalies, either stricture of the gullet is induced, or the lining. membrane of the stomach is destroyed, and the process of digestion impaired, a condition which leads to exhaustion and death. The time at which these indirect effects may prove fatal, is of course liable to vary. A person has been known to die from a stricture of the gullet, brought on by sulphuric acid, eleven months after the poison was swallowed ; and there is no reason to doubt that instances may occur of a still more protracted nature. In cases of chrOnic poison- ing there is sometimes great difficulty in assigning death exclu- sively to the original action of the poison, since the habits of life of the person, a tendency to disease, and other circumstances, may have occurred either to accelerate or produce a fatal result. To connect a stricture of the gullet proving fatal, with the effects of poisoning by a mineral acid, it would be necessary to show that there was no tendency to this disease before the acid was admin- istered ; that the symptoms appeared soon after the first effects of the poison went off; that these symptoms continued to become aggravated until the time of death ; and lastly that there was no other cause to which death could with any probability be referred. Th«se remarks apply equally to the secondary fatal effects of any poison-, such, for instance, as the salivation occasionally induced by EVIDEiSrCE FROM APPEARANCES AFTER DEATH. lOi corrosive sublimate, and the exhaustion and depression which are caused by tartarized antimony, when the acute symptoms of poison- ing by these substances have passed away. The characters of chronic poisoning have of late years acquired a special interest for the medical jurist. There is a difficulty about them which no accuracy of observation or judgment can surmount. The poison or poisons, if found in the dead body at all, must neces- sarily exist in fractional parts of a grain. This alone will be suffi- cient to create a doubt whether death has been caused by the poison, although it is quite consistent with medical experience that a person may die from chronic poisoning, and little or none of the poison be found in the body after death. In the case of Mrs. James {Reg. v. WmsZow), not more than the tenth part of a grain was found in the whole of the tissues of the body ; in the case of Isabella Banks {JReg. V. Smethurst), the quantity was greater than this, but less than a grain altogether ; while in the case of Mrs. Peters, of Yeovil, examined by Mr. Heripath, none was found in the body, although this chemist had extracted a quantity of antimony as sulphide from the urine of deceased, in less than nine days before death. In this case Dr. Garland had also found antimony in the evacuations during life, and had referred the intermittent irritation of the stomach and bowels, from which deceased had suffered, to the secret use of this mineral. The jury returned a verdict that deceased had died from disease, and that death was accelerated by some irritant. (" Lancet," August 4th, 1860, p. 119.) On some recent trials for poisoning {Beg. v. William Palmer, C. C. C. 1856), it has been a contested scientiiic question, whether a person can die from poison and no trace of the poison remain in the body. Mr. Herapath's evidence in Mrs. Peters' case not only now proves the affirmative, but goes to show that antimony may act fatally and be entirely eliminated from the system in about a week. (" Med. Times and Gaz.," Aug. 25, Sep. 12, and 29, 1860, pp. 190, 271, 317.) 2. Evidence from appearances in the body. — One of the chief means of determining whether a person had died from poison, is an examination of the body after death. In relation to external appearances, there are none indicative of poisoning upon which we can safely rely. It was formerly supposed that the bodies of persons who were poisoned, putrified more rapidly than those of others who had died from natural disease ; and evidence for or against poisoning was at one time derived from the external appearance of the body. This is now known to be an error ; the bodies of persons poisoned are not more rapidly decomposed cceteris paribus, than those of others who have died a sudden and violent death from any cause whatever. Irritant poisons act chiefly upon the stomach and intestines, which they irritate, inflame and corrode. We may likewise meet with all the consequences of inflammation, such as softening, thickening, ulceration, perforation, or gangrene. Sometimes the coats of the viscera are thickened, at other times thinned and softened, by the action of an irritant. 102 EEDNESS OF THE MUCOUS MEMBBANE. Neurotic {Cerebral and /S^jmaQ poisons do not commonly leave any well-toarked appearances in the body. The. stomach and intestines present no unnatural changes. There may be greater or less fulness of the vessels of the brain and spinal marrow, as well as of their membranes ; but even this is often so slight as to escape notice, unless attention be particularly directed to these organs. Eft'usion of blood is rarely found. The Narcotico-irritants or Cerebrospinal poisons may affect either the brain, or the stomach and bowels, and commonly all these parts according to their peculiar mode of action. It is important to bear in mind, that both Irrritants and Neurotics may destroy life without leaving any appreciable changes in the body. To such cases as these, the remarks about to be made do not apply. The proofs of poisoning must, in such exceptional cases, be procured entirely from other sources. Any evidence derivable from the appearances in the body of a person poisoned, will be imperfect unless we are able to distinguish them from those analogous changes often met with as the results of ordinary disease. These are confined to the mucous membrane of the stomach and bowels. They are redness, ulceration, softening and perforation. Each of these conditions may depend upon disease, as well as upon the action of irritant poisons. Itedness. — It is a main character of the irritants to produce, as a result of inflammation, redness of the mucous or lining membrane of the stomach and small intestines. This redness, when first seen, is usually of a deep crimson color, becoming brighter by exposure to air. It may be diffused over the whole mucous membrane ; at other times it is seen in patches, dots, or lines (strise), spread irrfegu- larly over the surface of the stomach. It is sometimes met with at the smaller, but more commonly at the larger end of this organ, and again we occasionally find the folds or prominences only of the mucous membrane presenting this red or inflamed appearance. Redness of the mucous membrane may, however, be due to gastritis or gastroenteritis as a result of disease ; and in order to assign the true cause of the inflammation, it will be necessary to have an account of the symptoms preceding death, or sorqe chemical proofs of the existence of irritant poison in the contents of the stomach or in the tissues of the body. In the healthy state, the mucous membrane of the stomach is pale and white, or nearly so, except during digestion, when it is slightly reddened ; and some observers have remarked that a slight redness has often remained in the stomachs of those who have died during the performance of the digestive process. When in contact with the spleen or liver, after death, the stomach is apt to acquire a deep livid color from the transudation of blood; and it is well known that the bowels acquire a somewhat similar color from the gravitation of blood which always takes place after death. None of these appearances are likely to be mistaken for the action of an irritant poison. There is an important class of cases in which redness of the mu- ULCERATION OF THE STOMACH. 103 ecus membrane of the stomach is found after death, not dependent on the action of poison, or any easily assignable cause. These cases, owing to their being so little known, and involved in much ob- scurity, deserve the attention of a medical jurist, since the appear- ances closely resemble those produced by irritant poison. A person may die without suflFering from any symptoms of disordered stomach ; but on an inspection of the body, a general redness of the mucous membrane of this organ will be found, not distinguish- able from the redness which is so commonly seen in arsenical poisoning. Several cases of this kind have occurred at Gruy's Hos- pital: and drawings which have been made of the appearance presented by the stomach, are preserved in the Museum collection. Great dispute has arisen respecting the length of time during which redness of the stomach produced by an irritant will be re- cognizable and easily distinguishable from putrefactive changes. It is sufficient to say, that no certain rule can be laid down on the subject: it must be left to the knowledge and discretion of the witness. I have distinctly seen the well-marked appearances of inflammation produced by arsenic in the stomach and duodenum in an exhumed body twenty-eight days after interment {Reg. v. Jen- nings, Berks Lent Ass. 1845) ; and in another instance, referred to me by Mr. Lewis, the coroner for Essex, in August, 1846, the red- dened state of the mucous membrane, in a case of arsenical poison- ing, was plainly perceptible on removing a layer of arsenic, nine- teen months after interment. (See, on this question, a case of sus- pected poisoning by Orfila, " Annales d'llyg." 1839, vol. 1, p. 127.) If, however, there should be a reasonable doubt respecting the cause of redness, and no poison is detected, it would be unsafe to rely upon this appearance alone as evidence of poisoning. Ulceration. — In irritant poisoning, the stomach is occasionally found ulcerated; but this is, comparatively speaking, a rare occur- rence. In such cases the mucous membrane is removed in small distinct circular patches, under the edges of which the poison (ar- senic) may be found. Ulceration of the stomach is a more common result of disease, than of tlie action of poison. As a consequence of disease, it is very insidious, going on often for weeks together, without giving any indication of its existence, except perhaps slight gastric disturbance with occasional nausea, vomiting, and loss of appetite. In this case, the ulceration is commonly seen in small circumscribed patches. It is worthy of remark, as a means of distinction, that ulceration has. never been known to take place from arsenic or any irritant poison, until symptoms indicative of irritant poisoning have occurred. In ulceration from disease, the mucous membrane is commonly only reddened in the neighborhood of the ulcer. In ulceration from poison, the redness is generally diffused over other parts of the stomach, as well as over the duo- denum and small intestines. A case, however, occurred in G-uy's Hospital, some years ago, in which, with a small circular patch of ulceration near the cardiac opening, the whole mucous membrane was red and injected ; but this singular condition of the stomach, 104 SOFTENING AND PERFORATION OF THE STOMACH. SO closely resembling the effects of an irritant poison, was unac- companied by any marked symptoms of irritation during life. The history of a case previous to death will thus commonly enable us to determine to what cause the ulceration found, may be due. Care must be taken to distinguish ulceration from corrosion. Ulceration is a vital process : the substance of a part is removed by the absorbents, as a simple result of inflammation. Corrosion, on the other hand, is a chemical action ; the parts are removed by the immediate contact of the poison: they are decomposed; their vitality is destroyed, and they combine with the corrosive matter itself. Ulceration requires time for its establishment, while corrosion is either an instantaneous, or a very rapid effect. Softening. — The coats of the stomach are not unfrequently found so soft as to yield and break down under very slight pressure ; and this may be the I'esult either of poisoning, of some spontaneous morbid change in its structure during life, or of the solvent action of the gastric juice after death. As this condition of the stomach, when caused by poison, is produced by those substances only which possess corrosive properties, it follows that in such cases, traces of their action will be perceived in the mouth, throat and gullet. lu softening from disease, the change will be confined to the" stomach alone, and it is commonly found only at the cardiac or greater end of the organ. When softening is really caused by an irritant poison, it is generally attended by other striking and unambiguous marks of its operation. Softening is not to be regarded as a com- mon character of poisoning: it is only an occasional appearance. I have met with an instance in which the coats of the stomach were considerably hardened by sulphuric acid. Softening can never be inferred to have proceeded from poison, unless other well-marked changes are present, or unless the poison is discovered in the soft- ened parts. The stomachs of infants have been frequently found softened from natural causes: such cases could not be mistaken for poisoning, since the history of them during life, the want of other appearances indicative of poisoning and the total absence of poison from the viscera would prevent such a suspicion from being enter- tained. Perforation. — The stomach may become perforated, either as a result of poisoning or disease. . Perforation from poisoning may arise: 1, from corrosion ; 2, from ulceration. The perforation by corrosion is by far the most com- mon variety of perforation from poisoning. It is occasionally wit- nessed when the strong mineral acids have been taken, especially sulphuric acid; the stomach, in such cases, is blackened and exten- sively destroyed, the aperture is large, the edges are rough and irregular, and the coats are easily lacerated. The acid escapes into the abdomen, and may be readily detected there by chemical analy- sis. The perforation from ulceration, caused by irritant poison (arsenic), is but little known. There are but few instances on record. In a great number of poisoned subjects examined during many years past at Guy's Hospital, not a single case has occurred. PEEFOEATION FEOM DISEASE. 105 It must, then, be looked upon as a rare appearance in cases of irri- tant poisoning. _ Perforation from disease. — This is by no means an unusual con- dition. Many cases of this disease will be found reported else- where. (" Guy's Hosp. Rep." No. 8.) It is invariably fatal when it proceeds so far that the contents of the stomach escape into the abdomen ; but sometimes the stomach becomes glued to the pan- creas or other organs during the ulcerative process, and the person may recover. Several instances of this kind of adhesion have been met with in inspections. The symptoms from perforation com- monly attack a person suddenly, while apparently enjoying perfect health. Hence these cases may be easily mistaken for those of irritant poisoning. The principal facts observed with regard to this formidable disease are the following: 1. It often attacks young women from eighteen to twenty-three years of age. 2. The preceding illness is extremely slight ; sometimes there is mere loss of appetite, or a capricious appetite, with uneasiness after eating. 3. The attack commences with a sudden and most severe pain in the abdomen, generally soon after a meal. In irritant poisoning the pain usually comes on gradually, and slowly increases in severity. 4. Vomiting, if it exists at all, is commonly slight, and is chiefly confined to what is swallowed. There is no purging : the bowels are generally constipated. In irritant poisoning the vomiting is usually severe, and purging seldom absent. 5. The person dies commonly in from eighteen to thirty-six hours ; this is also the average period of death in the most common form of irri- tant poisoning, i. e. by arsenic ; but in no case yet recorded has arsenic caused perforation of the stomach within twenty-four hours ; and it appears probable that a considerable time must elapse before such an effect could be produced by this, or any irritant. 6. In perforation from disease, the symptoms and death are clearly referable to peritonitis. 7. In the perforation from distease the aperture is commonly of an oval or rounded form, about half an inch in diameter, situated in or near the lesser curvature of the stomach, and the edges are smooth. The outer margin of the aperture is often blackened, and the aperture itself is funnel-shaped from within outwards, i. e. the mucous coat is the most removed, and the outer or peritoneal coat the least. The coats of the stomach, round the edge of the aperture, are usually thickened for some distance; and when cut they have almost a cartilaginous hardness. These characters of the aperture will not alone indicate whether it is the result of poisoning or disease ; but the absence of poison from the stomach, with the want of other characteristic marks of irritant poisoning, would enable us to say that disease was the cause. Besides the history of the case during life would materially assist us in our judgment. The great risk in all these cases is, that the effects of disease may be mistaken for those of poisoning ; for we are not likely to mistake perforation caused by irritant poison for the result of disease. Notwithstanding the well- marked difference above described, it is common to meet with cases 106 SPONTANEOUS OR GELATINIZED PERFOKATION. of imputed poisoning, where death has really occurred from peri- tonitis following perforation. I have been requii^ed to examine several cases of this kind ; one of them will be found elsewhere recorded. ("G-uy's Hosp. Reports," Oct. 1850, page 226.) In another the body was exhumed after several months' burial, and the stomach was found perforated from disease in the usual situa- tion. [Intestinal perforation sometimes occurs from sudden strain or effort, or external violence. — H.] Spontaneous or gelatinized perforation. — The stomach is occasion- ally subject to a spontaneous change, by which its coats are softened, and give way generally at the cardiac or greater end. As the effusion of the contents of the organ, in such a case, never gives rise to peritoneal inflammation, and no symptoms occur prior to death to indicate the existence of so extensive a destruction of parts, it is presumed to be a change in the dead body, and the coats of the stomach are supposed to undergo a process of solution or digestion. It is commonly attributed to the solvent action of the gastric juice, — the spleen, diaphragm, and other viscera being some- times softened. My colleague, Dr. Wilks, who has for many years conducted the inspections at Guy's Hospital, informs me that this post-mortem or cadaveric perforation of the stomach is so rare a condition, that it is not met with once in five hundred cases. In the last two cases in which it Avas observed, one patient had died from albuminuria and the other from head-affection ; but in neither of these could there be found any peculiarities regarding their food, the time of the last meal, or the state of the bodies to account for the spontaneous destruction of the coats of the stomach. (For remarks on this subject by Dr. Budd, see " Med. Graz." vol. 39, p. 895.) In January, 1845, 1 met with an instance of this perfora- tion in a child between two and three years of age. It was seized with convulsions, became insensible, and died twenty-three hours afterwards. After death, the greater end of the stomach was found destroyed to the extent of three inches ; and the edges were softened and blackened. There was no food in the stomach, and nothing had passed into the organ for thirty-two hours before death ! It was therefore impossible to ascribe death to the perfora- tion, or the perforation to poison. (For a full account of this case, see "Med. Gaz." vol. 36, p. 32.) An inspection of the body, with a general history of the case will commonly suffice to remove any doubt in forming an opinion whether the extensive destruction so commonly met with, has or has not arisen from poison. Thus, in a cadaveric perforation, the aperture is generally situated in that part of the stomach which lies to the left of the cardia ; it is very large, of an irregular form, and ragged and pulpy at the edges, which have the appearance of being scraped. The mucous mem- brane of the stomach is not found inflamed. There is occasionally slight redness, with dark brown or almost black lines (striae) in and near the dissolved coats, which have an acid reaction. It can only be confounded with perforation by the action of corrosives ; but the well-marked symptoms during life, and the detection of the poison MICROSCOPIC EXAMINATION; 107 after death, together with the changes in the throat and gullet, will at once indicate the perforation produced by corrosive poison. [It is vitally important that the post-mortem examiner should be qualified by practical training and experience, as well as judgment, to understand fully and distinctly the appearances referred to in the foregoing chapter. We fear, however, that the responsibility is too often assumed in this country by practitioners who have no right or reason to pretend to the indispensable qualifications, and whose ignorance and indiscretion might easily be exposed by a well di- rected cross-examination. The case of John Hendrickson, Jr., con- victed, on altogether insufficient medical testimony, of poisoning his wife with aconite, aifords a lamentable instance of this kind of perversion of medico-legal investigation. (See " Am. Journ. Med. Sci.," October, 1855, p. 447, for an able and justly severe review of the medical evidence in this trial by Dr. C. Lee.) But it is not only in the observation of the anatomical a^Dpcarances, even when fully competent to recognize their true characters, that we must exercise the greatest caution. The evidence afforded by the sight and sjnell of matters in the alimentary canal or other portions of the body, although sometimes -very significant, should always be subjected to the closest scrutiny. Odor and color are proverbially uncertain ; and although the recognition of peculiarities of form is less liable to error, yet when these are so minute as to require the employment of the microscope to determine them, the faculty of discriminating is at present restricted to an extremely limited cir- cle of observers. In the hands of a judicious and genuine expert in this mode of exploration, the microscope doubtless may be, as it already has been, resorted to with the happiest elFect in corrobora- tion of other more appreciable signs ; still our inclination is to look with particular reserve upon all results derived from such a source alone. We fully agree nevertheless with Dr. M. Stills in his in- dorsement of the views of Dr. Frazer, that the value of the micro- scope in identifying the presence of some vegetable poisons by their botanical characters has not received the attention which it deserves. (Wharton and Stills, " Med. Jurisp.," 2d ed. p. 474.) Dr. Frazer, in his interesting paper on the subject, gives some very valuable hints, and concludes with detailed instructions, which, while they must prove in the highest degree useful to the accomplished micro- scopist, at the same time demonstrate the absolute necessity of a special training on the part of any one who maj' desire to avail himself of such difficult tests. " In such cases I would propose," says Dr. Frazer, " that, aided by the history of symptoms, an aid of which we always avail our- selves in other forms of poisoning, the microscope be employed in their investigation ; and the most certain way, I believe, to accom- plish this result, especially for those not very intimately acquainted with the peculiar difi:erential-characters of the plants, is to compare whatever vegetable fragments may- be ejected by vomiting during life, or found in the body after death, with some recent specimens of those vegetables which are most suspected to have been the cause 108 MICROSCOPIC EXAMINATION. of the accident. I have satisfied myself in this manner that the leaves especially of aconite, henbane, foxglove, belladonna and several other of our indigenous poisonous plants can be easily re- cognized, and that they present distinctive characters adequate to establish ample ground for their discrimination. "The point in such an investigation, which 'we require to deter- mine in the first instance, is identically similar to the first step in deciding on the nature of a botanical specimen ; if the specimen con- sists altogether of cellular tissue, it is to be classed as one of the ' cellulares,' and possibly may prove to be some of the poisonous fungi ; should it, however, yield us distinct evidence of vascular tissue, thus demonstrating its more exalted place in the botanist's systematic arrangements, in that case we will have as our next duty, supposing it is a fragment of leaf which we are examining, to decide on the nature of the venation, which at once points out whether it constituted a portion of an exogenous or of an endogenous plant, the latter having the well-known parallel venation, and the former presenting an equally distinctive reticulated arrangement. Hav- ing advanced so far, we then have four other points, at least, for aiding our further identification of its source. " 1st. The presence or absence of hairs, their relative abundance on the upper or under surface of the leaf, and their shape, composi- tion and arrangement. " 2d. The appearance of the epiderm on the upper surface of the leaf, the form of the cells of which it is composed, the existence or non-existence of stomata, and if they are present, their shape, size and disposition in the epiderm. " 3d. Similar observations on the epiderm of the under surface of the leaf. " 4th. The disposition of the parenchyma of the leaf, and the de- velopment of various crystalline matter (raphides) in this tissue, and their form when they exist. " An agreement in these four points, with corresponding appear- ances in a recent specimen, would, I conceive, afford more than an equivalent to the degree of moral certainty which is now derived from a chemical analysis of a mineral poison ; and I can readily understand, with the scientific aids now at our disposal, that just as the chemist is able to place securely in a sealed tube, and exhibit before the court sublimates of arsenic and mercury as undoubted evidence of his analytic skill, so the microscopic observer might produce, to corroborate his testimony, accurate drawings of the fragments of a poisonous plant, printed by solar light, as photo- graphs, or more clearly obtained with the aid of a pencil or camera." (See " Edinb. Monthly Journ. of Med.," April, 1855, from "Dublin Hosp. Gaz.")— H.] [For a full discussion of the importance and relative value of the chemical analysis for establishing the proof of poisoning, see " Taylor On Poisons," Chap. XL From the foregoing remarks, it will easily be understood ho w dangerous it would be, in a case involv- MICEOSCOPIC EXAMINATION, 109 ing life and death to rely either upon symptoms or the aiitopsic ap- pearances, or even upon both, as affording positive proof of poison. A leading American authority, uses the following judicious lan- guage upon this point : " These verifications (the symptoms and the autopsy) once established, and a harmony between the lesions shown by the physician or physiologist, and the substance dis- covered by chemical analysis being settled, then, and only then, can the conclusion be reached that death was due to poison." (Wharton and Stille's " Med. Juris.," 1873, vol. ii. p. 287.) We would not however, be understood to say that the chemical evidence is always indispensable for proving the administration of poison. In certain cases, for good reasons, this chemical detection is impossible ; but in these exceptional instances, the other two factors — the symptoms and the anatomical lesions — as likewise the moral circumstances of the case, should be so positive and unequivocal, as to leave no shadow of doubt. — R.] 110 SULPHURIC ACID — SYMPTOMS. IRRITANT POISONS. CHAPTER YII. sulphuric acid, or oil of vitriol. — nitric acid, or aqua fortis. — hydrochloric acid.— symptoms. — appearances and analysis. Sulphuric Acid, or Oil of Yitriol. Symptoms. — "When this poison is swallowed in a concentrated form, the symptoms produced come on either immeAiately, or during the act of swallowing. There is violent burning pain, extending through the throat and gullet to the stomach, and the pain is often so severe that the body is bent. There is an escape of gaseous and frothy matter, followed by retching and vomiting, the latter accompanied by the discharge of shreds of tough mucus and of a liquid of a dark coffee-ground color, mixed with blood. The mouth is excoriated, the lining membrane and surface of the tongue white, or resembling soaked parchment ; in one instance the appearance of the mouth was as if it had been smeared with white paint. After a time, the. membrane acquires a gray or brownish color; the mouth is filled with a thick viscid substance consisting of saliva, mucus, and the corroded membrane : this renders speaking and swallowing difficult. If the poison has been administered by a spoon, or the phial containing it has been passed to the back of the throat, the mouth may escape the chemical action of the acid. A medical witness must bear this circumstance in mind, when he is called to examine an infant suspected to have been poisoned by sulphuric acid. Around the lips and on the neck may be found spots of a brown color from the spilling of the acid and its action on the skin. There is great difficulty of breathing, owing to the swelling and excoriation of the throat and larynx, and the coun- tenance has from this cause, a bluish or livid appearance ; the least motion of the abdominal muscles is attended with increase of pain. The stomach is so irritable, that whatever is swallowed is imme- diately ejected, and the vomiting is commonly violent and inces- sant. The matters first vomited generally contain the poison : they are acid, and if they fall on a limestone pavement there is effervescence ; if on colored articles of dress, the color is sometimes altered to a red or yellow, or it is entirely discharged and the texture of the stuff destroyed ; on a black cloth dress, the spots APPEAEANCES AFTER DEATH. Ill produced by the concentrated acid are reddish-brown, and remain moist for a considerable time. After a time there is exhaustion , accompanied by great weakness ; the pulse becomes quick, small, and feeble, the skin cold, mottled, and covered with clammy sweat. There is generally great thirst, with obstinate constipation of the bowels ; should nny evacuations take place, they are commonly either of a dark-brown or leaden color, in some instances almost black, arising from an admixture of altered blood. There are sometimes convulsive motions of the muscles, especially those of the face and lips. The countenance, if not livid from obstructed respiration, is pale, expressive of great anxiety and intense sufi'er- ing. The intellectual faculties are quite clear, and death usually takes place very suddenly, in from eighteen to twenty-four hours after the poison has been taken. Sulphate of indigo produces similar symptoms. The vomited matters are however bluish- black. Appearances after death. — The marked effects of this poison are not always observed in the stomach ; they may be confined to the region of the throat and windpipe. In an inspection of the body, the whole course of the alimentary canal from the mouth down- wards, should be examined ; since in recent or acute cases it is in the throat and gullet that we generally obtain strong evidence of the action of a corrosive poison. The discovery of the usual marks of corrosion in these parts is always highly corroborative of the signs of poisoning found in the stomach. During the inspection, the examiner must not omit to notice any spots on the skin produced by the action of the acid : these are commonly of a dark-brown color, and are situated about the mouth, lips, and neck. The appearances met with in the body 'of a person who has died from the effects of this acid vary, according to whether death has taken place rapidly or slowly. Supposing the case to have proved rapidly fatal, the membrane lining the mouth may be found .white, softened, and corroded. The mucous membrane of the throat and gullet is commonly found corroded, having a brown- black, or ash-gray color, and blood is effused in patches beneath it. The corroded membrane of the gullet is occasionally disposed in longitudinal folds, portions of it being partly detached. The stomach, if not perforated, is collapsed and contracted. On laying it open, the contents are commonly found of a dark-brown or black color and of a tarry consistency, being formed in great part of mucus and altered blood. The contents may or may not be acid, according to the time the patient has survived, and the treatment which has been adopted. On removing them, the stomach may be seen traversed by black lines, or the whole of the mucous mem- brane may be stained black or of a dark-brown color. On stretch- ing the coats, the red color indicative of inflammation may be sometimes seen in the parts beneath, or surrounding the blackened portions. When the stomach is perforated, the coats are softened, and the edge of the aperture is commonly black and irregular. In removing the stomach, the opening is liable to be made larger 112 FATAL DOSE. by the mere weight of the organ. The contents do not always escape ; but when this happens, the surrounding parts are attacked by the poison. In a case which occurred at Gruy's .Hospital, the spleen, the liver, and the coats of the aorta were found blackened and corroded by the acid, which had escaped through the perfora- tion. In some rare cases, the lining membrane of the aorta has been found strongly reddened. "When a person has survived for eighteen or twenty hours, traces of corrosive and inflaramatory action may be found in the small intestines. In one case the mucous membrane of the ileum was corroded. The interior of the windpipe, as well as of the bronchial tubes, has also presented marks of the local action of the acid. The acid has thus desti'oyed life without reaching the stomach. A remarkable instance in which the poison penetrated into and destroyed both lungs has been reported by Sir William Gull. (See " Med. Gaz.," vol. 45, p. 1102.) It is important for a medical witness to bear in mind, that the mouth, throat, and gullet are not always found in the state above described. Dr. Ogle met with a case in which the membrane of the tongue was but slightly afi'ected. The man had swallowed a large dose of the acid, and had died in nine hours. ("Med. Times and G-azette," April 21, 1860.) Strange as it may appear, cases are recorded in which, notwithstanding the introduction of this poison into the stomach, the gullet has escaped its chemical action. Mr. Dickinson has reported a case of poisoning with sulphuric acid, in which there was no corrosion of the mouth and throat. The patient, a female, set. 52, recovered in about five months. (" Lan- cet," N"ov. 26, 1853, p. 502.) Fatal dose. — The dangerous effects of sulphuric acid appear to arise rather from its degree of concentration, than from the abso- lute quantity taken. The quantity actually required to prove fatal, must depend on many circumstances. If the stomach is full when the poison is swallowed, the action of the acid may be spent on the food and not on the stomach ; and a larger quantity might then be taken than would suffice to destroy life if the organ were empty. The smallest quantity which is described as having proved fatal was in the following case : Half a teaspoonful of concentrated sul- phuric acid was given to a child about a year old by mistake for castor oil. The usual symptoms came on, with great disturbance of breathing ; and the child died in twenty-four hours, the quantity here taken could not have exceeded forty drops. (" Med. Gaz.," vol. 29, p. 147.) It is, however, doubtful whether this small quantity would have proved fatal to an adult. The smallest fatal dose which Dr. Christison states he has found recorded, is one drachm; it was taken in mistake by a young man, and killed him in seven days. (Op. cit., 162.) Even when diluted, the acid will destroy life rapidly. A man swallowed, on an empty stomach, six drachms of the strongest acid diluted with eighteen drachms of water. He suffered from the usual symptoms, and died in two hours and a half. (" Med. Times and Gaz.," 1863, vol. 1, p. 183.) The average period at which death takes place in cases of acute CHEMICAL ANALYSIS. 113 poisoning by sulphuric acid, is from eighteen to twenty-four hours. The shortest case recorded occurred to M. Rapp. A man, set. 50, swallowed three ounces and a half of concentrated sulphuric acid ; he died in three-quarters of an hour. ("Gazette M^dicale," Dec. 28, 1850.) On the other hand, there are numerous instances reported in which the poison proved fatal from secondary causes, at periods varying from one week to several months. Chemical analysis. — If the acid is in a pure state and concentrated^ it possesses these properties: 1. Wood, sugar, or other organic matter plunged into it, is speedily carbonized or charred, either with or without the application of heat. 2. "When boiled with wood, copper-cuttings, or mercury, it evolves fumes of sulphuric acid ; this is immediately known by the odor, as well as by the acid vapor first rendering blue, and then bleaching, starch-paper dipped in a solution of iodic acid. 3. When mixed with an equal bulk of water, great heat is evolved — nearly 200° F., in a cold vessel. Sulphuric acid when diluted does not carbonize organic substances. One test only is required for its detection, namely a solution of a salt of baryta — either the nitrate, or chloride of barium. Having ascertained by test-paper that the suspected liquid is acid, we add to a portion of it a few drops of nitric acid, and then a solution of nitrate of baryta. If sulphuric acid is present, a dense white pre- cipitate of sulphate of baryta will fall down ; this is insoluble in all acids and alkalies. If the precipitate is collected, dried, and heated to redness in a small platinum crucible, or in a folded piece of platinum foil, with five or six parts of charcoal powder, it will, if a suphate, be converted into sulphide of barium. To prove this, we add to the calcined residue, hydrochloric acid, at the same time suspending over it a slip of filtering paper moistened with a solution of acetate of lead. If the precipitate obtained is a sul- phate, the gas evolved will be sulphuretted hydrogen, known by its odor, and by its turning a salt of lead of a brown color. The cyanide or ferrocyanide of potassium may be used as a reducing agent in place of charcoal, in a proportion about equal to that of the sulphate of baryta. The experiment may then be performed in a reductiofa-tube in the flame of a spirit lamp. On breaking the glass and laying the incinerated residue on paper or card wetted with a salt of lead, a brown stain indicative of sulphide of lead is produced. In liquids containing organic matter. — If sulphuric acid is mixed with such liquids as porter, cofl"ee, or tea, the process for its detection is substantially the same, the liquid being first rendered clear by filtration. The precipitated sulphate of baryta, if mixed with organic matter, may be purified by boiling it in strong nitric acid ; but this is not commonly necessary, as the reduction of the dried precipitate may be equally well performed with the impure, as with the pure sulphate. Some liquids, such as vinegar, porter, and most wines, generally contain sulphuric acid or a sulphate, but the apid is in small proportion ; therefore, if there is an abundant precipi-r 8 114 DETECTION IN ORGANIC LIQUIDS. tate, there can be no doubt, cceteris pai'ibus, that free sulphuric acid has been added to them. Should the liquid be thick and viscid, like gruel, it may be diluted with water, and then boiled with the addition of a little acetic acid. For the action of the barytic test, , it is not necessary that the liquid should be absolutely clear, pro- vided it is not so thick as to interfere mechanically with the preci- pitation of the sulphate of baryta. So far with regard to articles administered, or of which the administration has been attempted. This process may be applied to the examination of matters vomited and of the contents of the stomach, — care being taken to separate the insoluble parts by filtration, or by the process of dialysis, before adding the test. The coats of the stomach should be cut up, and then boiled in distilled water. Sulphuric acid may be detected on articles of clothing by a similar process. The concentrated acid pro- duces brown stains on black cloth; the spots remain damp, and the fibre of the stuff is gradually softened and corroded. The stained portion of cloth should be boiled in water, and the solution filtered and tested with a salt of barium. If any free acid is present, the stained stuff and the solution obtained from it will redden litmus paper. It may thus be detected after the lapse of twenty-sevea years. It is a medico-legal fact of considerable importance, that the con- tents of a stomach, in a case of poisoning by sulphuric acid, are sometimes entirely free from any traces of this poison, even when it has been swallowed in large quantity. The acid is not commonly found when the person has been under treatment, when there has been considerable vomiting, aided by the drinking of water or other simple liquids, or when he has survived several days. If the case has been under treatment, the acid is either wholly absent or neutralized by antidotes. A girl swallowed four or five ounces of diluted vitriol, and died in eighteen hours. 'No portion of the acid could be detected in the stomach ; but she had vomited considera- bly, and the acid was easily proved to exist in the vomited matters, by examining a portion of the sheet of a bed which had become wetted by them. In another case, nearly two ounces of the con- centrated acid were swallowed ; the patient died in twenty-five hours ; the stomach was extensively acted on, and j'et no trace of the acid could be discovered in the contents. The liquidity of the poison, and the facility with which it becomes mixed with other liquids and ejected by vomiting, will readily furnish an explanation of this fact. In many cases of poisoning by sulphuric acid, there- fore, a medical witness must be prepared to find that chemical analysis will furnish only negative results. This, however, is not inconsistent with death having taken place from the poison. Prof. Casper relates three fatal cases that occurred to himself, in none of which the poison could be found after death. In one instance, in which death took place on the eleventh day, I found no trace of sulphuric acid in the body. If the stomach should be perforated, the contents will be found in the abdomen, or perhaps in the lower part of the cavity of the pelvis : they may then be collected, boiled NITRIC ACID. 115 with distilled water, and the solution examined for the acid by the process already described. If the contents of the stomach are highly putrefied, the sulphuric acid may be found combined with ammonia. IsTiTRic Acid. Aqua Fortis. Symptoms. — "When nitric acid is taken in a concentrated state, the symptoms bear a close resemblance to -those produced by sul- phuric acid. They come on immediately, and the swallowing of the acid is accompanied by intense burning pain in the throat and gullet extending downwards to the stomach : there are gaseous eructations, from the chemical action of the poison, swelling of the abdomen, violent vomiting of liquid or solid matters, mixed with altered blood of a dark brown color, and shreds of yellowish-colored mucus, having a strong acid reaction. The abdomen is generally exquisitely tender : but in one well-marked case of poisoning by the acid, the pain was chiefly confined to the throat : probably the poison had not reached the stomach. The mucous membrane of the mouth is commonly soft and white, after a time becoming yellow, or even brown ; the teeth are also white, and the enamel is partially des- troyed by the chemical action of the acid. There is great difficulty of speaking and swallowing, the mouth being filled with viscid mucus : the power of swallowing is, indeed, sometimes entirely lost. On opening the mouth, the tongue may be found swollen, and of a citron color ; the tonsils are also swollen and enlarged ; the teeth are yellow and corroded. As the symptoms progress, the pulse be- comes small, frequent and irregular, the surface of the body ex- tremely cold, and there are frequent rigors (shivering). The swal- lowing of liquids increases the severity of the pain, and occasions, vomiting. There is obstinate constipation. Death takes place in from eighteen to twenty-four hours, and is sometimes preceded by a kind of stupor, from which the patient is easily roused. The in- tellectual faculties commonly remain clear until the last. The vapor of this acid is destructive to life. In March, 1854,, Mr. Haywood, a chemist of Sheffield, lost his life under the follow- ing circumstances : He was pouring a mixture of nitric and sul phuric acids from a carboy containing about sixty pounds, wheui by some accident the vessel was broken. For a few minutes he- inhaled the fumes of the mixed acids, but it does not appear that any of the liquid fell over him. Three hours after the accident, he was sitting up and appeared to be in moderately good health. He was then seen by a medical man, and complained merely of some- cuts about his hands. He coughed violently. In three hours more there was difficulty of breathing, with increase of the cough. There was a sense of tightness at the lower part of the throat, and the- pulse was hard. At times he said he could scarcely breathe. He died eleven hours after the accident. On inspection, there was con- gestion of the windpipe and bronchial tubes, with effusion of blood in the latter. The heart was flaccid, and contained but little blood -^ and the lining membrane of the heart and aorta was inflamed. The- 116 APPEAEANCES AFTER DEATH-. blood gave a slightly acid reaction with test-paper. The windpipe was not examined. It is very probable the seat of mischief was in this organ, and that the deceased died from inflammatory effu- sion and enlargement of the parts about the opening of the wind- pipe. ("Lancet," April 15, 1854, p. 430.) A similar accident occurred to Mr. Stewart and to one of the janitors of an educational institution in Edinburgh in March, 1863. They both died from the effects of the acid vapor. Appearances after death. — Supposing death to have taken place rapidly from the liquid acid, the following appearances may be met with: The skin of the mouth and lips will present various shades of color, from an orange-yellow to a brown. Yellow spots produced by the spilling of the acid may be found about the hands and neck. The membrane lining the mouth is sometimes white, at others of a citron color ; the teeth are white, but present some- times a yellowish color. The throat and windpipe are much in- flamed. The lining membrane of the gullet is softened, and of a yellow or brown color, easily detached, often in long shreds. The windpipe is more vascular than usual, and the lungs are congested. The most strongly marked changes are, however, seen in the stomach. When not perforated, this organ may be found distended with gas, its mucous membrane partially inflamed and covered by patches of a yellow, brown, or green color, or it may be even black. Its coats may be so much softened, as to break down under the slightest pressure. In the duodetmm similar changes are found ; but in some cases the small intestines have presented no other ap- pearance than that of slight redness. It might be supposed that the stomach would be in general perforated by this corrosive liquid ; but perforation has not been often observed. In a case which proved fatal after the long period of six months, there was, at the intestinal end of the stomach, a distinct cicatrix with puckering and harden- ing of the surrounding mucous membrane, causing a slight contrac- tion of the intestinal orifice. The only other appearance consisted in some dark longitudinal lines on the posterior surface of the lining , membrane of the gullet. This had probably been caused by the acid. (" Lancet," JSTov. 24, 1860, p. 510.) The smallest quantity of this acid which I find reported to have destroyed life, is about two drachms. It was in the case of a boy, aged thirteen: he died in thirty-six hours. Death commonly takes place within twenty-four hours. Sobernheim relates a case of poisoning by nitric acid, which proved fatal in one hour and three quarters. (Op. cit. 402.) This I believe to be the most rapidly fatal instance on record, where the acid acted as a poison. The usual well-marked effects were found in the gullet, stomach, and small intestines. In infants, life may be destroyed by this poison in a few minutes, should it happen to affect the larynx. The . longest case is, perhaps, that recorded by Tartra, where a woman died from exhaustion, produced by the secondary effects of the acid, eight months after having swallowed it. CHEMICAL ANALYSIS. 117 Chemical analysis. In the simple state. — This acid may be met with either concentrated or diluted. The concentrated acid varies in color from a deep orange-red to a light straw-yellow. It may be recognized, 1. By evolving acid fumes when exposed to the air or when heated. 2. By its staining organic matter, yellow or brown, the color being heightened and turned to a reddish tint by contact with caustic alkalies. 3. "When mixed with a few copper cuttings, it is rapidly decomposed, a deep red acid vapor is given off, and a bluish colored solution of nitrate of copper is formed. Tin or mercury may be substituted for copper in this experiment. 4. The addition of gold-leaf and a few drops of hydrochloric acid : if nitric acid is present, the gold will be dissolved on warming the mixture. Common aqua fortis (nitric acid) sometimes contains as impurity, a sufficiency of hydrochloric acid to dissolve gold-leaf by heat. In the diluted state. — This acid is not precipitated like the sul- phuric, by any common reagent, since all its alkaline combinations are soluble in water. 1. The liquid has a highly acid reaction, and (if not too diluted) on boiling it with some copper turnings, red fumes of nitrous acid vapor are given off, the liquid acquiring a blue color at the same time. 2. A streak made on white paper with the diluted acid does not carbonize it when heated; but a scarcely visible yellow stain is left. 3. The liquid is neither precipitated by nitrate of baryta, nor by nitrate of silver. These two last experi- ments give merely negative results : they serve to show that sul- phuric and hydrochloric acids are absent. In order to detect nitric acid when mixed with water or other liquids, the liquid should be carefully neutralized by potash, and then evaporated slowly to obtain crystals. If the liquid contain nitric acid, these crystals will possess the following characters: 1. They appear in the form of lengthened fiiited prisms, which neither effloresce nor deliquesce on exposure. One drop of the solution, evaporated spontaneously on glass, will suffice to yield distinct and well-formed prismatic crystals. This character distinguishes the nitrate of potash from a large number of salts. 2. When moist- ened with strong sulphuric acid, the powdered crystals slowly evolve a colorless acid vapor. By this test, the nitrate is known from every other deflagrating salt. 3. A portion of the powdered crystals should be jjlaced in a small tube and mixed with their bulk of fine copper filings. The mass is then to be moistened with water, and a few drops of strong sulphuric acid added. Either with or without the application of a gentle heat, a decomposition im- mediately ensues, by which red fumes of niti-ous acid are evolved, recognizable by their color, odor and acid reaction. In operating on a small quantity of nitrate free from chloride, the crystals may be placed in a watch-glass and mixed with one or two drops of concentrated sulphuric acid and a few copper filings. Invert over this another watch-glass containing a small slip of blue litnius- paper wetted, and a slip of starch-paper moistened with a solution of iodide of potassium. After a longer or shorter interval the litmus will be reddened, and the starch-paper will assume a blue- 118 CHEMICAL ANALYSIS. black color. If the nitrate should he mixed with much chloride, then the power of dissolving leaf-gold on boiling the dry salt with strong hydrochloric acid, furnishes the best means of detection. 4. We add to the crystals a small portion of gold-leaf and hydro- chloric acid ; then boil for a few minutes. The gold will either wholly or entirely disappear, if nitric acid or a nitrate is present. Its partial solution will be indicated by a dark purple or brown color on the addition of chloride of tin to the liquid after boiling. ■In liquids containing organic matter. — IlTitric acid may be admin- istered in such liquids as tea, vinegar, or porter. In this case, besides the acid reaction, there will be a peculiar smell produced by the strong acid, when mixed with substances of an organic nature. The application of the usual tests may be here counter- acted ; thus, unless the quantity of nitric acid in the liquid is con- siderable, the orange-red fumes of nitrous acid are not evolved on boiling it with copper cuttings. If the liquid is viscid, this visci- dity must be destroyed by dilution with water ; and in all cases, if any solid or insoluble substances are present, as in the matters vomited or contents of the stomach, it must be filtered, in order to separate the insoluble portions. If we succeed in procuring a clear acid liquor, the color may be disregarded. After warming the acid, we should carefully neutralize it with a weak solution of carbonate of potash ; it may then be concentrated by evaporation. Paper dipped into this liquid and dried, burns with deflagration, and a few drops on a glass slide will yield crj^stals possessing those pro- perties which have been described as characteristic of the com- pound of potash with nitric acid. The crystals so obtained may be colored and impure ; but this does not interfere with the action of the most important test for nitric acid, namely, the mixture of copper filings and sulphuric . acid. The crystals may, however, if necessary, be purified by washing them with ether or alcohol. These liquids do not dissolve the nitrate of potash, but will often serve to remove from it the organic matters by which it is colored. When either the nitric acid, or the nitrate into which it has been converted, is mixed with common salt, the copper test cannot be employed. In such a case the gold test will furnish the best evi- dence. Hydrochloric acid with a small portion of gold-leaf may be added to the dried residue, and the mixture boiled. If nitric acid or a nitrate is present, even in minute proportion, some portion of the gold will be dissolved, a fact demonstrable by the addition of chloride of tin. Nitric acid may be detected in stains on clothing, if recent, by simply boiling the stained cloth in water, with or without the addi- tion of a small quantity of carbonate of potash. The carbonate must be used when an acid liquid is not obtained by boiling the stained cloth in distilled water. A simple method of detecting the acid is to boil at once a piece of the stained cloth with a fragment of leaf-gold and hydrochloric acid. If nitric acid is present in the stain, a portion of the gold will be dissolved. HYDROCHLORIC ACID— AN ALYSIS . 119 Hydrochloric Acid. Muriatic Acid. This acid, which is also called Muriatic Acid, and is popularly known under the name of Spirit of Salt, is but seldom taken as a poison. In the few cases which have been hitherto observed, the symptoms and appearances have been similar to those caused by nitric acid. The following case will show the nature of the symp- toms. A woman swallowed half an ounce of concentrated hydro- chloric acid, and in three-quarters of an hour, the prominent symptoms were burning pain in the throat and stomach, feeble pulse, cold and clammy skin, retching and vomiting of a brown matter streaked with blood and containing shreds of membrane. There was great exhaustion. The. throat became swollen, the patient lost the power of swallowing, and died in e.ighteen hours. She retained her senses until the last. The appearances in the body were as follows : the mucous membrane of the mouth and throat was white, softened, and destroyed in many places by the corrosive action of the acid. The membrane of the gullet was red and in- flamed. The back part of the stomach near the pylorus was black, stripped of its mucous membrane (which was generally softened), and marked with black lines. It was not perforated. (" Lancet," July 16, 1859, p. 59.) For a more detailed account of poisoning by this acid, see " On Poisons," second edition, p. 289. Chemical analysis. — In a concentrated state, hydrochloric acid evolves copious fumes. The pure acid is nearly colorless ; the com- mercial acid is of a lemon-yellow color, and frequently contains iron, arsenic, antimony, common salt and other impurities. When boiled with a small quantity of peroxide of mar^ganese, chlorine is evolved. It does not dissolve gold-leaf until a few drops of nitric acid have been added to it, and the mixture heated. In the diluted state, these properties are lost. It may then be recognized by the dense white precipitate which it gives when a solution of nitrate of silver is added to it. This precipitate is insoluble in nitric acid ; it acquires a purple and black color if exposed to light ; and when heated, it melts without decomposition, forming a yellowish-colored substance, on cooling. In organic liquids. — After proper dilution with distilled water, the liquid should be distilled at a low temperature, and the dis- tillate tested as above. Hydrochloric acid, as well as alkaline chlorides, is a natural con- stituent of the fluids of the alimentary canal. The presence of local chemical" changes in the throat and stomach, would show whether the acid had been taken as a poison. If the acid is found only in small quantity, no inference of poisoning can be drawn unless there are distinct marks of its chemical action upon the throat and stomach. It darkens the blood like sulphuric acid, although it has not the same degree of carbonating action on organic matter. 120 OXALIC ACID — SYMPTOMS. CHAPTER VIII. POISONING BY VEGETABLE ACIDS. — OXALIC ACID. — SYMPTOMS AND APPEARANCES. — CHEMICAL ANALYSIS. — ACID OXALATE OF POTASH OR SALT OF SORREL. — TARTARIC AND ACETIC ACIDS. — [AROMATIC VINEGAR.] Oxalic Acid. Symptoms. — If this poison is taken in a large dose, i. e. from half an ounce to an ounce of the crystals dissolved in water, a hot burn- ing acid taste is experienced during the act of swallowing it. Thi8 is accompanied by a similar sensation extending through the gullet to the stomach. There is sometimes a sense of constriction or suffocation ; the countenance is livid, and the surface of the skin soon becomes cold and clammy. Vomiting occurs either imme- diately or within a few minutes. Should the poison be diluted, there is merely a sensation of strong acidity, and vomiting may not occur until after a quarter of an hour or twenty minutes. In some cases there has been little or no vomiting ; while in others, this symptom has been incessant until death. In one case, in which an ounce of the acid was swallowed, the vomiting with pain in the stomach continued until the fifth day, when the man died suddenly (".Lancet," I^ov. 24, 1860, p. 509), and in another in which the poison was much diluted, vomiting did not occur for seven hours. (" Christison," 221.) The vomited matters are highly acid, and have a greenish-brown or almost black color ; they consist chiefly of mucus and altered blood. The patient complains of great pain and tenderness in the abdomen, with a burning sensation in the stomach. There are cold clammy perspirations and convulsions. There is in general an entire prostration of strength, so that if the person is in the erect position, he falls ; there is likewise unconsciousness of surrounding objects, and a kind of stupor from which, however, the patient may be without difficulty roused. Owing to the severity of the pain, the legs are sometimes drawn up towards the abdomen, or the patient rolls about on the fl"oor or bed. The pulse is small, irregular, and scarcely prrceptible ; the skin cold and- clammy ; and there is a sensation of numbness in the limbs with spasmodic breathing. The inspirations are deep, and a long interval elapses between them. Should the patient survive the first effects of the poison, the following symptoms may appear : soreness of the mouth, constriction and burning pain in the throat with pain in swallow- ing, tenderness in the abdomen, and irritability of the stomach, so that there is frequent vomiting, accompanied by purging. The tongue is swollen, and there is great thirst. APPEAKANCES AFTER DEATH. 121 A'p][)earances after death. — The mucous membrane of the tongue, mouth, throat, and gullet is softened and commonly white, as if bleached, but it is sometimes coated with a portion of the brown mucous matter discharged from the stomach. This latter organ contains a dark-brown mucous liquid, often acid, and having almost a gelatinous consistency. On removing the contents, the mucous membrane will be seen pale and softened, without always present- ing_ marks of inflammation or abrasion, if death has taken place rapidly. This membrane is white, soft and brittle, easily raised by the scalpel, and presents the appearance which we might suppose it would assume after hiaving been for some time boiled in water. The small vessels are seen ramifying over the surface, filled with dark-colored blood, apparently solidified within them. The lining membrane of the gullet presents the same characters. It is pale, and appears as if it had been boiled in water, or digested in alcohol ; it has been found strongly raised in longitudinal folds, interrupted by patches where the membrane has become abraded. In a case which was fatal in eight hours, the tongue was covered with white specks; the gullet was not inflamed, but the stomach was exten- sively destroyed, and had a gangrenous appearance. Portions of the mucous membrane were detached, exposing the muscular coat. With respect to the intestines, the upper portion may be found inflamed ; but, unless the case is protracted, the appearances in the bowels are not strongly marked. I am indebted to Mr. "Welch for the following case : A woman, aged 28, swallowed three drachms of the crystallized acid. She was found quite dead in one hour afterwards. On examining the body, both lungs were observed to be extensively congested, and the heart and large vessels were full of a dark-colored blood. The stomach contained about three-quarters of a pint of a dark-brown fluid, and its lining membrane was generally reddened. The other organs, except the brain, were healthy, and this presented appearances indi- cative of long-standing disease. This case is remarkable from the smallness of the dose, the rapidity of death, and the early produc- tion of a well-marked redness of the mucous membrane of the stomach. The diseased state of the body may have tended to accelerate death from the poison. In one instance the larynx was found filled with frothy mucus, and the left side of the heart and the lungs were gorged with dark-colored fluid blood. In another, the appearances of sanguinous apoplexy were found in the brain. A person fell dead after retching 'fiolently. Apoplexy was sup- posed to be the cause of death. On an inspection of the body, it was found that a large clot of blood was eft'used on the brain, and this appeared to account for death satisfactorily. But when the stomach was examined, oxalic acid was detected in it. This poison Iiad been taken, and had produced its usual eflects. The deceased had taken it with suicidal intention, and the violent vomiting which it caused had led to death by apoplexy from eft'usion of blood. (" Lancet," 1863, 1, p. 47.) Without a proper chemical investi- gation, it is obvious that the real cause of death would have been 122 CHEMICAL ANALYSIS. in this instance overlooked. In a few cases there have been scarcely any morbid appearances produced by this poison. It is worthy of observation that the glairy contents of the stomach do not always indicate strong; acidity until after they have been boiled in water. Oxalic acid does pot appear to have a strongly corrosive action of the stomach, like that possessed by the mineral acids. It is therefore rare to hear of the coats of the organ being perforated by it. The acid, when in a contracted state, renders the mucous coat soft and brittle, and perforation of the coats may occur either during life or after death as a result of its chemical action. Dr. Wood has recorded the case of a female, set. 27, found dead, whose death had been obviously caused by oxalic acid, but the quantity taken, and the duration of the case, were unknown. The stomach presented, at its upper and fore part near the cardiac opening, an irregular aperture of a size to admit the point of the finger. The smallest quantity of this poison which has been known to destroy life is one drachm (sixty grains). The boy, set. 16, took the poison in the solid form, and was found in about an hour insensible, pulseless, and his jaws spasmodicall}'^ closed. He had vomited some bloody matter ; his tongue and lips were unusually pale, but there was no excoriation. He died in eight hours. (" Lancet," Dec. 1, 1855.) Two cases occurred at Guy's Hospital, in each of which half an ounce of oxalic acid had been swallowed. Active treat- ment was adopted, and both patients recovered. When the dose of oxalic acid is half an ounce and upwards, death commonly takes place within an hour ; but there are numerous exceptions to this rapidity of action. Dr. Christison mentions an instance in which an ounce of oxalic acid killed a girl in thirty minutes; and another in which the same quantity destroyed life in ten minutes ; but in a third case death did not occur until the fifth day. The late Dr. Ogilv}', of Coventry, has reported a case of poisoning by oxalic acid, in which it is probable that death took place within three minutes after the poison had been swallowed. The quantity of the acid taken could not be determined. Chemical analysis. In the simple state. — This acid may be met with, either as a solid, or in solution in water. Solid oxalic acid crystallizes in long slender prisms, which, when perfect, are four-sided. In this re- spect, it differs from other common acids, mineral and vegeta.ble. The crystals are unchangeable in air ; they are soluble in water and alcohol, forming strongly acid solutions. When heated on platinum foil they melt, and are entirely dissipated in vapor without combustion and without being carbonized. Heated in a close tube, they melt, and the vapor is condensed in a white crystalline sublimate in a cold part CrysUls of Oxalie Acid, ..agniSed °^' ^^^ ^"^6. Thereshould be UO residue 30 diameters. whatcvcr if the acid IS pure ; but the com- CHEMICAL ANALYSIS. 123 mei'cial acid generally leaves a slight residue of fixed impurity. By this effect of heat, oxalic acid is easily distinguished from those crystalline salts for which it has been sometimes fatally mistaken, namely, the sulphates of magnesia and zinc. These leave white residues in the form of anhydrous salts. Tests. 1. Nitrate of silver. — When added to a solution of oxalic acid, it produces an abundant white precipitate of oxalate of silver. A solution containing so small a quantity of oxalic acid as not to redden litmus-paper, is affected by this test ; but when the quantity of poison is small, it would be always advisable to concentrate the liquid by evaporation before applying it. The oxalate of silver is identified by the following properties : It is completely dissolved by cold nitric acid ; if collected on a filter, thoroughly dried, and heated on thin platinum foil, it is entirely dissipated in a white vapor with a slight detonation; when the oxalate is in small quantity, this detonation may be observed in detached particles, on burning the filter previously well dried. 2. Sulphate of lime. — A solution of oxalic acid is precipitated white by lime-water and all the salts of lime. Lime-water is itself objectionable as a test, because it is precipitated white by several other acids. The salt of lime, which, as a test, is open to the least objection, is the sulphate. As this is not a very soluble salt, its solution must be added in rather large quantity to the suspected acid poisonous liquid pre- viously concentrated. A white precipitate of oxalate of lime is slowly formed. This precipitate should possess the following pro- perties : It ought to be immediately dissolved by nitric or hydro- chloric acid ; and it ought not to be dissolved by the tartaric, acetic, or any vegetable acid. In organic liquids. — -The process is the same, whether it is applied to liquids in which thei poison is administered, or to the matters vomited, or, lastly, to the contents of the stomach. Should the liquid be very acid, we must filter it to separate any insoluble matters; should it not be very acid, the whole may be boiled, if necessary, with distilled water filtered, and concentrated by evaporation. As a trial test we may employ sulphate of copper, or lime-water. From milk, gruel, coffee, blood, mucus and other viscid liquids, oxalic acid is readily separated by the process of dialysis. The liquid should be first boiled — the coats of the stomach (cut up) being included, if necessary. The distilled water placed in the outside of the tube will receive the acid. This may be concentrated by evaporation. Prismatic crystals may then be procured, and the silver' and lime tests may be applied. Oxalic acid may be com- pletely separated from the boiled and filtered organic liquid by the following process: To the filtered liquid, acidulated with acetic acid, acetate of lead should be added until there is no further pre- cipitation ; and the white precipitate formed, collected, and washed. If any oxalic acid was present in the liquid, it would exist in this precipitate under the form of oxalate of lead. Diffuse the precipi- tate in water, and pass into the liquid, for about half an hour, a current of sulphuretted hydrogen gas, taking care that the gas 124 CHEMICAL ANALYSIS. comes in contact with every portion of the precipitate. Black sulphide of lead will be thrown down ; and with it commonly the greater part of the organic matter mixed with the oxalate of lead. Filter, to separate the sulphide of lead ; the filtered liquid may be clear and slightly acid. Concentrate by evapoi'ation ; the sulphu- retted hydrogen dissolved in the liquid is thereby expelled, and oxalic acid may be ultimately obtained crystallized by slow evapo- ration in a watch-glass or on a glass-slide, for microscopical obser- vation. If there was no oxalic acid in the precipitate, no crystals will be procured by evaporation. If crystals are obtained, they must be dissolved in water, and tested in the manner above di- rected. Should the organic liquid contain sulphuric acid or sul- phates, these should be separated before precipitation by lead is resorted to. The presence of oxalic acid in an organic liquid may be detected by another method: Place a portion of the liquid containing the poison in a beaker, and insert in this a tube secured with skin, containing a solution of sulphate of lime. By osmosis, the oxalic acid will penetrate the mem- brane, and will form inside the mouth of the latter a deposit of crystals of oxa- late of lime, known by their octahedral form. Sometimes the chemical evidence may depend on stains on articles of clothing. Oxalic acid discharges the color of some dyes, and slowly reddens others ; but unless the stuff has been washed, the Crystals of oxalate of lime obtained acid remains iu the fabric and may there by dialysis of coffee, contaiaiog oxalic v. J 2. i. Jj Tj. i i 1 i acid. Maguifled 350 diameters '^^ detected. It docs not corrode or de- stroy the stuff" like mineral acids. In Heg. V. Morris (0. C. C. December, 1866) it was proved that the prisoner had attempted to administer a liquid poison forcibly to her daughter, a girl aged six years. It was sour in taste, made her lips smart, and caused vomiting. There was dryness of the ]ips,_and inflammation of the lining membrane of the mouth. Wo portion of the substance administered could he procured, but a crys- talline deposit of oxalic acid was obtained from some stains on the dress of the child. The woman was convicted. As oxalic acid is very soluble in alcohol, this liquid may be occasionally employed for separating it from the contents of the stomach and from many organic compounds. Crystals may be obtained from the alcoholic solution, and these may be purified and tested by the methods already described. [Oxalic acid cannot be detected in theblood ; and if injected into a vessel, it is so readily decomposed that it cannot be recognized even after a few minutes. (Wharton & Still^'s " Med. Juris.," 1873, vol. ii. p. 329'.)— R.J acid oxalate of potash — tartaric acid. 125 Acid Oxalate of Potash, or Salt of Sorrel. Symptoms and effects. — The poisonous effects of this salt entirely depend on the oxalic acid which it contains. It is much used for the purpose of bleaching straw and removing ink-stains, and is sold for this purpose under the name of essential salt of lemons. Its poi- sonous properties are not generally known, or no doubt it would be frequently substituted for oxalic acid. Out of three cases of poison- ing by this substance, two proved fatal, while in the other the patient recovered. In the case of recovery, a young lady, aged twenty, swallowed an ounce of the salt dissolved in warm water. She was not seen by any one for an hour and a half ; she was then found on the floor, faint and exhausted, having previously vomited considerably. Therewasgreatdepression,the skincoldand clammy, the pulse feeble, and there was a scalding sensation in the throat and stomach. There was also continued shivering. Proper medical treatment was adopted, and she recovered in two days, still suffer- ing from debility and great irritation of the stomach. During the state of depression, it was remarked that the membranes of the eyes were much injected, and the pupils dilated. There was also great dimness of vision. (" Med. Gaz." vol. 27, p. 480.) This salt destroys life almost as rapidly as oxalic acid itself ; and in the symptoms which it produces, it closely resembles that poison. In one case, half an ounce killed an adult in so short a time as eight minutes ; but probably the fatal effects were in this instance accele- rated by the debilitated state of the person who took it. In another case, reported by M. Chevallier, death took place in ten minutes. (" Ann. d'Hyg." 1850, vol. 1, p. 162.) In some instances this poison- ous substance has been supplied by mistake for cream of tartar, and has thus caused death. Chemical analysis. — It is not very soluble in cold water, but its solution may be readily mistaken for that of oxalic acid. 1st, it has an acid reaction ; and 2d, it is precipitated by nitrate of silver and sulphate of lime, like oxalic acid : but with the latter test the pre- cipitation is much more copious. It is distinguished from oxalic acid: 1, by its crystals, which when slowly produced on a glass slide assume the shape of small rhombic prisms, sometimes grouped in a plumose form ; and 2, by heating a portion on platinum foil: while oxalic acid is volatile, the binoxalate leaves an ash, which, when sufficiently heated, is white and alkaline ; it may be proved to contain carbonate of potash by its dissolving with effervescence in diluted nitric acid, and forming nitrate of potash. Tartaric Acid. Symptoms and appearances. — Tartaric acid has not been considered to possess any poisonous properties ; but one case has occurred, in which there was no doubt that it acted as an irritant, and destroyed life. The case referred to was the subject of a trial for manslaughter at the Central Criminal Court {Beg. v. Watkins), in January, 1845. 126 ACETIC ACID. The accused gave the deceased, a man aged twenty-four, by mis- take, one ounce of tartaric acid instead of aperient salts. The de- ceased swallowed the whole dissolved in half a pint of warm water at a dose: he immediately exclaimed that. he was poisoned; he complained of having a burning sensation in his throat and stomach, as though he had drunk oil of vitriol, and that he could compare it to nothing but being all on fire. Soda and magnesia were admin- istered with diluent drinks. Yomiting set in, and continued until death, which took place nine days afterwards. On inspection, nearly the whole of the alimentary canal was found highly inflamed. The accused admitted that he had made a mistake, and tartaric acid was found in the dregs of the cup. The jury acquitted the prisoner. Another case of poisoning by this acid, with a report of the results of analysis, has been publishejd by M. Devergie. (" Ann. d'Hyg.," 1851, vol. ii. p. 432.) This case gave rise to a controversy between the late M. Orfila and M. Devergie, the points in dispute relating chiefly to the processes for the detection of the acid in the stomach and tissues. (See "Ann. d'Hyg.," 1852, vol. i. pp. 199, 382, and vol. ii. p. 230.) Acetic Acid. This acid has been generally excluded from the class of poisons. Common vinegar, which contains only five per cent, of acetic acid, has often been taken in large doses without injurious consequences. From the experiments performed by Orfila on dogs, and from one case which he reports as having occurred in the human subject, acetic acid, when concentrated, appears to exert an irritant action on the body. (" Annales d'Hygi^ne," 1831, vol. ii. p. 159 ; also " Toxicologic," vol. ii. p. 198.) This is not more than we might have expected, seeing that the concentrated acid is highly corro- sive. In the case referred to, the deceased, a young female aged nineteen, was found dying on the highway. She suffered from con- vulsions — complained of pain in the stomach, and died in a very short time. On inspection, the stomach was found neither softened nor corroded, but its mucous membrane near the pylorus was almost black. The mucous glands were prominent, and the vessels were filled with black coagulated blood. ViNEGAK, which maybe regarded as an organic mixture contain- ing but a very small proportion of acetic acid (five per cent.), may be examined by distilling a portion, and testing the distilled liquid for the acid. Vinegar, as it exists in commerce, always contains a small quantity of sulphuric acid, and occasionally traces of arsenic and lead. In general it is easily recognized by its odor. Pelletan observed in the case of a child that the abuse of vinegar led to a thinning of the mucous membrane of the stomach ; and Landerer remarked that the milk of a wet-nurse who had been in the habit of taking large quantities of the Vinegar of Eoses, became thin, very acid, and deficient in casein and oil. The infant which she POISONING BY POTASH AND SODA. 127 was suckling graduallj' wasted and died, and the woman herself suffered severely. (" Heller's Archiv.," 1847, 2 H. S. 185.) [Akomatic VINEGAR, which is a stronger preparation (containing at least ninety per cent, of acetic acid), rendered still more irrita- ting by the aromatic oils dissolved in it, may be unintentionally used in such a manner as to produce very serious, if not fatal injury. We have attended a lady whose husband, in his anxiety to restore her from a fainting fit, had poured a quantity of aromatic vinegar into her nostrils. The result of this accident was the corrosion and subsequent violent inflammation of the lining membrane of the nostrils and of the posterior surface of the soft palate. The same amount of irritation, extending into either the larynx or oesophagus, would probably have destroyed her life. — H.] CHAPTER IX. POISONING BY ALKALIES AND ALKALINE SALTS. — POTASH, SODA, AND AMMONIA. — NITRATE AND SULPHATE OF POTASH. — CHLORIDE OF BARIUM. Potash and Soda. Symptoms. — The symptoms produced by potash and soda, when taken in large doses, are similar, so that one description will serve for both. The most common form in which these poisons are met with, is in the state of pearlash (carbonate of potash) and soap-lees (carbonate of soda). The person experiences, during the act of swallowing, an acrid caustic taste, owing to the alkaline liquid, if sufficiently concentrated, excoriating the mucous membrane. There is a persistent sensation of burning heat in the throat, extending down the gullet to the stomach. Vomiting is not always observed ; but when it does occur, the vomited matters are sometimes mixed with blood of a dark brown color, and with detached portions or flakes of mucous membrane ; this efi'ect depending on the degree of causticity in the liquid swallowed. The surface is cold and clammy ; there is purging, with severe pain in the abdomen, resembling colic. The pulse is quick and feeble. In the course of a short time, the lips, tongue, and throat become swollen, soft, and red. Period of death. — The most rapidly fatal case of poisoning by alkalies which I have found reported is that of a boy, who died in three hours after swallowing three ounces of a strong solution of carbonate of potash. In a case which occurred in 1835, a child, aged three years, took a small quantity of concentrated solution of pearlash, which had deliquesced, and died in twenty-four hours. Death was caused in this instance by the inflammation induced in the larynx, causing suffocation. In this. respect, the caustic alkalies may destroy life rapidly, like the mineral acids. But death may 128 APPEARANCES AFTER DEATH. be also a slow result of these poisons. Thus, in an instance which was communicated to me, a lady swallowed, by mistake, one ounce and a half of the common solution of potash of the shops, which contains about 5 per cent, of caustic alkali, She recovered from the first symptoms of irritation, but died seven weeks afterwards, from pure exhaustion, becoming greatly emaciated before her death. The alkali had probably destroyed the lining membrane of the stomach, and had thus impaired digestion. Afpearances after death. — In recent cases there are marks of the local action of the poison on the mucous membrane of the mouth, throat, and gullet. This membrane has been found softened, de- tached, and inflamed in patches of a deep chocolate color, sometimes almost black. A similar appearance has been met with in the mucous membrane of the larynx and windpipe. The stomach has had its mucous surface destroyed in patches, and there has been partial inflammation. In one instance, as a result of the action of soda, I found it puckered and blackened. The quantity of these alkaline poisons required to destroy life is unknown. The fatal effects depend rather on the degree of concentration of the liquid, than on the absolute quantity of alkali present. Chemical analysis. — Solutions of Potash and Soda have a strongly alkaline reaction ; they are distinguished from those of their re- spective carbonates by giving brown pre- Fig- 3. cipitates with a solution of nitrate of sil- ver. The Carbonates, on the other hand, yield a whitish-yellow precipitate. Pot- ash is known from Soda by the following characters : 1. Its solution, when not too ' much diluted with water, is precipitated of a canary-yellow color by perchloride of platinum. 2. It is precipitated in granular white crystals, on adding the alkaline liquid gradually to a strong solution of tartaric acid, containing a ,„ , .„ , small quantity of alcohol, and occa- Crystals of Nitrate of Soda, magnified . ti , « • ,-. . , ri 30 diameters. SlOUally StimUg the miXturC. bODA. 18 not precipitated by either of these tests, which will serve equally to distinguish the salts of -potash from those of soda, if we except the acid oxalate and acid tartrate of potash : these, from being but little soluble in water, are not precipitated. 3. If we neutralize the two alkalies by diluted nitric acid, and .crys- tallize the liquid on a slip of glass, — should the alkali be potash, the crystals will have the form of long slender fluted prims ; if soda, of rhombic plates. (Fig. 3.) 4. Potash and its salts are known by their giving a reddish-violet color, while soda and its salts give a bright yellow color to the colorless flame of alcohol. In liquids containing organic matter. — Such liquids are frothy; they possess an alkaline reaction, a peculiar alkaline odor, and are soapy to the feel. The organic liquid may be evaporated to dry- ness, then heated in a capsule to char the animal and vegetable POISONING BY AMMONIA. 129 matter, and the alkali will be recovered from it in a state of car- bonate, by digesting the residuary ash in distilled water. Ammonia. Spirit op Hartshorn. The vapor of strong ammonia is poisonous. It may destroy life by producing violent inflammation of the larynx, or of the lungs and air-passages. It is often injudiciously employed to rouse per- sons from a fit. A case is on record of an epileptic having died under all the symptoms of croup, two days after the application of strong ammonia to the nostrils. This had been employed to rouse him from a fit. A singular case of recovery from the poisonous effects of this vapor, by Dr. Sanchard, is reported in the "Anuales d'Hygi^ne" (Janvier, 1841). A case of poisoning by the vapor breathed in the manufacture of ice from liquefied ammonia is reported (Hiezmann's " Jahresbericht Toxicologic," 1872, p. 470). The effects were chiefly manifested in the lungs, and many days elapsed before recovery took place. Symptoms and appearances. — The strong solution of ammonia pro- duces symptoms similar to those described in speaking of potash, but as it is much more irritating, it produces a choking sensation, followed by intense heat and burning pain in the throat, gullet and stomach. Serious injury to the organs of respiration is one of the results of the action of this poison. A gentleman liable to attacks of fainting died in three days, after swallowing a quantity of a liquid administered to him by his son. This liquid, which was at the time believed to be sal volatile, was, in fact, a strong solution of ammonia. The deceased complained immediately of a sensation of choking and strangling in the act of vomiting. Symptoms of difficulty of breathing set in, with other signs of irritation in the throat and stomach. The mucous membrane of the mouth and throat was corroded, and dissolved, and it was evident that the liquid had caused great local irritation. The difficulty of breath- ing was such as to threaten suffocation, and at one time it was thought that an operation must be resorted to. The state of the patient, however, precluded its performance, and he died on the third day. On inspection, the viscera presented strong marks of corrosion. The covering of the tongue was softened, and had peeled off ; the lining membrane of the air-passages was softened and covered with 'layers of false membrane, the result of inflammation; and the larger bronchial tubes were completely obstructed by casts or cylin- ders of this membrane. The lining membrane of the gullet was softened, and at the lower part, near its junction with the stomach, the tube was completely dissolved and destroyed. There was an aperture in the stomach in its anterior wall, about one inch and a half in diameter ; the edges were soft, ragged, and blackened, pre- senting an appearance of solution. The contents of the stoinach had escaped. On the inside, the vessels were injected with dark- 9 180 POISONING BY NITRATE OF POTASH. colored blood, and there were numerous small effusions of blood in various parts of the mucous membrane. The coats were thinned and softened at the seat of the aperture. The blackened and con- gested appearance of the lining membrane somewhat resembled that which is seen in poisoning by sulphuric or oxalic acid. The mucous matter on the coats of the stomach was feebly add. 'Eo poison of any kind was found in the layer of mucus or in the coats. There was not in any part the slightest trace of ammonia, the poison which had caused the mischief. The deceased had lived three days ; remedies had been used, and every trace of ammonia had disappeared. The immediate cause of death was an obstruc- tion of the air-tubes, as a result of inflammation, caused by the local irritant action of the liquid ; it was quite obvious that a quantity had entered the windpipe. The perforation of the stomach had probably taken place shortly before death, or there would have been marks of peritonitis. The injury tq the stomach and gullet would have been sufficient to cause death, even supposing that the liquid had not penetrated into the lungs. Carbonate of ammonia. — The concentrated solution of this salt (sal volatile) is probably more active as a poison than is commonly supposed. A man in a fit of passion, swallowed about five fluidrachms of a solution of sal volatile. In ten minutes, he was seized with stupor and insensibility ; but upon the application of stimulant' remedies he recovered. He sufl'ered for some time after- wards, from severe irritation about the throat and gullet. A female, set. 19, while in a state of unconsciousness, was made to swallow a quantity of hartshorn. She felt a severe pain in the stomach immediately, and in about an hour afterwards she vomited some blood. This vomiting of blood continued for several days. These symptoms were followed by great irritability of the stomach, and the constant rejection of food. There was obstinate constipa- tion of the bowels, with emaciation and loss of strength. She died in about three months from the time at which she had swallowed the alkaline poison. On inspection, the gullet was found healthy; the orifice, at its junction with the stomach, was slightly contracted. The intestinal opening (pylorus) was contracted to the size of a crowquill, and the coats were thickened. On the posterior wall of the stomach there was a dense cicatrix of the size of half a crown, and from this point fibrous bands ramified in various directions. The duodenum and other parts of the intestinal canal were healthy. (" Med. Times and Gazette," Nov. 26, 1853, p. 554.) Chemical analysis. — Animonia is distinguished from potash and ' soda by its pungent odor and entire volatility. The carbonate of ammonia may be known from other salts by its alkaline reaction, its odor, and its volatility as a solid, and from pure ammonia by its eflfervescing on the addition of an acid. ]S"iTKATB OF Potash. Nitre. Saltpetre. There appears to be some uncertainty in the action of this salt,' both as to the symptoms and the fatal effects on the body. Mr. SULPHATE OF POTASH, 131 Fuller, of Oswestry, communicated to me a case which proved fatal in December, 1863. A man swallowed an ounce of nitre, mixed with water, by mistake for Epsom salts, about nine o'clock in the morning. It produced vomiting with severe pain, but no purging. There was coldness of the surface and lividity of the face. Death took place in three hours. On inspection, the mucous membrane of the stomach was found highly inflamed, especially towards the mid- dle of the greater curvature, where for several inches it resembled scarlet cloth. The pylorus and duodenum were of a deep crimson color. The peritoneal surface was very vascular, especially over the stomach, the vessels having a vermilion red color, as if they had been injected. The heart and lungs were healthy, the blood was fluid and more florid than natural. The other organs presented no unusual appearance. ITo analysis was made of the contents of the stomach, but that the nitre was the cause of death no doubt could be entertained, and a verdict was returned accordingly at the cor- oner's inquest. Analysis. — For the chemical properties and method of detecting this salt, see page 117. Sulphate op Potash. Symptoms and appearances. — The question whether this should be regai'ded as an irritant poisonous salt or not, was much debated among members of the profession, in reference to a case which was tried at the Central Criminal Court in October, 1843. (The Queen v. Haynes.) The accused had given to the deceased, the night before her death, two ounces of sulphate of potash, dissolved in water ; and it was alleged that a fortnight previously to this, she had taken in divided doses, as much as a quarter of a pound of the salt. The Avoman thought that she was' pregnant, but this was disproved by an examination of the body ; and it was charged that the prisoner had given her the salt with the intention of causing a^ miscarriage. After the last dose, she was seized with sickness, audi died within a very short time. The stomach was found empty,, but highly inflamed ; and there was blood eff'used on the brain.. One 'medical witness referred death to the action of the sulphate- as an irritant poison ; the other to apoplexy, as an indirect result of the violent vomiting caused by it. The prisoner was acquitted: of the charge of murder, but subsequently found guilty of admin^ istering the substance with intent to procure abortion. Both of the witnesses admitted that, in small doses, the salt was innocent ;. but that in the dose of twoounces, it might produce dangerous effects.. Several other fatal cases are recorded. (See "Ann. d'Hygi^ne,"' Avril, 1842.) According to Mr. Mowbray (" Medical Grazette," vol. 88, p. 54),, sulphate of potash is much employed in France as a popular abor- tive. He quotes several instances in which, in large doses, it pro- duced severe symptoms, resembling those of irritant poisoning, and. even death. In one case, two drachms acted powerfully ; and. in another that fell under his own observation, four drachms of the 132 SALTS OF BAETTA. salt aclministered to a lady after her confinement, had all the efiects of an irritant poison. There is no doubt that the most simple purgative salts may, under certain circumstances, and when given in large doses, destroy life. A case is elsewhere related, in which sulphate of magnesia caused death, and gave rise to a criminal charge in this country. (On Poisons," 2d ed. p. 4.) It is said that sulphate of potash has in some cases caused vomiting and other serious symptoms, from its containing as impurity sulphate of zinc. This, if present, would he easily discovered by the appropriate tests. A more serious impurity has been lately detected by Mr. Bussy, namely the arseniate of potash. He found this poison in a sample of sulphate, supplied by a wholesale house in Paris. (" Pharm. Journ." May, 1872, p. 954.) This impurity may be derived from arsenical sulphuric acid used in its manufacture. It would be proper to test for arsenic any sample of sulphate which has caused irritation. (See Arsenic.) Arsenic may thus find its way into all medicines in which sulphate of potash is used, e. g., the compound colocynth pill and the compound powder of ipecacuanha. Sulphate of potash may be easily identified. It is in hard dry crystals, soluble in water, forming a neutral solution in which potash and sulphuric acid may be discovered by the appropriate tests. Salts of Baryta. Chloride of barium. Symptoms.— A woman, set. 23, took by mis- take for Epsom salts less than a teaspoonful (100 grains) of the chloride. This was at 12.30,1st October, 1858. In half an hour there was a feeling of deadly sicknes8,,with sharp burning pains in the stomach and bowels. Vomiting and purging set in violently, the purging being attended with straining. An hour and a half after she had taken the poison, the following symptoms were ob- served by Mr. "Walsh. Face pale and anxious, eyes deeply sunk, surface cold, heart's action feeble, pulse scarcely perceptible, tongue natural and warm, loss of muscular power, sensation and intelli- gence not affected, pupils natural. Fluids taken were instantly rejected with a ropy mucus. There was pain in the stomach, sing- ing in the ears, twitching of the face, and twisting of the legs and arms. At 9 P. M. the syniptoms had abated, but at 2 A. M. (z. e. in about fourteen hours) the purging had returned, and the symptoms were much worse. There was a loss of voluntary muscular power. The breathing was slow and labored, and indicated effusion in the bronchial tubes, but the woman was sensible. Soon after 3 A. M. she was convulsed, and these convulsions continued in paroxysms for two hours, when she died, seventeen hours after taking the poison. During the fits she had several watery evacuations, and consciousness was lost. There was no post-mortem examination. ("Lancet," 1859, vol. 1, p. 211.) The Carbonate of baryta is said to have destroyed life in two PHOSPHORUS. 133 cases, in each of which only one drachm was taken ; but the follow- ing case, which occurred to Dr. Wilson, shows that this compound is not so poisonous as the chloride. A young woman swallowed half a teacupful of the powdered carbonate, mixed with water, at a time when she had been fasting twenty-four hours. There was no particular taste. In two hours, she experienced dimness of sight, double vision, ringing in the ears, pain in the head, and throbbing in the temples, with a sensation of distension and weight at the pit of the stomach. There was also palpitation of the heart. After a time she complained of pain in the legs and knees, and cramps in the calves. She vomited twice a fluid like chalk and water. The skin was hot and dry, the pulse frequent, full, and hard. The symptoms gradually abated, and she recovered, although the pain in the head and stomach continued for. a longtime. ("Med. G-az." xiv. 448.) The carbonate is used as a poison for rats and mice. Analysis. — Chloride of barium crystallizes in plates : it is soluble in water. 1. The solution yields an insoluble white precipitate with sulphuric acid or an alkaline sulphate. This precipitate is nearly insoluble in nitric acid. 2. The powdered salt, burnt on platinum wire in a smokeless flame, imparts to it a greenish-yellow color. 3. Chlorine may be detected by a solution of nitrate of silver. Carbonate of baryta is a white insoluble powder. It is entirely dissolved with eftervescence (carbonic acid) by diluted hydrochloric acid. On evaporation, it yields crystalline plates of the chloride of barium, which may be tested by the processes above mentioned. CHAPTEIi X. PHOSPHORUS. — SYMPTOMS AND APPEARANCES. — CHRONIC POISONING. — FATAL DOSE. — CHEMICAL ANALYSIS. — RED OR ALLOTROPIC PHOS- PHORUS. Phosphorus is not often used in attempts at murder. The smell and taste as well as luminosity commonly reveal its presence. At the Norwich Autumn Assizes, 1871 {liey.. v. Fisher)^ a girl of eighteen was convicted of an attempt to poison a family. She put a vermin compound containing phosphorus into a teapot containing tea. When hot water was poured on it, the smell at once led to suspicion. Phosphorus was found in it, taken from a pot care- lessly left about the house. The girl was convicted, and sentenced to penal servitude for life. The late Professor Casper of Berlin, describes a case in which the luminous appearance of the poisoned food led to a suspicion of poisoning with phosphorus, and this was subsequently proved. A woman put a preparation of phosphorus into some soup, and gave it to her husband. lie ate it in a dark 134 PHOSPHORUS — SYMPTOMS. room in the presence of some friends, and they noticed that the liquid as he stirred it was luminous. (Vierteljahrsschrift, July, 1864.) In this way a person may be warned and a life saved. (See "Ann. d'Hyg." 1870, 2, 203.) Symptoms. — Phosphorus acts as an irritant poison, but its opera- tion is attended with some uncertainty^, according to the state in which it is taken. The symptoms are frequently slow in appearing: it is only after some hours, and sometimes even one or two days, that signs of irritation with convulsions and spasms appear; but when these once come on, the case proceeds rapidly to a fatal termination. In the first instance the patient experiences a disa- greeable taste resembling that of garlic, which is peculiar to this poison. An alliaceous or garlic odor may be perceived in the breath. There is an acrid burning sensation in the throat, with intense thirst, nausea, severe pain and heat, with tenderness and a pricking sensation in the stomach, followed by distension of the abdomen and frequent vomiting. The vomited matters are black, or of a dark green or cofiee-ground color, and have the odor of garlic : white vapors may be seen to proceed from them, and in the dark they may even appear phosphorescent. Purging has been noticed among the symptoms, and the motions have been observed to be luminous in the dark. The pulse is small, frequent, and scarcely perceptible. There is great -prostration of strength, and coldness of the skin with other symptoms of collapse. The patient may die quietly in a coinatose state, or be convulsed before death. Jaundice has been observed among the symptoms. A woman, set. 26, swallowed a decoction of lucifer-matches in coffee. In an hour an emetic was given to her, and she vomited half a pint of clear glairy fluid, having the smell of phosphorus, and containing particles of blue coloring matter (Prussian blue) derived from the matches. She had no pain in the stomach, and no purging. In four days she appeared to have recovered ; but about this time there was bleeding from the nose ; she was jaun- diced, and blood appeared in the matter vomited. Febrile symp- toms set in with purpura, and she died in about a week after taking the poison. (" Ed. Monthly Journal," Oct. 1860.) On April 20, 1861, a girl swallowed a quantity of phosphorus paste. When seen soon afterwards by Mr. Parsons of Bridgewater, her lips as well as parts of her dress were smeared with this substance, and there was a strong odor of phosphorus in her breath. Her countenance was tranquil : her pulse regular : there was no sickness or nausea, and she complained of nothing but slight thirst. Her -Symptoms ivere so slight that they excited no suspicion that the girl had swallowed the poison. She passed a restless night, and the next day she com- plained of heat in the mouth and throat, and of a slight sensation of nausea and retching. There was no pain or tenderness in the region of the stomach, the pulse was regular but weak. On the 22d she dressed herself and was able to walk about the ward : she left the hospital and went home, having walked a mile : she had her tea as usual at night, and went to bed. On the following day, PHOSPHORUS — APPEARANCES. 135 the 23d, she complained of pain in her bowels, with sickness and purging. These symptoms became worse. On the 25 th there was pain in the bowels, which were tender on pressure and slightly tympanitic. The pulse was intermittent, and the girl was fast sinking. She died on the 26th, having survived the effects of the poison nearly a week, and no well-marked symptoms having set in until the fifth day. An inspection of the body was not permitted, and the only fact observed after death was a tendency to rapid putrefaction. The whole of the body became speedily livid, and the finger-nails were blue — a condition noticed by a witness to have existed before death. (For other cases, see " Ann. d'Hyg." 1869, 2,397.) _ J'S ' It will be perceived that, in reference to the delay in the appear- ance of symptoms, their slightness taken as a whole, and the time at which death occurred, this case is similar to the one previously related. If it were not for the peculiar character of the circum- stantial evidence, these cases might easily throw a pi'actitioner off his guard in forming an opinion. Chronic poisoning. — Chronic poisoning by phosphorus is accom- panied by nauseous eructation, frequent vomiting, a sense of heat in the stomach, purging, straining, pains in the joints, wasting, hectic fever, and disease of the stomach, under which the patient slowly sinks. Some interest is attached to the chronic form of poisoning by phosphorus from the researches of Dr. Strohl and others, on the effects of the vapor upon persons engaged in the man- ufacture of phosphorus or lucifer matches. It has been remarked that such persons have suffered from necrosis of the jaw, carious teeth, and abscesses. There has been also great irritation of the respiratory organs, and bronchitis has frequently shown itself among them. (See " On Poisons," 2d edit. p. 345.) Appearances. — Among the appearances produced by phosphorus are marks of irritation and inflammation in the stomach and intes- tines. The stomach has been found much contracted, and its mucous membrane inflamed, occasionally softened and presenting purple or violet-colored spots. Mr. Worbe found the stomach per- forated in three places in a dog which had been poisoned by a solu- tion of phosphorus in oil. In one fatal case the body was found in a state of great muscular rigidity. The membranes of the brain were congested, and there was serious effusion between them. The substance of the brain was also congested. The heart was flaccid and nearly empty. The mucous membrane of the stomach, gullet and, small intestines was very red, and there were patches in which the membrane was destroyed. When the stomach was opened, a white vapor escaped, accompanied by a strong smell of phosphorus. This organ contained a tablespoonful of a viscid greenish matter, from which particles of phosphorus with some Prussian blue (used as a coloring for the phosphorus paste), subsided on standing. ("Lancet," June 13, 1857, p. 600.) The mucous membrane has been found raised in small bladders or vesications, but this appear- ance was probably owing to putrefaction, as the body was not 136 PHOSPHOBUS — PERIOD OF DEATH, examined until twenty-three days after death. Schuchardt de- scribes the blood as dark and fluid, and it does not become red on exposure to the air. Ecchymoses are sometimes found on the skin and on the surfaces of various organs. (" Brit, and For. Med. Eev." 1857, vol. 19, p. 606. " Journal de Chimie M^dicale," 1857, p. 84.) Among the appearances met with in the acute form of poisoning is a fatty degeneration of the voluntary muscles as well as of the liver, heart and kidneys. (See a paper on this subject by Dr. Moore, "Dublin Medical Press," :N"ov. 15, 1865.) The viscera, and even the flesh of animals recently poisoned by phosphorus, have the peculiar odor of this substance, and they are frequently luminous in the dark. (G-altier, " Toxicologie," vol. 1, p. 184.) Mr. Clowes informed me, that in examining some fowls which had been poisoned with phosphorus, he was struck with the strong odor of this substance on opening the gizzards, and with the appearance of a line white fume, which was luminous when ob- served in a dark room. In the case of a woman who died while taking phosphorus medicinally, it was remarked that the whole of the viscera were luminous, — thus indicating the universal diflfusiom of this poison by absorption. (Casper's " Wochenschrift," 21 and 28 Feb. 1846, 115, 135.) Fatal dose. — That phosphorus is a powerful poison, is proved by two cases quoted by Sir E,. Christison. In one, death was caused by a grain and a half in twelve days ; in the other, by two grains in about eight days. It has been supposed to operate as a poison only by becoming converted into phosphorous acid ; but although this conversion takes place, it is probable that phosphorus passes directly into the blood, since the urine voided during life has been observed to be luminous : hence it is itself probably a blood-poison. Period at which death takes place. — This has varied greatly, in the cases hitherto observed, from a few hours to a week. In a case related by Orfila, death took place in four hours. In another also related by him, death occurred only after seventeen days. Dr. Habershon quotes a case which is said to have proved fatal in half an hour. (" Med. Chir. Trans." 1867, vol. 50.) This is the shortest period recorded. In general, several days elapse before a fatal result occurs, and during this time the patient undergoes much suffering. This was observed in a young woman who swallowed a quantity of phfisphorus-paste intended for poisoning rats. She did not die until the fifth day. (" Journal de Chimie M^d." 1845, p. 508.) In two cases of acute poisoning Avith phosphorus communi- cated to me by the late Dr. W. D. Moore, one proved fatal in seventy-two, and the other in eighty-eight hours. The symptoms and appearances were similar to those already described. Fatty degeneration of the diver and other organs was especially marked. (" The Medical Press," Nov. 15, 1865, p. 434.) In a case which occurred to Dr. Anderson, a child aged one year and eight months had sucked the heads off about twenty phosphorus-matches before it was detected. 'Eo symptoms appeared until the second day, when the child was drowsy and slept for twenty hours. Castor oil PHOSPHORUS — ANALYSIS. 137 and oil of turpentine were given. On the fourth day, it vomited ; the skin vras hot, tongue dry, there was great thirst with a quick pulse and cold extremities. On the sixth day, there was much vomiting of a matter like coffee-grounds (altered blood). There was great pain in the stomach ; the child became unconscious, and gradually sunk, dying on the seventh day after taking the poison. There was no purging, but the motions were passed involuntarily, containing coagulated blood. An alliaceous odor was perceived in the breath during the progress of the case, and the body had a yellowish (icteric) tint. There was no odor of phosphorus noticed on post-mortem inspection, nor were the viscera luminous in the dark. Phosphorus could not be detected by Mitscherlich's pro- cess. (" Lancet," 1871-2, 189.) Chemical analysis. — Phosphorus is a solid, of waxy consistency, having a peculiar odor and taste resembling garlic. It is the odor and taste which prevent it from being criminally employed as a poison, and render it easy of detection in articles of food. It evolves a white vapor in daylight, and a faint bluish luminosity in the dark. It melts and takes fire at a temperature of 113°, burn- ing with a bright yellow flame, and producing thick white acid vapors by combustion. It is not soluble in water, although water in which it has been kept acquires poisonous properties by reason of the phosphorous acid formed. It is dissolved by alcohol, ether, chloroform and the oils. Its most perfect solvent is the sulphide of carbon. Organic ynixtures. — The smell which phosphorus imparts to solids and liquids is remarkably characteristic. When it has been taken in a solid form, the particles may be separated as a sediment, by Avashing the contents of the stomach in water. These may be melted under water into one mass, either by plunging the tube containing them into hot water, or by pouring hot water upon them in a glass. If a portion of the organic liquid is exposed in the dark, the particles of phosphorus will be easily recognized by their luminosity, as well as by their combustion when the surface on which the material is spread is heated. Owing to its great solu- bility in sulphide of carbon, phosphorus may be separated from many organic matters by digestion with this liquid. It is thus procured from flour and phosphorus-paste, or from the residue of the contents of the stomach after washing and decantation. On the spontaneous evaporation of the sulphide, decanted from the organic liquid or solid, the phosphorus may be procured in small globules or beads. These are ignited when touched with a hot wire, and burn with the bright flame of phosphorus. If the phosphorus is in a state of solution, or is in too small quantity to be dissolved out of the material by sulphide of carbon, its presence may be indicated by distilling the liquid containing it in the dark — the boiling point being raised by the addition of sul- phuric acid. The vapor appears luminous as it is condensed in the glass condensing-tube. So delicate is the process of distillation, which was first suggested by Mitscherlich, that in one experiment 138 PHOSPHORUS — IODINE. with the head of a single lucifer-match the luminosity appeared for half an hour in the condensing-tube. The most absolute darkness is required for the success of this experiment. [It should be remembered that the presence of the vapor of alco- hol, chloroform, etc. (substances in which the viscera of the body may have been preserved), may entirely prevent the luminosity in the above experiment. — R.] If the person has survived several days, it is not likely that any free phosphorus will be found in the stomach or contents. !N"one was found in the stomach contents or fatty liver of the girl on the sixth day (page 134), but the distillation process succeeded with the broken top of the pot which had held the phosphorus-paste, although this was empty and had been thrown into a tub of water. In Dr. Habershon's case of death on the fifth day, none was found by Dr. Stevenson in the stomach or contents. The phosphorus in these cases is oxidized rapidly, and thus, like other poisons, it may disap- pear from the body. Under these circumstances, it may according to some authorities be still discovered as phosphoric acid, combined with some base — probably ammonia ; but as the phosphates are found in the secretions, which are generally acid, it would be difficult to satisfy an English court that their presence proved IMisoning by phosphorus, unless the symptoms, appearances and circumstantial evidence were so strong that chemical evidence was scarcely necessary. The remarkable substance, known under the name of allotropic phosphorus, is not possessed of poisonous properties. This fact, long since announced by Liebig (" Letters on Chemistry," 165), has been since confirmed by experiment. It has been given to animals in doses of thirty grains without causing symptoms of poisoning. In October, 1860, a woman, set. 26, swallowed the composition scraped from a number of lucifer matches made with allotropic phosphorus. She suffered no inconvenience. She procured other matches of common phosphorus, took a decoction of them in coffee, and died from the effects. Analysis. — Allotropic phosphorus is easily recognized by its red color and infusibility. When a mixture containing it is heated to about 500°, it burns like common phosphorus, and yields similar products. It is insoluble in all liquids, and by its insolubility in sulphide of carbon it is distinguished and separated from common phosphorus. It has no odor or faste, and is not luminous in the dark. Iodine. Symptoms. — ^From experiments on animals, as well as from obser- vation of its effects on man, iodine has -a strong local action as an irritant on the stomach and bowels. In large doses, it occasions a burning heat in the throat, severe pain in the abdomen, with vomit- ing and purging ; the vomited matters having the peculiar odor of iodine, and being of a yellow color, except when any farinaceous food has been taken, in which case they are blue, or even black. IODINE. 139 The fecal matters may also contain iodine if the poison has been taken in the solid state. Besides these symptoms, there is great thirst, with anxiety, headache, giddiness, trembling and convul- sive movements of the limbs, and fainting ; these last symptoms indicating that the poison has become absorbed. When taken for some time in small doses, it gives rise to salivation, vomiting and purging, pain in the stomach and cramps ; the pulse becomes'small and frequent ; there is a general wasting of the body ; and it has been observed that, in this form of chronic poisoning, certain glands are liable to become affected and diminished by absorption — the breasts in the female, and the testicles in the male. Iodine pro- duces these secondary effects (iodism), whether it is taken inter- nally, or applied externally. Iodine is rarely used as a poison. In May, 1864, an attempt was made by a woman to poison a fellow-servant by mixing tincture of iodine with food in a plate. The remarkable discoloration of the farinaceous food which it produced led to suspicion, and prevented any ill effects from following. Iodine gives a blue, green, or dark color to most organic liquids, and imparts to them a peculiar odor. It stains the skin and other organic substances yellow, the color being removed by an alkali. When in strong solution, it is corro- sive, and destroys the parts which it touches ; in this state it has been maliciously employed for throwing on the person. Appearances after death. — As this is an irritant as well as a corro- sive poison, the lining membrane of the gullet, stomach and intes- tines is found inflamed and excoriated. In one instance, the mucous membrane near the pylorus was corroded, and detached in a space of two or three inches. Analysis. — The odor is sufficient to identify it. This may be concealed by alkalies or alkaline substance. When heated, it sublimes in a purple vapor. The addition of a cold solution of starch produces a blue color, but many substances prevent this re- action. It is very soluble in sulphide of carbon, forming a rich pink solution. The sulphide has the property of removing it from water and other liquids in which it is dissolved. It may thus be separated for chemical examination, by decanting the watery liquid from the sulphide which, on evaporation, leaves the iodine in crystals. 140 ARSENIC — SYMPTOMS. METALLIC IRRITANTS. CHAPTER XI. ARSENIC. — ARSBNIOUS ACID. — SYMPTOMS. — CHRONIC POISONING. — APPEARANCES AFTER DEATH. — FATAL DOSE. — CHEMICAL ANALYSIS. — ARSENITES. — ARSENIC ACID. — ORPIMENT AND OTHER COMPOUNDS. White arsenic. Arsenious acid. — The term White Arsenic is commonly applied to the arsenious acid of chemists. It is seen under the form of a white powder visibly crystalline in a strong light, or when viewed with a lens. It is also met with, but more rarely, in opaque brittle masses resembling enamel. It is called an acid from its power of combining with alkalies, but it possesses a feeble acid reaction when dissolved in water. It is often described as having an acrid taste, but this does not appear to be correct ; a small quantity of it has certainly no appreciable taste, a fact which may be established by direct experiment, and might be inferred from its sparing solubility in liquids. It would appear from nu- merous cases on record, that it has been unconsciously taken in fatal quantities, in all descriptions of food, without exciting the least sensation on the tongue. Most of those persons who have been criminally, or accidentally destroyed by arsenic, have not been aware of any taste in taking the poisoned substance. In eases in which the powder has been taken in large quantity, it is described as having had a roughish taste. Water boiled for an hour on the poison and allowed to cool, holds dissolved the 40th part of its weight, or about twelve grains in one ounce. If boiled for a shorter time, not more than the 80th part will be dissolved. Cold wa'ter allowed to stand for many hours on the poison does not dissolve more than from the 1000th to the 500th part of its weight ; i. e. one half grain of arsenic to neai'ly one fluidounce of water. When arsenic in powder is mixed with cold liquids, a portion of the powder floats and adheres to the sides of the vessel. This appear- ance has sometimes led to a suspicion of poisoning. Symptoms. — These will vary according to the form and dose in which the poison has been administered. The time at which they come on, is generally in from half an hour to an hour after the poison has been swallowed. This is the average period. I have known them to appear in a quarter of an hour. In all cases in which arsenic enters the system from without, as by its application ARSENIC — SYMPTOMS. 141 to the skin, or to ulcerated or diseased surfaces, the symptoms ar« rarely manifested until after the lapse of some hours, or even days. The person first experiences a feeling of sinking or faintness, de- pression, nausea, followed by sickness, with an intense burning pain in the region of the stomach, increased by pressure. The pain in the abdomen becomes more and more severe, and there is violent vomiting of a brown turbid matter, mixed with mucus, and some- times streaked with blood. These symptoms are followed by purg- ing, which is more or less violent, and this is accompanied by severe cramps in the calves of the legs. The matters discharged from the stomach and bowels have had in some instances a yellowish color, as it was supposed, from a partial conversion of the poison of sul- phuret, but more probably from an admixture of bile. The vomited matters are in some cases colored with blood, and the mixture of blood with bile has often given to them a green or brown color. In other cases, they may consist of a large quantity of mucus ejected in a flaky state and having a milky-white appearance, as if from admixture with the poison. The color of the vomited matters may be blue or black when colored arsenic has been taken, or the admix- ture of bile may render them of a deep green color. The vomiting is in general violent and incessant, and is excited by any liquid or solid taken into the stomach. There is tenesmus (straining), and the discharges by the bowels are frequently tinged with blood. There is a sense of constriction, with a feeling of burning heat in the throat, commonly accompanied by the most intense thirst. The pulse is small, ver}' frequent, and irregular ; sometimes wholly imperceptible. The skin is cold and clammy in the stage of col- lapse ; at other times ' it is very hot. The respiration is painful from the tender state of the stomach. There is great restlessness, but before death, stupor sometimes supervenes, with paralysis, tetanic convulsions, or spasms in the muscles of the extremities. In one instance trismus (lock-jaw) appeared in three-quarters of an hour. (" Orfila," vol. 1, p. 449.) Although pain is in general among the early and well-marked symptoms, arsenic appears in some cases to destroy sensibility. In a case in which the stomach was found intensely inflamed after death, the patient complained of no pain during the time she survived. [Cases of poisoning by arsenic present the greatest possible variety in the character, combination and severity of the symptoms. Most frequently the symptoms are those just described. In a second class, they are those of collapse — there being extreme prostration of strength, a cold clammy skin, a frequent, almost imperceptible pulse, or one as low as thirty or forty beats in a minute. A third class is marked by the patient falling into a profound sleep, which terminates in a fatal coma. (See " Guy's Forensic Medicine," 1868.)— E,.] Chronic poisoning. — Should the person recover from the first eft'ects, and the case be protracted, or should the dose have been small and administered at intervals, there will be infiammation of the conjunctivae, with sufl["usion of the eyes and intolerance of light, 142 AESENIC — APPEARANCES AFTER DEATH. conditions which are, however, often present among the early symptoms above described. (" Med. Times," Aug. 30, 1,851, p. 229.) There is also irritation of the skin, accompanied by a vesicular eruption, which has been called eczema arsenicale. Sometimes this has assumed the form of nettle-rash or of the erruption attending scarlet fever. Local paralysis, preceded by numbness or tingling in the fingers and toes, and other symptoms of nervous disorder, are also common consequences. Exfoliation of the cuticle and skin of the tongue, with the falling oft" of the hair, has likewise been, witnessed. (Case of the Turners^ 1815, Marshall, 119.) Saliva- tion has been observed to follow, especially when small doses of the poison have been given for a length of time. (" Med. Gaz." vol. 16, p. 790.) Strangury and jaundice have been noticed among the secondary symi:)toms. (" Marshall on Arsenic," 44, 111.) Arsenic is not an accumulative poison ; it is temporarily deposited in the organs after absorption, but is rapidly eliminated by the urine ; and in from two to three weeks, if the person survives, the whole of that which has been absorbed may be removed from the body. Dr. C. Maclagan states that it begins to pass out of the body by the urine as early as three-quarters of an hour after it has been taken (p. 50). Appearances after death. — The principal changes produced by arsenic are generally confined to the stomach and boM'els. They are commonly well marked in proportion to the largeness of the dose, and the length of time which the person has survived after taking the poison. Our attention must be first directed to the stomach. A rsenic seems to have a specific effect on this organ : for, by whatever channel the poison may have entered into the system, whether through a wounded, diseased, or ulcerated surface, or by the act of swallowing, the stomach has been found inflamed. The mucous membrane of the stomach is sometimes partly detached and is covered with a layer of mucus, mixed with blood or bile, and with a thick white pasty-looking substance containing arsenic. It is commonly found red and inflamed in dotted or striated patches, extending between the two apertures ; the color, which is of a dull or brownish-red, becomes brighter on exposure to the air: at other times it is of a deep crimson hue, interspersed with black- looking lines, or patches of altered blood. The redness is usually most strongly marked at the greater end ; in one case it may be found spread over the whole raucous surface, giving to it the appear- ance of red velvet ; in another it will be chiefly seen on the promi- nences or folds of the membrane. In one instance, the coats were thickened and of a gelatinous consistency, without any marked inflammatory redness. The stomach has been found highly inflamed in a case which jDroved fatal in two hours. Thus it would appear that intense inflam- mation of the mucous membrane may be observed within a very short period. This organ usually contains a mucous liquid of a dark color tinged with blood. The coats are sometimes thickened in patches, being raised up into a sort of tumor, with arsenic AESENTC — FATAL DOSE. 143 imbedded in them : at other times they have been found thinned. The mucous membrane is rarely found ulcerated, and still more rarely gangrenous. Ulceration of the membrane, as the result of the action of arsenic, has been found as early as ten hours after the poison had been taken. Perforation of the coats is not a common result of arsenical poisoning : there are but few instances on record. Various appearances are said to have been met with in the lungs, heart, brain and urinary organs ; but they are not so characteristic of arsenical poisoning as to admit of medico-legal use in enabling a medical man to distinguish poisoning from disease. It is to the stomach and intestines that he must look as the basis of reliable evidence in regard to appearances after death. Dr. "Wilks met with an ecchymosed condition of the lining membrane of the left ventricle of the heart in a case in which a man died in twelve hours, from acute poisoning by arsenic. In a few instances, the mouth, throat and gullet have been found inflamed, but in general there are no changes in these parts to attract particular attention. The mucous membrane of the small intestines may be inflamed throughout, but commonly the inflammatory redness is confined to the upper part, i. e. the duodenum, especially to that portion of it Avhich joins the stomach. Of the large intestines, the rectum appears to be the most prone to inflammation. The liver, spleen and kidneys present no appearances which can be connected with the action of arsenic, although these, like the other soft organs, may become receptacles of the absorbed poison. It is worthy of observation in relation to the known antiseptic properties of arsenic, that the parts especially afl^ected by this poison (the stomach and intestines) occasionally retain the well-marked character of irritant poisoning for a long time after death. Absorbed arsenic does not,- however, appear to prevent the decomposition of the soft organs in which it is deposited. Arsenic may destroy life as the result of external application to any diseased or ulcerated surface, or to a wound. (See " Guy's Hospital Eeports," Oct. 1864, p. 220.) ^atal dose. — The smallest /ate? dose of arsenic hitherto recorded is two grains. ("Provincial Med. Journal," June 28, 1848, p. 347; also "Medical Gazette," vol. 39, p. 116.) Under circumstances favorable to the operation of this poison, the fatal dose in an adult may be assigned at from two to three grains. Large doses of arsenic commonly destroy life in from eighteen hours to three days. The average time at which death takes place is twenty-four hours ; but the poison maj"^ destroy life within a much shorter period. In a case which occurred in April, 1849, death took place in two and a half hours. (" Guy's Hospital Reports," Oct. 1850, 183. See also " Ann. d'Hyg." 1837, vol. 1, p. 339.) Mr. Foster of Huntingdon, met with the case of a child under three years of age, who died within two hours from the eftects of arsenic. One case is said to have proved fatal in twenty minutes. On the other hand, life is occasionally protracted for many days. In October, 1847, a man who had swallowed 220 grains of arsenic was admitted into Guy's 144 ARSENIC — APTALYSIS, Hospital, and died on the seventh day. In the case of Dr. Alexan- der, death took place on the sixteenth day ; and although a large quantity of arsenic had been taken, no traces were found in ttie body. (" Med. Times and Gazette," April 18, 1857, p. 389.) In an instance in which ai'senic was applied externally to the head, the person did not die until the twentieth day. The longest duration of a case of poisoning by arsenic is probably that reported by Belloc. A woman, set. 56, employed a solution of arsenic in water to cure the itch, which had resisted the usual remedies. The skin became covered with an erysipelatous eruption, and the itch was cured, but she experienced severe suffering. Her health gradually failed, and she died after the lapse of two years, having suffered during the whole of this period from a general tremor of the limbs. (" Cours de M^d. L^g." 121.) A girl, set. 9, died rather suddenly, after an illness of about ten days. The mother had rubbed some precipitate ointment mixed with arsenic on the head of the child which was diseased. Her object, she stated, was to kill the vermin on the scalp. No symp- toms of note were observed until about the fifth day after the application, when the child appeared ill and complained of thirst. On the eighth day she was very unwell ; there had been cramp, with slight action on the bowels, but no vomiting. She became drowsy, and died on the tenth day. Mr. Ha ward examined the body, and forwarded to me the viscera for chemical analysis, the case being very obscure. The lining membrane of the stomach and duodenum was inflamed : in the stomach the inflammation was well marked towards the greater end : these were the principal post- mortem appearances. Traces of arsenic were found in the mucous fluids of the stomach, in the coats of the stomach and intestines, and in four ounces of the liver, but arsenic of a solid form could nowhere be detected. A portion of the diseased hairy scalp was examined, and yielded arsenic as well as mercury (from white pre- cipitate) in large proportion, — the arsenic being estimated at from two to three grains. The remarkable features of the case were these : no symptoms appeared until after the fourth day, and then only great, thirst; there was slight purging, with cramps, on the eighth day, and death took place on the tenth, without any vomiting. Arsenic was found in the stomach and contents, and its presence there might have led to an erroneous inference of its having been criminally administered by the mouth. It was, however, merely in traces, and obviously enough the result of mucous elimination. The nature and mode of occuri-ence of the symptoms were also opposed to any other presumption. That absorbed arsenic may be thus transferred from the blood to the stomach and intestines, has been distinctly proved by the experiments of Dr. Pavy and myself. (" Guy's Hospital Reports," 1800, 6, 397.) Chemical analysis. Arsenic as a solid. — In the simple state, white arsenic may be identified by the following properties : 1. A small quantity of the powder placed on platinum foil is entirely vola- ARSENIC — ANALYSIS. Pig. 4. 145 Fig. 5. Ordinary reduc- tion tube, with two sublimates ; tlie upper, brown- ish black ; the lower, the pure metal in an annu- lar deposit. Crystals of Arsenious Acid by sublimation, magnified 30 diameters. tilized at a moderate heat (370°) in a white vapor. If a small portion of the white powder be very slowly heated in a glass tube of narrow bore, it will be sub- limed without melting, and form a ring of minute octahedral crystals, remarkable for their lustre and brilliancy. TJnder a microscope of high magnifying power (250 diameters), the appearance of these crystals is highly characteristic (Fig. 4). 2. On boiling a small quantity of the powder in distilled water, it is not readily dissolved, but it partly floats in a sort of film, while a part becomes aggregated in small lumps at the bottom of the vessel. It requires long boiling, in order that it should become dissolved and equally diffused through water. 3. When a small portion of the white powder, i. e. from one-fourth to one-twentieth part of a grain, is heated with two parts of soda flux (obtained by incinerating acetate or tartrate of soda in a close vessel) [or with an excess of perfectly dried ferrocyanide of potassium. — E..] in a glass tube about three inches long, and from one-eighth to a quarter of an inch in diameter, it is decomposed : a ring of me- tallic arsenic of an iron-gray color is sublimed and deposited in a cool part of the tube. During the reduction there is a percep- tible odor, resembling that of garlic, which is possessed by me- tallic arsenic only, while passing from a state of vapor to arsen- ious acid. In this experiment of reduction, there are frequently two rings deposited in the tube (Fig. 5) : the upper and larger ring has a brown color, and appears to be a mixture of finely divided metallic arsenic and arsenious acid ; the lower ring is small and consists of the pure metal. The appearance presented by these sublimates is indicated in the annexed illustration. By heating gently the tube containing the sublimate (reduced to powder) in another tube of larger diameter, the metallic arsenic, during volati- lization, forms octahedral crj'stals of arsenious acid, which, after examination by the microscope, may be dissolved in a few drops of water, and tested by one or more of the liquid reagents. The metallic sublimates, or the crystals produced from them, 10 146 ARSENIC — LIQUID TESTS. may be further subjected to the following process: Break the glass on which the sublimate is deposited, into fragments, and digest these in a few drops of the strongest nitric acid containing nitrous acid, previously proved to be free from arsenic. The sublimate is thereby converted into arsenic acid. The acid solution should be evaporated to dryness; the white uncrystalline residue obtained should be dissolved in a few drops of distilled water, and a strong solution of nitrate, or of aramonio-nitrate, of silver added in small quantity to the residue. A brick-red coloration indicates arsenic acid, and thus proves incontestably that the sublimate was of an arsenical nature. The upper or brownish-looking sublimate may be readily converted into one of the pure metal, by gently heating it in the flame of a spirit lamp. Arsenious acid is then volatilized, and an iron-gray deposit of metallic arsenic appears. If the heat is continued, the whole of the metallic sublimate is volatilized and deposited in a cool part of the tube, in transparent and colorless octahedra of arsenious acid. This is the special character of an arsenical sublimate: it may be thus distinguished from sublimates of all metals, or metalloids. The lower metallic sublimate pro- cured by reduction sometimes .presents itself, not in an annual form, but in detached particles of a somewhat globular shape. These are of an iron-gray color, quite unlike sublimed mercury, and when examined by the microscope, it may be seen that they con- sist of crystalline masses nucleated, and that they are not strictly spherical. This sublimate is frequently produced in the last stage, when the residue in the tube is strongly heated. The process of reduction, with the corroborative results above mentioned, is, when thus applied, conclusive of the arsenical nature of the substance under examination. Arsenic insolution in water. Liquid tests. — The solution of arse- nious acid is clear, colorless, possesses scarcely any perceptible taste, and has but a feebly acid reaction. In this state, we should first evaporate slowly a few drops on a glass slide, wh^n a crystalline deposit wiJl be obtained. ' On examining Fig- 6- this with a microscope, it will be found to consist of numerous minute octahedral crystals, presenting triangular surfaces by reflected light. (See Fig. 6.) 1. Silver test. — On adding to the solu- tion of white arsenic ammonio-nitrate of silver, a pale yellow precipitate of arse- nite of silver falls down ; changing, under exposure to daylight, to an olive-green color. The test is made by adding to a strong solution of nitrate of silver, a weak solution of ammonia, and continuing to add the latter, until the brown oxide of silver, at first thrown down, is almost re- dissolved. The yellow precipitate is soluble in nitric, tartaric, Crystals of Arsenious Acid from a fiolutioB, magnified 124 diameters. maesh's peocess. 147 citric and acetic acids, as well as in ammonia. It is not dissolved by potash or soda. 2. Copper test. — On adding to another portion of the solution ammonio-sulphate of copper, a light-green precipitate (arsenite of ■copper) is formed, the tint of which varies according to the pro- portion of arsenic present, and the quantity of the test added: hence, if the arsenic is in small proportion, no green precipitate at first appears; the liquid simply acquires a blue color from the test. In less than an hour,_if arsenic is present, a bright green deposit is formed, which may be easily separated from the blue liquid by decantation. This test is made by adding ammonia to a weak solution of sulphate of copper, until the bluish-white precipitate, at £rst produced, is nearly redissolved; it should not be used in large quantity if concentrated, as the deep blue color tends to obscure or conceal the green precipitate formed. The dried precipitate of arsenite of copper, when slowly and moderately heated in a well-dried reduction-tube, will yield a ring of octahe- dral crystals of arsenious acid — oxide of copper being left as a residue. 3. Sulphuretted hydrogen test. — The gas may be procured by adding to sulphide of iron in a proper apparatus, a mixture of one part of strong sulphuric acid and three parts of water. The arsenical liquid should be slightly acidulated with pure diluted hydrochloric acid, before the gas is passed into it: at least, care should be taken that it is not alkaline. A yellow precipitate (orpiment) is immediately produced if arsenic is present, and it may be collected after boiling the liquid sufficiently to drive off any surplus gas. It is known to be sulphide of arsenicf by the following properties : 1. It is insolu- ble in water, alcohol, and ether, as well as in diluted hydrochloric acid, and vegetable acids: but it is decomposed by strong nitric and nitro-hydrochloric acids. 2. It is immediately dissolved by potash, soda, or ammonia ; forming, if no organic matter is present,, a colorless solution. 3. When dried and heated with three parts, of soda-flux, or an equal part of dry cyanide of potassium [or still better, with dried ferrocyanide of potassium. — R.], it yields a subli- mate of metallic arsenic. Marsh's process. Hydrogen test. — The action of this test depends, on the decomposition of arsenious acid and its soluble compounds,, by nascent hydrogen evolved from the action of diluted sulphuric or hydrochloric acid on zinc. The materials should be first proved, to be free from arsenic. The apparatus is of the most simple kind,, and is so well known as to need no description or illustration. The arsenic may be introduced into the short leg of the tube in the- state of powder ; but it is far better to dissolve it in water, by boil- ing, either with or without the addition of a few drops of hydro- chloric acid. The metallic arsenic combines with the hydrogen, forming arsenuretted hydrogen gas, which possesses the following properties: 1. Filtering paper wetted with a solution of nitrate of silver is immediately blackened by the gas — the silver being re- duced to the metallic state. Lead-paper is not changed in color 148 eeinsch's peocess. unless sulphuretted hydrogen is also present. 2. It burns with a pale bluish-white flame, and thick white smoke (arsenious acid). 3. A slip of glass or white porcelain held in the flame near the point (for not too long a time) acquires a dark stain from the de- posit of metallic arsenic upon it. This deposit presents a metallic lustre in the centre (a), a white film of arsenious acid on the outside (c), and between the two a dark ring of a pulverulent substance (b), which, when viewed by transmitted light, is hair-brown in color towards the margin, but perfectly Fig- 7. opaque in the centre. In order to deter- mine the arsenical nature of the deposits, the following plan may be adopted : Several of them should be received and accumulated in small porcelain capsules, held in the flame of the burning gas. To one, add a solution of chloride of lime; the arsenical deposit is- immediately dissolved. To a second, add a solution of sulphide of am- monium ; the metallic deposit is detached, Deposit obtained by Marsh's but iiot perfectly dissolvcd : yet ou cvapo- ApparaiuB. ration it yields a pale yellow film of sul- A Metal, B Mixed deposit. i-t /• • rn j_i't ii x» c Arsenious acid. P^ide of arscuic. To & third, add a lew drops of the strongest nitric containing some nitrous acid. The deposit is dissolved : evaporate the acid solution gently to dryness ; carefully neutralize the residue, and add one or two drops of a strong solution of nitrate of silver. A brick-red stain, or a dark red precipitate of arsenate of silver will be produced. * lieinsch's process. — In the application of this process, the liquid suspected to contain arsenic, or the solid dissolved in distilled water, is boiled with from one-sixth to one-eighth part of pure hydrochloric acid (proved to be free from arsenic), and a small slip of copper is then introduced. A slip of polished copper foil (electric copper) about a quarter of an inch square, attached to the end of a thin platinum wire, may be employed for the experiment. The copper must be first proved to be free from arsenic, as this is a very com- mon contamination of commercial copper in the form of foil, gauze, or wire. If arsenic is present in the liquid, even in small quantity, the polished copper acquires either immediately or within a few minutes a dark iron-gray coating from the deposit of this metal. This is apt to scale off, if the arsenic is in large quantity, or if the liquid is very acid or long boiled. "We remove the slip of copper, wash it in water, dry it, and gently heat it in a small reduction tube, when arsenious acid will be sublimed in minute ochtahedral crystals : if these should not be apparent from one piece of copper, several may be successively introduced. "When the quantity of arsenic is small, the polished copper merely acquires a faint bluish tint. The deposit is in all cases materially affected by the quantity of water present, or, in other words, the degree of dilution, and sometimes it will appear only after the liquid has been much con- ARSENIC IN ORGANIC MATTERS. 149 centrated by evaporation. The presence of arsenic as an impurity in copper may be detected by the following method suggested by Mr. Abel. Add to pure hydrochloric acid, diluted with six parts of water, one or two drops of a weak solution of persulphate or perchloride of iron. Boil the acid liquid and introduce the copper, well cleaned and polished, into the boiling liquid. Arsenicated copper soon acquires a dark tarnish, while the non-arsenicated (elec- tric) copper retains its color under these circumstances. Arsenic in organic matters. — Arsenic may exist in an insoluble form — i. e., as a crystalline powder — in the contents of the stomach, or any liquid article of food. If coarsely powdered it may be sepa- rated as a heavy sediment, by careful washing with distilled water, and then dried and tested by the reduction process (p. 145). Any liquid for analysis should be strained through muslin or filtered through paper in order to separate all insoluble matters:' these should be well pressed and drained. Should the liquid be colored, this is of little moment, provided it is clear. If viscid, it should be diluted in water, and boiled with a small quantity of hydro- chloric acid ; on standing, a deposit may take place, and this should be separated by a filter. As a trial test, we may now boil in a por- tion of the liquid, acidulated with pure hydrochloric Acid, a slip of pure copper highly polished, and examine any deposit on the metal by the method above described. If the copper comes out unchanged, there is no detectable quantity of arsenic pi'esent. Let us assume that the organic liquid is milk or beer ; it will be necessary to determine whether any arsenic is dissolved in it. Filter a portion; place it in a dialysing tube, and immerse the mouth of the tube in distilled water. In a few hours the arsenic will have traversed the animal membrane, and will be found in a clear and nearly colorless solution in water. The fluid tests may then be applied to this liquid for the detection of arsenic. They should never be applied directly to colored organic liquids. Viscid mucous and farinaceous liquids containing arsenic, may be thus treated, and the arsenic speedily detected. "When arsenic is present in an organic liquid in large quantity, it may be precipitated as sulphide by a current of washed sid- phuretted hydrogen. The liquid should be boiled, filtered, and acidu- lated with hydrochloric acid before passing the gas into it. When precipitation has ceased, the liquid should be again filtered, the pre- cipitate collected, dried, and weighed. By operating on a measured portion of the solution, the amount of white arsenic present may be determined by the weight of the sulphide obtained ; five parts by weight of sulphide being equal to four parts of white arsenic. The properties of the yellow precipitate should be verified accord- ing to the rules mentioned at page 147. In some cases arsenic may be present, but in a quantity too small to be precipitated as sulphide by sulphuretted hydrogen. In others, the presence of certain substances may interfere with or prevent precipitation. The presence of any alkaline in a liquid prevents the formation of a precipitate. For this reason the sul- 150 DISTILLATION PROCESS. phide of ammonium must not be used in place of sulphuretted hydrogen. It does not precipitate a solution of arsenic until an acid is added, and acids will precipitate from the test itself sul- phur, which has been mistaken for the sulphide of arsenic. An erroneous charge of poisoning has been based on this chemical mistake. Distillation process. — "When the poison is in so' small a quantity that it does not admit of precipitation by sulphuretted hydrogen, and no solid particles of arsenic are found in the stomach, in its contents, or in any article of food, another method may be resorted to for detecting its presence. This method equally applies to the detection of arsenic deposited as a result of absorption in the soft organs of the body, as in the liver, kidney, or heart, and to arsenic in all its forms, except the pure insoluble sulphide or orpiment. The substance, whether food, blood, mucus, the liver, or other organ, should be first thoroughly dried, either by exposure to a current of air or by a water-bath. The dried solid should then be broken into small portions and placed in a flask or retort of sufficient capacity, with a sufficient quantity of the strongest hydrochloric acid (free from arsenic) to drench it completely. After some hours' digestion in the cold, the retort or flask (a) containing the mixture Apparatus for distilling organic and mineral substances containing Arsenic. — which should be of such a size that the materials should not fill it to more than one-third or one-half of its capacity — should be fitted with a long condensing tube (c), and then gradually heated by a sand-bath until the acid liquid begins to pass over. A metallic head, formed of a cone of tin plate, should be placed over the retort or flask so as to concentrate the heat and prevent condensation in the upper part of the vessel. A small flask receiver {d) with a loosely-fitting cork may be employed to collect the product. This should contain a small quantity of distilled water so as to fix and condense any vapors that may pass over. -The receiver, as well as the condensing-tube, should be kept cool by wetting its surface with cold water diflused on a layer of blotting-paper placed over it. A perfect condensation of the distilled liquid is insured by DISTILLATION PROCESS. 151 this arrangement. This distillation may be carried to dryness on a sand-bath, or nearly so ; and it may be sometimes advisable, in order to insure the separation of the whole of the arsenic as chlo- ride, to add to the residue on the retort when cold, another portion of pure and concentrated hydi'ochloric acid, and distill to drj'ness. I have, however, found that portions of dried liver and stomach gave up every trace of arsenic by one distillation, when a sufficient quantity of hydrochloric acid had been used, and the process was slowly conducted by a regulated sand-bath heat. The liquid product may be colored, turbid, and highly offensive if distilled from decomposed animal matter. Exposure to the air for a few hours sometimes removes the ofFensiveness, and there is a precipitation of sulphur, or of some sulphide of arsenic. The dis- tillate may be separated from any deposit by filtration, and if still turbid, it may be again distilled at a lower heat to separate it from any organic matter that may have come over. If there is a yellow deposit, it should be examined for sulphide of arsenic. If arsenic is present in the substance submitted to distillation, the distillate will contain arsenic in the form of soluble chloride ; this does not escape from a diluted solution at common tempera- tures. The quantity of dry organic substance used in the experi- ment must depend on the quantity of arsenic present, as revealed by a preliminary trial with Eeinsch's process. If large, two or three drachms of the dried substance, or even less, will yield suffi- cient chloride of arsenic for further proceedings. For the absorbed and deposited poison, half an ounce of the dried organ, correspond- ing to two ounces of the soft organ, will frequently suffice ; but a negative conclusion of the absence of arsenic should not be drawn from a smaller quantity than two to four ounces of the dried sub- stance, whether liver, feidney, or heart. These tissues, it must be remembered, contain about 76 per cent, of water. If oily matters should be distilled over, this may be separated by passing the distillate through a paper filter wetted with water. The distilled liquid, containing chloride of arsenic, should if clear be submitted to a further stage of analysis. For this purpose one- third of it should be diluted with three or four parts of water, and boiled in a clean flask. When boiling, a piece of bright copper-foil (free from arsenic), of about the size of the sixteenth of a square inch, should be introduced. If there is chloride of arsenic in the liquid, even up to the ^ijijoth of a grain, its presence will be indi- cated by a change of color, and by the deposit of a dark metallic film on the copper. If the liquid should be too much diluted for this purpose, it may be concentrated on the polished copper, and the deposit will after a time be apparent. If the quantity of arsenic present is believed to'be very small, the surface of copper introduced should be proportionately small. Bettendorff's process may be also employed for the detection of small quantities of arsenic in the distillate: Add to a solution of chloride of tin its bulk of fuming hydrochloric acid. "Warm this mixture, and then add to it a few drops of the distillate. The presence and proportion of arsenic are 152 DISTILLATION PBOCESS, indicated by a dark-brown precipitate consisting of reduced arsenic. (For an account of this test see "Wigger's " Jahresbericht," 1871, p. 528.) The remaining two-thirds of the distilled liquid, suffi- ciently diluted, should now be introduced into a Marsh's tube, or into an evolution flask provided with a funnel-tube, the capacity of which must be regulated by the quantity of acid liquid to be ex- amined. The kind of apparatus employed in this stage is repre- sented in the engraving. Fig. 9. a the flask with funnel-tube b, and containing piece c ; the funnel-tube should be long enough just to dip below the surface of the acid liquid. The short con- necting piece is bent at a right angle, and, like b, is carried through -"^rmi v. John Day, of Geelong, who has given so much attention to this subject. In all cases in which a doubt may exist, chemical and other pro- cesses should be resorted to for confirmatory evidence. If the stain is of sufficient size, a slip of the dress, with the stain upon it, may be removed and suspended by a thread in a test- tube, containing a small quantity of distilled water. After a tew minutes or a few seconds, should the stain be recent, a red liquid will bo seen falling to the bottom of the test-tube, giving, when the blood is fresh, a red color to the lower stratum of water, and when of old standing, a dark red-brown color. Should the stuff be thick and coarse, or not readily pervious to water, the separation may not take place in less than an hour. If the quantity of colored liquid thus obtained is small, the supernatant clear water may be carefully poured off or drawn off by a pipette ; but it will be found more convenient to use a small tube and a small quantity of water. The colored liquid may then be tested by weak ammo- nia, and by the application of heat, as already described. If ammonia produces any eftect upon the solution of blood, it is simply to brighten it ; this alkali never changes the red color of blood to green or crimson. When the stain is old, the solution in water is very slowly ob- tained, and does not present the bright red color of blood. In some cases, if the stain is of very old standing, and had been much exposed to the atmosphere, water will have scarcely any solvent effect on it, and it maj" be found impossible to obtain a red-colored liquid even after twenty -four hours' maceration. At the most, the water may acquire a pale brown or yellowish color, but wholly un- like that imparted by blood. In such a case it is useless to add ammonia. We may, however, generally form a correct judgment by the microscopical appearance of the stain before wetting it, and by obtaining crystals of hsematin with the use of glacial acetic acid (see p. 309, post). Water may dissolve sufficient albumen (or serum) to become opaline by heat, or by the addition of nitric acid, although we may fail to obtain any evidence of the presence of corpuscles. From the results obtained by spectral analysis (post p. 302), it appears probable that acid and other vapors in the atmos- phere affect blood-stains and altei- their chemical properties. Where much coal is burnt, sulphurous acid may operate in this manner. Under other circumstances, when the quantity of blood effused is moderately large, it may be detected by the process above men- tioned, after the lapse of a considerable time. I have thus de- tected the blood of the human body, and of the bullock, on cotton, DETECTION OP BLOOD ON CLOTHING. 295 linen, and flannel, after the lapse of three years. If the stuff is dyed, we should proceed to examine the stains found upon it by a similar process. The dye is commonly fixed, and is not soluble in water. _ Thus, then, in testing for blood, we rely upon: 1. The solubility of the red coloring matter in water. 2. The negative action of ammonia. 3. The positive effect of heat in entirely co- agulating and destroying the red coloring matter. Should the linen or stuff" which is stained with blood have been heated to a high temperature, the coloring matter may, as a result of coagulation, be rendered insoluble in water : but this is an ex- ceptional condition. In the case of a body found wounded and burnt, it would be proper to allow for such a change, and the chemical evidence would fail. Should the blood-stain be mixed with oil or grease, this will interfere with the solvent action of water. Should it be on a plaster-wall or on wood, we must scrape or cut out a portion, and digest it in a small quantity of water, in a tube or watch-glass. An unstained portion of the plaster or wood should also be examined. There are red stains bearing a resemblance to blood, which are insoluble in water. These may be identified by their special char- acters. Among them are : 1. Certain ret/ c^z/es, as madder, which, when fixed by a mordant, is not readily affected by ammonia. 2. iron moulds. These are of a reddish-brown color, sometimes of a bright or orange red ; they are quite insoluble in water, but are easily dissolved by diluted hydrochloric acid, and on adding ferro- cyanide of potassium to the hydrochloric solution, the presence of iron will be at once apparent. Care should be taken that the acid used for this purpose contains no iron. Another method is to apply to the spot glacial acetic acid, followed in a few minutes by a solution of tannic acid : a bluish stain of ink is produced. Iron- moulds are generally distinguished by their brown color, and by the absence of all stiffening of the fibre on the stained spot. 3. Red paint. Stains made with red paint containing peroxide of iron, have been mistaken for blood. They may be easily known by digesting them in diluted hydrochloric acid, and applying to the solution the tests for iron. Like those produced by iron-moulds, they are quite insoluble in water, and therefore cannot be confounded with blood-stains. The same may be said of spots of the ammonio- nitrate of silver changed by light, which I have known to be mis- taken for old stains of blood. The stuff" on which the spots of blood are found, may be itself stained with a red dye or color, or it may be dyed with iron ; in this case it will be necessary to test by the same process a piece of the colored or stained portion, in order to furnish negative evidence that the suspected stains are due to blood. 4. Among soluble stains resembling those of blood, are the spots produced by the juices of the mulberry., currant, gooseberry, and other red fruits. They may be sometimes recognized chemically, by drop- ping on them a weak solution of ammonia — -when the spot is turned either of a bluish, olive-green, or green color. The red of cochineal is changed to a crimson on the addition of weak ammonia; but a 296 REMOVAL OF BLOOD-STAINS. spot of blood thus treated undergoes no change of color from the addition of the alkali. Diluted acids brighten the red colors of fruit stains, but they do not alter the color of blood. It is also worthy of note that a strong solution of chlorine bleaches the red colors from fruit stains, but when applied to a stain of blood, it turns the red coloring matter of a dark olive-green color, and does not bleach it. These effects are only well observed on white stuffs. If a colored liquid is obtained from a piece of the stained stuff suspended in water, it is easily distinguished from blood, by its ac- quiring a green or crimson tint on the addition of ammonia, and by the red color not being coagulated or destroyed when the liquid is boiled. A solution of chlorine added to the colored liquid also presents a ready means of distinction. The colors of fruits and flowers are instantly destroyed — while the color derived from blood is altered to a dingy olive, and the albumen of the serum is precipi- tated. In some red stuffs, the dye is often so bad, that water will dissolve out a portion of the color ; but in this case, the action of ammonia, heat, and chlorine will serve readily to distinguish the stains from blood. The soluble red or bi'own stains given by woods or roots, such as LogiDood, Brazil-wood, or Madder-root, are changed to a crimson color by ammonia. They contain tannic acid, and ac- quire a dark olive-green color when touched with a persalt of iron. It may be generally remarked of these stains, whether they are soluble or insoluble in water, that, although to the naked eye they may bear a slight resemblance to blood, they are wholly different when examined microscopically. The distinction of color is well marked, and there is an absence of any appearance of coagulum, or of stiffening of the fibre. When thus carefully examined, it is not probable that they can ever be mistaken for blood. Removal of bloodstains. Examination of washed stains. — An attempt may have been made to wash out blood-stains, so that the color may be more or less changed, and no chemical evidence ob- tainable. There is a common notion that certain chemical agents will remove or destroy these stains ; but this is not the case ; the color may be altered, but when dried on the stuff it is not easily discharged or bleached. Chlorine, a most powerful decolorizing agent, turns the coloring matter of blood of a green-brown color. Btypochlorous acid has a similar effect. This acid has been recom- mended as useful by its bleaching properties for distinguishing the stain of blood from all other stains, excepting those produced by iron-rust. Orfila has, however, shown that it is not fitted for such a purpose, and that there are no better methods of testing than those above described. (" Ann. d'Hyg." 1845, 2, 112.) I have found that nothing removes a blood-stain, whether wet or dry, so effectually as simple maceration in cold water, although, when the stain is old, the process is sometimes slow. Washed stains maj now be readily detected by means of guaiacum, provided they are on a colorless article of clothing. A drop of the tincture is poured on the stuff, and if there is no change of color, peroxide of hydrogen is added. The blue color appears immediately, and becomes more DETECTION ©F BLOOD ON WEAPONS. 297 intense by the evaporation of the ether, or on the addition of alcohol to dissolve the white resin. On an important trial for murder, at the Shrewsbury Lent Assizes, 1841 {Reg. v. Misters), this question as to the power of certain chemi- cal reagents in discharging stains of blood was raised. Alum was traced to the possession of the prisoner ; it was found dissolved in a vessel in his bedroom, and it was supposed that he had removed the blood-stains from his shirt by the use of this salt. Two medical witnesses deposed that they had made experiments, and had found that alum would take the stains of blood out of linen ; according to one, sooner than soap and water. The results of my experiments do not correspond with these. I have not found that alum removes stains of blood so readily as common water; and when alum is added to a solution of hseraatine in water, so far from the color being discharged, it is slowly converted to a deep greenish-brown liquid. In one experiment, a slip of linen having upon it a stain of dried blood of old standing, was left in a solution of alum for twenty -four hours, but not a particle of the red coloring matter had been extracted, although it was changed in color. The eftect of yellow soap, as well as of potash, soda and their carbonates, is to change the red color of blood to a deep greenish-brown, like many other reagents, but they do not exert on it any discharging or bleach- ing power. Defection of blood on weapons. — When recent, and on a polished instrument, stains of blood are easily recognized ; but when of old standing, or on a rusty piece of metal, it is a matter of some diffi- culty to distinguish them from the stains produced by rust or other causes. If the stain is large and dry, a portion may be easily scraped off; this should be placed in a watch-glass with some dis- tilled water, the solution filtered to separate any oxide of iron, and then tested. If the water by simple maceration does not acquire a red or red-brown color, the stain is 7iot due to blood. If it acquires a red color, the solution may be tested by the methods above de- scribed. Sometimes the stain appears on a dagger or knife either in the form of a thin yellowish or reddish film, or in streaks, and is so superficial that it cannot be mechanically detached. We should then pour a thin stratum of water on a piece of plate-glass, and lay the stained part of the weapon upon the surface. The water slowly dissolves the coloring matter of blood, and the colored liquid may be examined by the chemical processes above recom- mended. If the weapon has been exposed to heat, this mode of testing may fail. There is often a remarkable resemblance to the stains of blood on metal, produced by the oxide or certain vegetable salts of iron. If the juice or pulp of lemon or orange is spread upon a steel blade, and is exposed to the air for a few days, the resemblance to blood pro- duced by the formation of citrate of iron is occasionally so strong that I have known well-informed surgeons to be completely de- ceived : they have pronounced the spurious stain to be blood. These stains, which owe their color to citrate of iron, may be thus distin- 298 ARTERIAL AND VENOUS BLOOD. guished : The substance is soluble in water, forming, when filtered, a yellowish-brown solution, totally dift'erent from the red color of blood under the same circumstances. The solution undergoes no change of color on the addition of ammonia. It is unchanged in color, but may be partially coagulated at a boiling temperature, and it is at once identified as a salt of iron by giving a blue color with the ferrocyanide of potassium. These stains of the citrate of iron are apt to be soft and deliquescent, while blood-stains are likely to be hard and brittle. It is not always easy to distinguish by sight a stain of blood on a weapon from a mark produced by iron-rust. "When suspicion exists, marks are pronounced to be due to blood, which under other circumstances would have passed unnoticed. One source of diflaculty is this : the iron-rust on an old knife is often mixed with some article of food, or even with blood itself. We must here pur- sue the same mode of examination as if the stain were of blood ; we macerate the weapon, or a portion of the colored deposit scraped from the surface, in a small quantity of distilled water, and filter the liquid. If the stain is due to iron-rust alone, this will be sepa- rated by filtration, and the liquid will pass through colorless. The absence of blood is thereby demonstrated. In blood-«tains on rusty weapons, blood and oxide of iron are necessarily intermixed. In order to detect and separate them the following plan may be adopted : Scrape off portions of the supposed dry blood and rust into a porcelain capsule ; moisten the substance with water and let it stand covered. If blood is present, the water will acquire a reddish-brown hue, and the addition of guaiacum and peroxide of hydrogen will show whether the red color is owing to blood. The effect is strongly marked when the water is allowed to evaporate to dryness and leaves a reddish stain on the white porcelain. The guaiacum and peroxide of hydrogen have no action upon iron-rust. This can be detected by the action of hydrochloric acid and the usual tests. All the particles of dried blood acquire a bluish coloration around them, while the particles of rust are unchanged. The guaiacum and peroxide applied to the film of water on which the rusted weapon had been placed will give a blue color if blood is present, otherwise not. By this process, blood was readily detected on a rusted knife used in an act of murder committed ten years previously. ISo blood was seen on the blade with the aid of a lens. From the foregoing remarks, we may justly infer that the che- mical analysis of suspected spots or stains on weapons and clothing is by no means an unimportant duty. If we cannot always obtain from these experiments affirmative evidence, they often furnish good negative proof, and thus tend to remove unjust suspicions against accused parties. Arterial and venous blood. — ^It is not possible to distinguish arte- rial from venous blood by any physical or chemical characters, when it has been for some days effused, and is in a dry state upon arti- cles of dress or furniture : but this, in medico-legal practice, is not ARTERIAL AND VENOUS BLOOD. 299 often a subject of much importance, since there are few cases of severe wounds, either in the throat or other parts of the body, in which the two kinds of blood do not escape simultaneously. The most striking and apparent difference between them, when recently effused, is the color — -the arterial being of a bright scarlet, while the venous is of a dark red hue ; but it is well known that the latter, when exposed to air for a short time, acquires a florid red or arte- rial color; and the kinds of blood, when dried, cannot be distin- guished chemically by any known criterion. Arterial blood con- tains more fibrin than venous, and coagulates more firmly. The microscope shows no appreciable difference in the blood-corpuscles, and chemistry does not enable us to apply any test so as to make a satisfactory distinction between them. In this deficiency of microscopical and chemical evidence, an attempt has been made to establish a distinction by noticing the physical appearance of the blood-stains. Thus, it is alleged, the arterial blood will be indi- cated by its being sprinkled over surfaces upon which it lias fallen, while the venous blood is always poured out in a full stream. In most wounds which prove fatal by hemorrhage, the blood is poured out simultaneously from arteries and veins. The sprinkled ap- pearance of the blood, when it exists, will, cceteris paribus, create a strong presumption that it was poured out from a living body, for after the heart has ceased to act, the arteries lose the power of throwing out the blood in jets. The sprinkling is usually observed when the wounded artery is small, and the blood is effused at a distance. This is a fact which a medical jurist should not over- look, although, for the reasons stated, too great a reliance must not be placed on it. The spots of blood, if thrown out from a living bloodvessel, speedily consolidate, and the fibrin, with the greater portion of the coloring matter, is found of a deep red color at the lower part of the spot, the upper portion being of a pale red. The iower and thicker part has commonly a shining lustre, as if gum- med, when the spot is recent, and when it has been effused upon a non-absorbent surface. When blood falls upon porous articles of clothing, as linen or cotton, it is absorbed, and produces a dull stain. In dark-colored articles of dress, it is sometimes difficult by daylight to perceive these stains. The part appears stiffened, and has a dull red-brown color, which is sometimes more perceptible when seen by the re- flection of the light of a candle. In trusting to the coagulation of the sprinkled blood as evidence of its escape from a living vessel, it must be remembered that three hours may elapse before it coagu- lates in the healthy body after death. Hence, blood which has escaped from a recently dead body, although it would not be found diffused as if by spurting, might, in so far as coagulation is con- cerned, assume the "appearance of having been eft'used from a living body. In spite of the great advances made in the construction and use of the microscope, there is no method known by which the blood of a man can be distinguished from that of a woman, or the blood 300 THE GUAIACUM PB0CE3S. of a child from that of an adult. A medico-legal question has arisen, on more than one occasion, whether there were any means of distinguishing menstrual blood from that of the body generally. This liquid contains fibrin, although the proportion is less than in venous or arterial blood, red coloring matter, and the other con- stituents of blood. The only differences noticed are of an acci- dental kind : 1st, that it is acid, owing to its admixture with vaginal mucus ; and 2d, that under the microscope it is mixed with epithelial scales, which it has derived from the mucous membrane in its passage through the vagina. (Donne, " Cours de Microscopie," p. 139.) In the bodies of women who had died suddenly while menstruating. Dr. AVebber found coagulated blood upon the uterine mucous membrane. If, therefore, menstrual blood does not coagu- late, it is simply because it has already coagulated within the uter- ine cavity, and cannot do so again ; it is more fluid than ordinary blood, because, during its trickling descent, it becomes mixed with watery urine and vaginal mucus. (" Schmidt's Jahrb.," 1847, 7, 139.) A case occurred in France, which induced the Minister of Justice to refer the consideration of this question to the Academy of Medicine. The reporters, MM. Adelon, Moreau, and Le Canu, came to the conclusion that there were no means of distinguishing menstrual blood dried on clothing from that which might be met with in a case of infanticide or abortion. ("Ann. d'Hyg.," 1846, 1,181.) The Guaiacum process. — Dr. John Day, of Geelong, Australia, was the first to demonstrate by numerous experiments the proper mode of employing the guaiacum test. (" Australian Med. Journ." May 1867, and Nov. 1869.) Schonbein had already discovered that the resin was blued by blood in the presence of a principle which he' called autozone (which had no action on the resin), and this prin- ciple was soluble in ether. His theory was that autozone in contact with blood was changed into ozone, and blued the resin ; but whether this theory be or be not correct, the facts remain — 1, that the red coloring matter of blood produces no change in tincture of guaiacum ; 2, that it undergoes no change of color when mixed with pure peroxide of hydrogen dissolved in ether (autozone) ; 3, that in the presence of those two solutions the red coloring matter of blood immediately renders the guaiacum resin blue ; 4, that no red coloring matter, animal or vegetable, excepting the reds of blood (hsematine), has been found to produce this blue coloration of guaiacum in the presence of peroxide of hydrogen. It may be here observed that the alcoholic solution of guaiacum resin should be fresh made from the inner or unoxidized portions of resin, and the solution kept in the dark. The pure ethereal solution of peroxide of hydrogen is procurable under the erroneous name of ozonized ether. M. Lefort has objected to this process on the ground that the resin of guaiacum is blued by an " unlimited" number of substances (" avec un nombre presque illimit^ de substances appartenant aux trois r^gnes de la nature," "Ann. d'Hygi^ne," 1870, 2, 432); but THE SPECTRUM PROCESS. 301 this objection is irrelevant and misleading. Schonbein and Dr. Day have both proved clearly that the coloring matter of blood does not cause a bluing of guaiacum resin, and' therefore it could not possibly be mistaken for any one of the " unlimited" number of substances, having nothing in common with blood, which change the color of this resin. It is always proper in practice to employ the guaiacum first. If this is blued, then other methods of detect- ing blood should be resorted to. Out of a large number of cases, I have not met with one instance during six "years in which this bluing of the guaiacum by direct contact formed any obstacle to the detection of blood. The same remarks apply to the coloring matter of bile, which, according to Dr. Jamieson ("Australian Med. Journ." Oct. 1869), produces a bluing of the guaiacum resin in contact with peroxide of hydrogen. In practice, stains of bile are so strongly marked by their peculiar color, that no one competent to undertake such in- vestigations could fall into an error of confounding these with blood-stains. The mistakes which have arisen respecting blood on clothes have been chiefly traceable to the presence of stains derived from red fruits and flowers, artificial red dyes, and some red mineral substances, such as red oxide of iron. M. Lefort states that stains produced by the red coloring matter of wine gave a blue color on the addition of a mixture of guaiacum and peroxide, but this was only after some hours' exposure ! (Op. cit. p. 438.) It is the very essence of this mode of testing, that the eftect in blood is immediate, or that it takes place within a few seconds. J^o reliance can or ought to be placed upon any change of color which requires hours for its production, since the resin alone, or in mixture with peroxide, is slowly blued under long exposure to air. If this mode of testing were followed, the results would be in all cases fallacious. The test operates equally well on fresh and old blood, and on concentrated as well as very diluted blood, even ' on blood which has been boiled. In conjunction with the spectroscope, it is the only certain method of discovering washed blood {vide infra). Pro- vided soine small portion of red coloring matter remains, the change to blue is perceptible. If the stain on the material gave no indi- cation of color — whatever might be the effect of this or any other tests — it would be unsafe to affirm that blood was present. On the other hand, the proper precautions being observed in the use of this test, if there is no bluing of the guaiacum resin in the presence of peroxide, it will be safe to say that the mark or stain is not owing to blood. Every prudent witness would avoid relying upon one test, and therefore, as so small a quantity of blood is required for the action of guaiacum, it will be always easy to reserve a portion for the spectroscope and other chemical tests, so that not even a shadow of an objection should be raised against the results. Spectrum analysis. Spectral test. — In the previous edition of this work, the discovery made by Dr. Stokes on the existence of a pecu- liar spectrum for blood was briefly referred to. ("Proc. E. S." vol. 13, No. 66, p. 360.) Since that time many researches on this sub- 802 SPECTEUM ANALYSIS. jeet have been made by Mr. Sorby, of Sheffield, and other observers, and the spectral analysis applied to blood has been made the subject of evidence on various trials for murder. The great advantage of this process is that it admits of the examination of blood without in any way interfering with the subsequent application of the che- mical tests already described. We simply examine the light as it traverses a solution of the red coloring matter, and with a proper spectral eye-piece attached to a microscope we notice whether the colored spectrum has undergone any change. If the red liquid , owes its color to recent or oxidized blood, two dark absorption bands will be seen breaking the continuity of the colored spectrum. These are situated respectively at the junction of the yellow with the green rays, and in the middle of the green rays. If the blood is quite recent and of a bright red color (scarlet, hiematine, or carmine) the two absorption bands are distinct and well defined. There can be no doubt that in the hands of a competent person, and one skilled in micro-spectral observations, this optical method will enable him to discover the minutest traces of blood, provided any red coloring matter remains. Thus Mr. Sorby states that a spot of blood only one-tenth of an inch in diameter, or a quantity of the red coloring matter amounting to no more than the TTy'nsth part of a grain, is sufficient to give conclusive evidence of its pre- sence by spectrum analysis. Mr. Sorby thus detected blood in the form of deoxidized hsematin on the rusty blade of a knife with which the murder of Mrs. Gardner was committed in 1862, after the lapse of ten years. Blood-stains which have been washed in water, and blood which has even been boiled or heated to 212°, may be thus detected. In the latter case, ammonia with the aid of a gentle heat, is employed to dissolve the matters rendered in- soluble by boiling. Spectral analysis does not enable us to make any distinction beyond that of recent and old blood, and this dis- tinction cannot be so drawn as to enable us to fix a specific or even an approximate date. Certain accidental conditions may rapidly produce on blood the same effect as exposure to air for a long period of time. It indicates no distinction in the blood of the sexes, of the foetus and adult, or in the blood of man and animals. As a corroborative process it furnishes most valuable and trustworthy evidence, and there is no case in which blood admits of a chemical, examination, in which spectral analysis does not admit of a safe application before the chemical tests are applied. Preyer makes a distinction in the use of the spectroscope, which it will be well for the medical witness to bear in mind. The absence of the absorption bands in a red colored liquid, however much it may resemble blood, proves that it is not blood, but some other red coloring matter. This direct method, i. e., the demon- stration by two absorption bands of the presence of undecomposed coloring matter (haemoglobin), has however only a limited appli- cation. In practice, the proof of the presence of blood by the spec- troscopic examination of the products of its decomposition by chemical agents is not satisfactory. (Op. cit. p. 112.) If certain DETECTION OP BLOOD- CORPUSCLES. 303 spectra of an artificial kind produced by chemical agents are relied upon as absolute proof of the presence of blood, the witness must be prepared to state from personal experience, the efleet of the che- micals employed upon other red coloring matters. In the hands of experienced observers this difficulty would not arise. Microscopical evidence. Blood-corpuscles. — Hitherto the micro- scope has been referred to as an aid to the examiner in drawing a distinction between the appearances presented by blood-stains in the dry state, and those caused by other sub- stances. Its use, however, extends much beyond Fig. 50. this. The spots or stains may be so small as not to admit of removal, for the purpose of applying chemical tests. If an examination of the dry- stain with a low power (20 or 30 diameters) justifies further proceedings, we may then em- ploy the microscope for the purpose of detecting ^, , , , . ,, II, T 1. T 1 • 1 ii 1 r- 1 Blood-corpuscle highly those pecuhar bodies on which the color of red magnified. blood is known to depend. The red coloring matter of blood consists of minute coloi-ed cells or corpuscles, floating in a clear liquid (serum). The engraving (Fig. 50) shows the form which the corpuscle presents in the class mammalia, a represents the circular form, when seen in front, the shaded portion being a depression which under a certain disposition of the light assumes the appearance of a solid and opaque nucleus ; b represents the cor- puscle seen edgewise, in which case it presents somewhat the out- line of a biconcave lens. It owes this form to the central depres- sion on each face. Other red coloring matters, such as madder, cochineal, or lac, do not owe their color to the independent cells or corpuscles. Hence, if corpuscles, of the form and size of those found in mammalian blood, are visible under the microscope, there can be no doubt that the liquid is blood. Such evidence can, however, be safely received only from one who has been accus- tomed to the use of this instrument and to the examination of blood. In order to examine the suspected substance for corpuscles, the best plan of proceeding, when the particles of coagulum are very small, is to breathe several times on a glass slide, then place the small fragments of coagulum on the slide, and again breathe over them. A slip of thin glass may then be laid upon them. If they consist of blood, a red margin will soon appear, and in the fluid portion, by the aid of a magnifying power of from 300 to 500 diameters, some of the corpuscles of the blood may be recognized. They are seldom so perfectly spherical as in the fresh state, and they appear small, and frequently shrunk or corrugated. In some cases, only fragments of the envelopes can be seen. The condensed moisture of the breath may serve the purpose of water, in breaking up the small portions of dried blood without destroying the cor- puscles by too much dilution. If the suspected clot is in larger quantity, it may be removed from the stuff and placed to macerate in one or two drops of water on a glass slide. It should be covered with thin glass, in order to 304: CHARACTERS OF BLOOD-CORPUSCLES. prevent rapid evaporation. This method of extracting the corpus- cles has frequently failed, owing to the quantity of water employed having been too large. Under these circumstances, the corpuscles are distended, become of a globular form, paler and .are finally destroyed, while the water simply becomes colored. It is by no means easy in all cases to obtain from dry coagula clear and distinct evidence of the presence of these corpuscules, especially when the blood is old. In drying, the blood-cells lose their form, and they do not readily resume it when again moistened. Unless they are seen after a short maceration in a very small quantity of water, it is probable they will not be seen at all. To accelerate their sepa- ration, various chemical liquids have been recommended. The strong solutions of sulphate of soda and common salt, as well as liquid albumen and serum, have been employed as fluid media for breaking up the dried clots of blood. There are disadvantages attending the use of these; and after many experiments, I have found that a mixture of glycerine and water may be employed iu place of pure water. The proportions which are most convenient are one part by measure of glycerine, to three parts by measure of distilled "water. A solution of arsenious acid, in the proportion of four grains to an ounce of distilled water, as recommended by Dr. Kunze, is also a rapid solvent of the coagula. "When this is used, the examination should take place as soon as the liquid begins to be colored at the margip, or the corpuscles may be destroyed, and only fragments of their envelopes seen. In reference to stains on clothing, if they present any appearance of dry coagula, these should be carefully scraped oft', and treated in the manner above described. If no portions Fig. 51. of solid coagula can be procured, there will be but little hope of obtaining evidence of the presence of corpuscles in the suspected stain. The stained portion may be cut out and mace- rated in a small quantity of water. Under these circumstances, the corpuscles may be sometimes seen aggregated, or in groups, in the a. Corpuscules of blood in fibrcs of the stuft^s in the Subjoined engraving, linen fibre ; b, a group de- . i • i . i , • f i i i i • ^ tached in which the stam or blood was on a shirt. (Briand's " Manuel de M^d. L6g." p. 747, 1863.) The subjoined illustrations (Figs. 52 and 53) show the appearances ' presented by blood corpuscles, when examined by a power of about 300 diameters, and under different methods of treatment. Fig. 52 represents the appearance of a drop of healthy human blood. The red blood-cells are partly detached, partly united in rolls, and partly in irregular clusters. In the vacant spaces between them there are delicate threads of fibrin. The outlines of the blood-cells are ren- dered, in some instances, indistinct, by reason of this web of fibrin above them. In Fig. 53 the corpuscles are seen free from fibrin, and in groups as well as singly. Only a small portion of those which were in the field have been engraved. The shaded bodies are the white cor- BLOOD OF MAN AND ANIMALS. 305 puscles of the blood ; they are not so well defined in form, and present an irregularity of surface, by which they may be distin- guished from the colored blood-cells. Fig. 53. Fig. 53. Hnmaa blood-corpascles with fibrin. Human blood-corpuscles from a dried specimen, magaified 319 diameters. Some practice in the use of the microscope is required to enable a medical man to arrive at a correct conclusion in these investiga- tions. Granules of stai'ch and the spores of vegetables might be mistaken for blood-corpuscles. Erdmann states that in examining some articles of clothing in a case of suspected murder, he thought he had found blood-globules in the liquid which he procured, but he found on further inspection that they consisted of the red- colored spores of an alga known as the porphyridium cruentum. (" Ed. Med. Journal," Oct. 1862, p. 370.) The size of their bodies as well as their shape will sometimes aid the observer. The blood- corpuscles have a definite size; the bodies seen under the micro- scope may be either too large or too small to fall within the ex- ceptional range of size. Hence the micrometer is a necessary adjunct to the instrument. Granules of starch would be indenti- fied by the blue color imparted by iodine. Blood of man and, animals. — When marks of blood have been detected on the dress of an accused person, it is by no means un- usual to find these marks accounted for by his having been en- gaged in killing a pig, bullock, or sheep, or in handling fish or dead game. Of course, every allowance must be made for a state- ment like this, which can be proved or disproved only by circum- stances ; but the question here arises whether we possess any certain means of distinguishing' the blood of a human being from that of an animal. Some years since, M.^Barruel and other French medical jurists aflBrmed that by mixing fresh blood with one-third or one-half of its bulk of strong sulphuric acid, and agitating, the mixture with a glass rod, a peculiar odor was evolved, which differed in the blood of man and animals, and also in the blood of the sexes. This odor, it was said, resembled that of the cutaneous exhalation of the animal the blood of which was made the subject of experi- ment. (See Devergie, "M^d. L^g." vol. 2, p. 907.) It is true that 306 BLOOD OF MAN AND ANIMALS. strong sulphuric acid does give rise to a particular odor when mixed with fresh blood, probably owing to its decomposing action on some of the animal principles ; and it is possible that some persons may discover a difl'erence in the odor, if not according to the sex, at least according to the animal. But assuming this to be true, there is probably not one individual among a thousand whose sen^e of smelling would allow him to state, with undeniable certainty, from what animal the unknown blood had really been taken. In a case of some importance, which occurred in Paris, the testing of blood by odor completely failed in the hands of M. Barruel and two other eminent French medical jurists, MM. Tardieu and Cheva- lier. The mistakes made by these experts are admitted by them- selves to have been of so serious a nature as to render this mode of obtaining evidence in any future case inadmissible. (" Annales d'Hyg." 1853, 1, 413.) For additional remarks on this subject, see paper in " Guy's Hospital Eeports," Oct. 1851. There are no chemical differences between the blood of man and animals. The red coloring matter, the albumen and fibrin are the same, and chemical tests produce on them precisely similar results. The microscopical differences refer to the shape and size of the cor- puscles. 1. With respect to shape. In all animals with red blood, the globules have a disk-like or flattened form. In the mammalia, excepting the camel tribe, the outline of the disk is circular (Fig. 50 a). In this tribe, and in birds, fishes, and reptiles, the corpus- cles have the form of a lengthened ellipse or oval. In the three last-mentioned classes of animals they have a central nucleus, which gives to them an apparent prominence in the centre. The blood corpuscles of all the mammalia, including those of the camel tribe, have no central nucleus, and they appear depressed in the centre. The microscope, therefore, enables an observer to distin- guish the blood of birds, fishes and reptiles from that of a human being; and this may be of great" importance as evidence. The chief microscopical distinction between the blood of man and domestic animals, consists in a minute difference in the size of the corpuscles. This, however, is only an average difference ; for the corpuscles are found of different sizes in the blood of the same animal. In making use of this criterion, it would be necessary to rely upon the size of the majority of the corpuscles seen in a given area, and under the same power of the microscope. It is a curious fact that their size bears no relation to the size of the animal. Thus, in the horse, ox, ass, cat, mouse, pig and bat, they are, on an average, nearly of the same size; the difference is so slight as to be practically inappreciable. In these animals they are smaller than in man, and in several of the mammalia. The corpuscles in man, the dog, the- rabbit and the hare are of nearly the same size. In the blood of the sheep and goat, they are smaller than in other mammalia. The size of the corpuscles bears no proportion to the age of the animal ; thus in the blood of the human foetus they are to be found as large as in that of an adult. „ BLOOD-CEYSTALS — H^MATIN. 307 The measured diameter of the corpuscles in human blood varies, according to Gulliver, from g^Voth to j-^^Tsth. of an inch, the average size in both sexes being j^Voth of an inch. From an examination of numerous specimens of fresh human blood, I have found the average diameter of the globules to be the ^^V^th part of an inch, the maximum size being ^^jV^th, and the minimum ^n'T)5th of an inch. The corpuscles of human blood are larger than those of domestic animals. The subjoined measurements, in fractions of an inch, are those given by Mr. Gulliver, excepting the figures in brackets, which are from my own micrometrical ob- servations. The average diameter is, in the dog ^^'^^th (max. 75VTjt5i,min. ^jViyth)— inthehare,5 5V7th(max. 5^Vijth,min. g^V-ffth), in the mouse, ^gV^th — in the ass, :jT;Vtrtli — (rabbit, 7t)Vuth) — in the pig5 753T)th {-^^^-A) — in the ox, -^^^^t^i. — (in the cow, ■^b'ss^^ to 4 5Vrth) — in the cat, ^^^ynth — in the horse, j^\^th. (gxiVTsth) — in the sheep, ^^'sijth (s^'^^d to g^oth)— in the goat, g^'ssth. These mea- surements apply to recent blood, which has not been allowed to be- come dry on animal or vegetable stuffs. In this case, a distinction might be made between the blood of a human being and a sheep or goat. With respect to the dog, hare and rabbit it w^ould be, even under these favorable circumstances, a matter of some diffi- culty. When blood is dried on clothing, and it is necessary to extract the corpuscles by means of a liquid of a different nature from the serum, we cannot rely on slight fractional differences, since we cannot be sure that the corpuscles, after having been once dried will ever reacquire in a foreign liquid, the exact size which they had in serum. Medical evidence must therefore be based, in such cases, on mere speculation. (See " Guy's Hospital Reports," vol. 7, pt. 2, 1851.) In reference to this question, therefore, it must be regarded as still unsolved. There are no certain methods of distinguishing microscopically, or chemically, the blood of a human being from that of an animal, when it has been once dried on an article of clothing. The extent to which a medical witness is justified in going on trials for murder, on which the important question arises, appears to me to be this : the size and shape of the corpuscles may or may not be consistent with their being the corpuscles of human blood, but it is impossible, in the presence state of science, to affirm that they are not those of some domestic animal, belonging to the class mammalia. For information on this subject, see Ritter's Prize Essay, " Ueber die Ermittelung der JBlutflecken in Kriminal- fallen," Wurzburg, 1854, and Friedberg's "Histologie des Blutes," Berlin, 1852. These authors affirm, from their observations, that it is not possible to distinguish by the microscope human from animal blood, in criminal cases. " Evidence based upon such varying averages as those above given, must be treated as speculative and unsafe. Blood-crystals. Hcematin. — Another process for the microscopical detection of blood has been of late years suggested by some German 308 BLOOD-CBYSTALS. medical jurists, coloring matter Fig. 54. Hscmatia crystals. It consists in procuring crystals from the dry red of blood. Lehmann and Kunze ascertained that all red blood is capable of crystallization or of breaking up, into crystalline forms, from whatever animal or organ it may have been taken. Lehmann thus de- scribes his method of procuring these hsematin crystals: A drop of blood which has been kept a day, is allowed to evaporate on a glass slide ; a drop of distilled water is then added, and the whole is covered with a slip of thin glass. After a time, when the water has to some extent evaporated, regular red-colored crystals, of various sizes and forms, such as those represented in the quadrant « Some are columnar and prismatic, while plates. The second quadrant. of Fig. 54, are visible others are in the form of rhombic b, represents the crystals procured, by a similar process, from the heart-blood of a cat. The third, c, crystals from the venous blood of a guinea-pig,.which appear in regular tetrahedra ; and the fourth, d, crystals from the venous blood of a squirrel, some of which are prismatic, and others in the form of rhombic and hexahedral plates. The hsematin-crystals are represented in this and the other engrav- ings as transparent. They are, in fact, translucent, and under a good light, of a well-marked red, or red-brown color. In Fig. 55 the first quadrant, a, shows the prisms and rhombic plates obtained by Lehmann from human venous blood ; b, blood- crystals from human blood, in rhombic plates, as delineated by Eobin and Verdeil (" Chimie Anatomique"), and c, crystals ob- Fig. 55. Fig. 56. tained from human blood, by Dr. Kunze, by a process described below. Some of these have a rhombic form ; others are shaped like a hemp-seed ; and a few, being double at one extremity, have the appearance of a swallow's tail. In the quadrant d are represented crystals as obtained by Lehmann from the l^ed blood of a fish. It is to be observed of these crystals that they are all colored, having BLOOD-CRYSTALS. 809 more or less the red color of the blood ia varying degrees of inten- sity. In apiplying Lehmanii's process to a fragment of a dried clot of human blood, which had been kept for six months, prismatic crys- tals were seen, mixed with bodies of an ovoid shape. A number of ^hese are delineated in the last engraving (Fig. 66). They have the characters of the phosphates and other salts of the blood. No rhombic plates, or tetrahedra, such as those described by Lehmann, were seen. The prismatic crystals had lihe characters of phosphate of magnesia. They were colorless on a red ground, which Owed its color to the dissolved hsematin. The production of crystals from the coloring matter of blood, as contained in a dry coagulum, may be easily effected by a process sug- gested by Dr. Kunze, of Merseburg. (Casper's " Vierteljahrschrift," April, 1864, p. 262.) This gentleman recommends the strongest glacial acetic acid. As the object is not here to search for blood- corpuscles, any stuff superficially stained is soaked in a small quan- tity of water for one or two hours, until the coloring matter is dis- solved, and a reddish-brown solution is obtained. The red liquid is evaporated to dryness, and the dry residue is boiled in an excess of glacial acetic acid, until the acid is strongly colored. The acid liquid is poured off, and one or two particles of common salt are well stirred into it. It is then slowly evaporated on a slide, or on a watch-glass, at a temperature of about 180°, and the residue is examined, either in the wet or dry state, by a microscopical power of 300 to 500 diarneters. The blood-crystals, if present, appear in groups, as small dark specks. They are somewhat irregular in shape — have generally a prismatic form, some with rhombic termi- nations, while others assume a spindle shape, and others again are joined at an angle, so as to resemble a bird's tail, or they cross each other like the letter X. In repeating Kunze's experiments, I have found- that the use of common salt was not necessary. It had the effect of encumbering the field of view with cubic and other crys-, tals of chloride of sodium. Having removed a portion of the dried coagulum from human blood, which had been kept loosely exposed for six months, I powdered it arid boiled it in glacial acetic acid, in a small porcelain cup, until a quantity of coloring matter had obviously been dissolved. The acetic acid, under these circum- stances, acquired a dark reddish or reddish-brown color. A few drops of the clear liquid, evaporated on a slide, left .minute red- colored crystalline-looking masses. They were plainly distinguish- able from the cubic crystals of common saltj naturally contained in the blood, as well as from the phosphates. They varied much in size and shape, but generally assumed the form of slender prisms with irregular rhombic terminations. Hsematin-crystals, as they were thus procured from human blood, were found to have an average length of j^'suth of an inch, and a width of j^Vuth of an inch. ' Those obtained from sheep's blood were smaller than those obtained from the blood of man and of the bullock. The general 310 THE CAUSE OF DEATH FROM WOUNDS. resemblance, however, is so great, that it would be obviously im- possible to base any distinction between human and animal blood Upon these observations. The association of cubic crystals of salt with these blood-crystals, when no chloride of sodium has been added to the liquid, is an additional proof of the presence of blood, as this is one of the principal saline constituents of that fluid. In stains of old date, I have observed, in association with hsematine crystals, dagger crystals, resembling those of hydrochlorate of ammonia. Similar experiments were made with the coloring mat- ters of cochineal, logwood and kino. On treating the first with acetic acid, a pink-red color, differing from that of blood, is pro- duced, while the extracts of logwood and kino give a yellowish- brown color with this acid. In no case, on evaporating the acid solutions, were any crystals resembling those of hsematin or chlo- ride of sodium obtained. CHAPTER XXVII. THE CAUSE OF DEATH FROM WOUNDS. — WOUNDS DIRECTLY OR INDIRECTLY FATAL. — DEATH FROM HEMORRHAGE. — INTERNAL BLEEDINO. — DEATH FROM MECHANICAL INJURY. — FROM SHOCK. — DEATH FROM NUMEROUS PERSONAL INJURIES IRRESPECTIVE OF ANT MORTAL WOUND. It is important for a medical witness to bear in mind that in all cases of wounds criminally inflicted, the cause of death must be certain. I^o man is ever convicted upon mere medical probability. In general, there is only one real cause of death, although other circumstances may have assisted in bringing about a fatal result. Thus, a person cannot die of disease in the bowels and a stab in the chest at the same time, nor of apoplexy from disease and compres- sion of the spinal marrow at the same instant. Hence, it is our duty, when several apparent causes for death exist, to determine which was the real cause ; and in stating it to the court, to be pre- pared to offer our reasons for this opinion. In most cases of local injury, when a person dies speedily, there will be no great trouble in settling whether disease or the injury was the cause. A diffi- culty may, however, exist when a person has recovered from the first effects of a wound, and has subsequently died. Besides, there may be cases in which the cause of death, in spite of the most careful deliberation, will be still obscure ; or sometimes it may happen that the death of a person appears to be as much dependent on bodily disease as on an injury proved to have been received at the time he was laboring under disease. How is an opinion to be expressed in such a case ? The course which I apprehend a medical DEATH FROM LOSS OF BLOOD. 311 witness ought to pursue, provided he has duly deliberated on the circumstances before he appears in court, and his mind is equally balanced between the two causes, is to state at once his doubt to the jury without circumlocution, and not allow it to be extracted from him in cross-examination. It is the hesitating to assign a satisfactory cause, or the assigning of many causes for death, that gives such advantage to a prisoner's case, even when the general evidence is entirely against him. Occasionally, many causes of death are assigned by a medical witness, among which some have a tendency to exculpate, and others to inculpate an accused person in a greater or less degree, and it is left to the jury to select from the number, one upon which to found a verdict. In a case of this kind an acquittal is commonly obtained. Wounds directly or indirectly fatal. — A wound may cause death either directly or indirectly. A wound operates as a direct cause of death when the wounded person dies either immediately, or very soon after its infliction, and there is no other cause internally or externally to account for death. In wounds which cause death indirectly, it is assumed that the person survives for a certain period, and that the wound is followed by inflammation, suppuration, pyaemia, gangrene, tetanus, erysipelas, or some other mortal disease, which is a direct, and not an unusual consequence of the injury. Under this head may be also arranged all those cases which prove fatal by reason of surgical operations rendered imperatively neces- sary for the treatment of an injury — presuming that these opera- tions have been performed with ordinary skill and care. We shall for the present consider only the direct causes of death in cases of wounds. They are three in number: 1. Hemorrhage, or loss of blood. 2. Great mechanical injury done to an organ important to life. 3. Shock, or concussion, affecting the brain or spinal marrow, whereby the functions of one or more vital organs are arrested, sometimes with but slight injury to the part struck or wounded. From either of these causes, a wounded person may die imme- diately, or within a few minutes. 1. Death from hemorrhage. — Loss of blood operates by producing fatal syncope (p. 57.) A quantity of blood escaping from a vessel, although insufficient to cause death by afiecting the heart and cir- culation, may readily destroy life by disturbing the functions of the organ or part into which it is effused. Thus, a small quantity effused in or upon the substance of the brain, or at its base, may prove fatal by inducing fatal compression ; and again, if, in a case of wounded throat, blood should flow into the windpipe, it may cause death by asphyxia — i. e., by stopping the respiratory process (p. 58.) In these cases it is obvious that the blood acts mechanic- ally; and in respect to the last condition, a medical man, unless circumspection is used, may involve himself in a charge of mala- praxis. If he allows the wound to remain open, the wounded person may die through hemorrhage — if he closes it too soon, he may die through suffocation ; and, in either case, the counsel for a prisoner will not fail to take advantage of a plausible objection of 312 DEATH FEOM LOSS OF BLOOD, this kind. In wounds of the chest, involving the heart and lungs, death is frequently due, not so much to the actual quantity of blood effused, as to the pressure which it produces upon , these organs. A few ounces effused in the cavity of the membrane in- cluding the heart (pericardium), will entirely arrest the action of this organ. The absolute quantity of blood required to be lost in order to prove fatal, will, of course, vary according to numerous .circumstances. The young, the aged, they who are laboring under infirmity or disease, will perish sooner from loss of blood than others who are healthy and vigorous. Women, cceieris paribus, are more speedily destroyed by bleeding than men. Infants are liable to die from this cause, as a result of slight wounds. An infant has been known to bleed to death from the bite of a single leech, or from the sim- ple operation of lancing the gums. Even the healthy and vigorous, when their vital powers have been depressed by maltreatment, or by brutal violence, will sink under the loss of a comparatively small quantity of blood. (" "Watson on Homicide," p. 90.) A medicaJ jurist must not forget that some persons h^ve a predisposition to excessive bleeding from slight injuries ; and this condition is often hereditary. The slightest wound or puncture — the bite of a leech or the extraction of a tooth — Mnll be attended with a loss of blood which cannot be arrested, and which will slowly lead to death by exhaustion. Cases have been frequently recorded in our medical journals of fatal hemorrhage following the extraction of teeth, when there had been previously nothing to indicate the probable occurrence of death from so trivial a cause. Such cases are without difficulty detected, since a surgeon may always infer, from the part injured and the extent of the injury, whether the bleeding is likely to be copious or not. When a person bleeds to death from what would, under common circumstances, be a simple wound, the ad- mission of this fact may in certain cases lessen the responsibility of an accused party. A sudden loss of blood has a much more serious consequence than the same quantity lost slowly. A person may fall into a fatal syn- cope from a quantity of blood lost in a few seconds, which he would have been able to bear without sinking, had it escaped slowly. This is the reason why the wound of an artery proves so much more rapidly fatal than that of a vein. Death speedily follows the wound of a large artery like the carotid ; but it takes place with equal certainty, although more slowly, from wounds of smaller arteries. In a case in which one of the intercostal arteries was wounded by a small shot, hemorrhage caused death in thirty-eight hours. The loss of blood which follows the division of the smaller branches of the external carotid artery is often sufficient to destroy life, unless timely assistance be rendered. If a wound is in a vascular part, although no vessel of any importance be divided, the person may die from bleeding. It is difficult to say what quantity of blood should be lost, in order that a wound may prove fatal. The whole quantity contained in the body of an adult is calculated at about FATAL INTERNAL BLEEDING. 313 one-fiftli of its weight — i. e., about thirty pounds ; of this, one- fourth is considered to be arterial, and the remaining three-fourths are venous blood. Some physiologists have estimated the propor- tion as one-eighth of the weight of the body. (" Med. Times and Gaz.," Aug. 28, 1858, p. 232.) According to Mr. Watson, thfe loss of from five to eight pounds is sufficient to prove fatal to adults. But while this may be near the truth, many persons will die from a much smaller quantity ; the rapidity with which the effusion takes place having a considerable influence, as well as the age, sex, and bodily condition of the wounded person. It has been found, by experiment, that a dog cannot bear the loss of more blood than is equivalent to one-twelfth part of the weight of its body. Internal hemorrhage. — Hemorrhage may prove fatal, although the blood does not visibly escape from the body. In incised wounds, the flow externally is commonly abundant ; but in contused, punc- tured and gunshot wounds, the eff'usion may take place internallj'^, and rapidly cause death. In severe contusions, or contused wounds, ■ involving highly vascular parts, the efi'usion may go on to an extent to prove fatal, either in the cavities of the body, or throughout the cellular membrane and parts adjacent ; many pounds of blood may thus be slowly or rapidly effused. The most fatal internal hemor- rhages are those which follow ruptures of the organs from violence or disease. Ruptures of the heart, lungs, liver, and kidneys have thus caused death. In November, 1864, a man who had been run over was brought to Guy's Hospital. He complained of pain in the back, but there were no symptoms of severe injury, and no marks of violence were seen on the skin of the back. He left the hospital and walked with some assistance to his home. A few hours after- wards he was found dead in bed. On inspection, there was a large quantity of blood efl'used in the abdomen. This had proceeded from one kidney, which had been ruptured transversely through its whole substance. In these cases the bleeding is not necessarily immediate ; but slight muscular exertion may increase it and accelerate death. In death from severe flagellation, blood may be effused in large quantity beneath the skin and among the mus- cles ; this effusion will operate as fatally as if it had flowed from an open wound. The means of ascertaining whether a person had died from bleed- ing by an open wound are these: Unless the wound is situated in a vascular part, we shall find the vessel or vessels from which the blood has issued, divided, the neighboring vessels empty, and the body more or less pallid ; although this last condition is of course liable to be met with in certain cases of disease, as also under copious venesection — points easily determined by an examination. The blood will commonly be found more or less clotted or coagulated on those surfaces on which it has fallen. If, with these signs, there is an absence of disease likely to prove rapidly fatal, and no other probable cause of death is apparent, it may be fairly referred to loss of blood. This opinion may, however, be materially modified in reference to open wounds, by the fact of the body not being seen 314 DEATH FKOM SHOCK. on the spot where the injury was actually inflicted — by the wound having been sponged — the blood removed by washing, and all traces of bleeding destroyed. Under these circumstances, the case must in a great measure be made out by presumptive proof ; and here a medical witness may have the duty thrown upon him of examining articles of dress, furniture, or weapons, for marks or stains of blood. It must not be supposed that all the blood met with round a wounded dead body, or in a cavity of the body, was actually effused d uring life. As soon as the heart's action ceases, the arteries pour out no more ; but the blood, so long as it remains liquid, i. e., from four to eight or ten hours, and the warmth of the body is retained, continues to drain from the divided veins and smaller vessels. The quantity thus lost, however, is not considerable, unless the veins implicated are large, or the part is highly vascular, i. e., full of small vessels. 2. Death from great mechanical injury done to a vital organ. — "We have instances of this becoming a direct cause of death in the crush- ing of the heart, lungs, or brain, by any heavy body passing over or falling on the cavities, as in railway accidents. The severe me- chanical injury is sometimes accomplished by a considerable effu- sion of blood, so that the person really dies from hemorrhage; but in other instances the quantity of blood lost is inconsiderable, and the fatal effects may be referred to shock to the nervous system. Sometimes a slight amount of violence may prove suddenly fatal. These are, however, to be regarded as exceptional instances. 3. Death from shock. — This is sometimes a direct cause of death under the infliction of external violence ;. and in this case life is destroyed without the injury being to all appearances sufficient to account for so speedily fatal a result. Mr. Savory has suggested that death from shock is nothing more than death from temporary exhaustion of nerve-force, the result of a violent, sudden, and ex- cessive expenditure of it. (" Lectures on Life and Death," p. 171.) Whatever theory may be adopted to explain it, there ia no medical doubt that a person may die from what is termed shock, without any marks of severe injury being discovered on his body after death. We have examples of this mode of death in accidents from light- ning, or from severe burns or scalds, in which the local injury is often far from sufficient to explain the rapidly fatal consequences. As instances of this form of death from violence, may be also cited those cases in which a person has been suddenly killed by a blow upon the upper part of the abdomen, or on the pit of the stomach, which is supposed to operate by producing a fatal impression on the nerves and nerve-ganglia of the cardiac plexus. Whether this be or be not the true explanation, it is admitted by experienced surgeons, that a person may die from so simple a cause without any mark of a bruise externally, or physical injury internally to account for death. On the skin there may be some abrasion or slight dis- coloration ; but as it has been elsewhere stated these are neither constant nor necessary accompaniments of a blow. Concussion of the brain, unattended by visible mechanical injury, furnishes DEATH FROM SHOCK. 315 another example of tliis kind of death. A man receives a severe blow on the head ; he falls dead on the spot, or becomes senseless, and dies in a few hours. On an inspection, there may be merely the mark of a bruise on the scalp ; in the brain there may be no rupture of vessels or laceration of substance, and all the other organs of the body may be found healthy. In certain railway accidents persons have died under somewhat similar circumstances. There has been no physical indication of a mortal injury, and no cause apparent to account for death. This can be referred only to the shock or violent impression which the nervous system has sustained from the blow or violence — an impression which the vital powers were wholly unable to counteract or resist. A medical witness must give his evidence with caution in such cases ; since it is the custom to rely in the defence upon the absence of any visible mortal wound or physical injury to account for death, as a proof that no injury was done — a principle which, if once unrestrictedly admitted, would leave a large number of deaths, undoubtedly occurring from violence, wholly unexplained. There is another form of shock, which is of some importance in medical jurisprudence. A person may have received many injuries, as by blows or stripes, not one of which, taken alone, could, in me- dical language, be termed mortal ; and yet he may die directly from the eflects of the violence, either on the spot, or very soon afterwards. In the absence of any large effusion of blood beneath the skin, death is commonly referred to exhaustion, but this is only another mode of expression ; the exhaustion is itself dependent on a fatal influence or impression produced on the nervous system. A prizefighter after having, during many rounds, sustained numerous blows on the body, may, either at or after the fight, sink and die exhausted. His body may present marks of bruises, or even lace- rated wounds, but there may be no internal changes to account for death. In common language, there is not a single injury which can be termed mortal ; and yet, supposing him to have had good health previously to the fight, and all marks of disease indicative of sudden death to be absent, it is impossible not to refer his death to the direct effect of the violence. It is a well-ascertained medical fact, that a number of injuries, each comparatively slight, are as capable of operating fatally, as any single wound whereby some bloodvessel or organ important to life is directly affected. Age, sex, constitu- tion and a previous state of health or disease may accelerate or retard the fatal consequences. A case of somewhat similar kind may present itself in the pun- ishment of flagellation, which is occasionally followed by death, either as a direct consequence of shock, or from indirect causes, such as inflammation and its consequences. At the trial of Grover- nor Wall, the judge directed the jury that the long continuance and severity of pain (in flagellation) may be productive of as fatal consequences as if instruments or weapons of a destructive kind were used. It is not often that scholastic flagellation is a cause of death in this country. One case, however, which occurred a few 316 MORTALITY OF WOirNDS. years since, excited public attention from the atrocity of the cir- cumstances attending it. It was the subject of a trial for man- slaughter at the Lewes Autumn Assizes, 1860 {Beg. v. Mopley). The evidence showed that the prisoner had beaten deceased, a youth of sixteen, most severely for nearly two hours with a rope and stick. The external wounds were slight, but an inspection showed that the muscles as well as all the soft parts beneath the skin had been considerably bruised and lacerated, and that there were extensive effusions of blood in the cellular membrane of the arms and legs. There was no mortal wound in the common sense of the term, but there was no reasonable doubt that the deceased bad died from the violence inflicted on him by the prisoner. His guilt was established by the fact that he had endeavored to conceal the effects of his violence by removing the marks of blood — that he had covered the body of the deceased with clothing so as to conceal the bruises — that he had procured a coroner's inquest to be held in haste, and while concealing from the jury the fact that he had beaten the youth on the night of his death, stated that he had found him dead, and suggested that he might have died of disease of the heart. There can be no doubt, frond the medical facts of this case, that the deceased died either while the prisoner was in- flicting the violence or soon afterwards. No attempt was made to dispute the cause of death. Apart from the depressing effects on the nervous system of long-continued and severe pain, there was in this instance such an effusion of blood internally as would account for the production of fatal syncope. From these considerations, it is obviously unreasonable to expect that in every case of death from violence or maltreatment, there must be some specific and visible mortal injury to account for this event. When the circumstances accompanying death are unknown, a medical opinion should certainly be expressed with caution; but ,if we are informed that the deceased was in ordinary health and vigor previous to the infliction of the violence, and there is no mor- bid cause to account for his sudden illness and death, there is no reason why we should hesitate in referring death to the eflfects of a number of injuries. Among non-professional persons an unfounded prejudice exists that no persons can die from violence unless there be some distinctly mortal wound actually inflicted on the body. By this we are to understand a visible mechanical injury to some organ or bloodvessel important to life; but this is obviously an erroneous notion, since death may take place from the disturbance of the functions of an organ important to life, without this being neces- sarily accompanied by a perceptible alteration of structure. The prevalence of this popular error often leads to a severe cross-ex- amination of medical witnesses. "When there are several wounds, it is difficult to decide on their relative degree of mortality, and on the share which each may have had in causing death. By a wound being of itself m,ortal, we are to understand that it is capable of causing death directly or indirectly, in spite of the best medical assistance. It is presumed MORTALITY OF WOUNDS. 317 that the body is healthy, and that no cause has intervened to bring about or even accelerate a fatal result. The circumstances of a person laboring under disease when wounded in a vital part, will not, of course, throw any doubt upon the fact of such a wound being necessarily mortal, and of its having caused death. If there should be more wounds than one, it is easy to say fron;i the nature of the parts involved, which was likely to have led to a fatal result. In order to determine on medical grounds, whether a wound was or was not mortal, we may propose to ourselves this question : "Woiild the deceased have been likely to die at the same time, and under the same circumstances, had he not received the wound? There can obviously be no general rule for determining the mortal nature of wounds. Each case must be judged by the circumstances which attend it. In some continental States, the law requires that a medi- cal witness should draw a distinction between a wound which is absolutely and one which is conditionally mortal. An absolutely mortal wound is defined to be that in which the best medical assis- tance being at hand, being sent for, or actually rendered, the fatal event could not be averted. Wounds of the heart, aorta, and in- ternal carotid arteries are of this nature. A conditionally mortal wound is one in which, had medical assistance been at hand, been sent for, or timely rendered, the patient would, in all probability have recovered. Wounds of the brachial, radial, and ulnar arteries may be taken as instances. The responsibility of an assailant is njade to vary according to the class of injuries to which the wound may be referred by the medical witnesses ; and. as it is easy to suppose, there is seldom any agreement on this subject. Our crimi- nal law is entirely free from such subtleties. The effect of the wound, and the intent with which it was inflicted, are looked to ; its anatomical relations, which must depend on pure accident, are never interpreted in the prisoner's favor. Some extenuation may, perhaps, be occasionally admitted when a wound proves mortal, through an indirect cause, as inflammation or fever, and medical advice was obtainable, but not obtained until every hope of re- covery had disappeared. It appears, however, from the case of the Queen v. Thomas and others (Gloucester Aut. Ass., 1841), that the mere neglect to call in medical assistance is not allowed in law to be a mitigatory circumstance in the event of death ensuing. The deceased died from the effects of a severe injury in the head, in- flicted by the prisoner, but had had no medical assistance. The judge said it was possible that, " if he had had medical advice, he might not have died; but whoever did a wrongful act must take the whole consequence of it. It never could make any difference whether the party injured had or had not the means or the mind to apply for medical advice." The prisoners were convicted. Ac- cording to Lord Hale, if a man be wounded, and the wound, al- though not in itself mortal, turn to a gangrene or fever for want of proper applications, or from neglect, and the man die of gan- grene or fever, this is homicide in the aggressor: for though the 318 ACCELEBATION OF DEATH BY DISEASE. fever or gangrene be the immediate cause of death, yet the wound being the cause of the gangrene or fever is held the cause of death, causa causati. These nice questions relative to the shades of re- sponsibility for personal injuries, occasionally arise in cases in which persons have been wounded at sea, on board of a ship in which there was no surgeon. CHAPTER XXVIII. DEATH OF WOUNDED PERSONS FROM NATURAL CAUSES. — DISTINCTION BE- TWEEN REAL AND APPARENT CAUSE. — DEATH FROM WOUNDS OR LA- TENT DISEASE. — -ACCELERATINa CAUSE. — DEATH FROM WOUNDS AFTER LONG PERIODS. — AVOIDABLE CAUSE OF DEATH. — NEGLECT. — IMPRU- DENCE. — UNSKILFUL TREATMENT. — UNHEALTHY STATE OF BODY. Death of v)ounded persons from natural causes. — It is by no means unusual for individuals who have received a wound, or sustained some personal injury, to die from latent natural causes ; and as, in the minds of non-professional persons, death may appear to be a direct result of the injury, the case can only be cleared up by the assistance of a medical practitioner. Such a coincidence has been witnessed in many instances of attempted suicide. A man has in- flicted a severe wound on himself while laboring under disease ; or some morbid change, tending to destroy life, has occurred sub- sequently to the infliction of a wound, and death has followed. Again, a natural cause of death may be lurking within the body at the time that a wound is criminally inflicted, and a close atten- tion to the symptoms preceding, and the appearances after death, can alone enable a surgeon to distinguish the real cause. A man may be severely wounded, and yet death may take place from- rupture of the heart, the bursting of an aneurism, from apoplexy, phthisis, or other morbid causes which it is here unnecessary to specify. ("Cormack's Ed. Jour." May, 1846, p. 343.) If death can be clearly traced to any of these diseases by an experienced surgeon, the prisoner cannot be charged with manslaughter ; for the medical witness may give his opinion that death would have taken place about the same time and under the same circumstances whether the wound had been inflicted or not. On these occasions one of the following questions may arise: "Was the death of the person accelerated by the wound, or was the disease under which he was laboring so aggravated by the wound as to produce a more speedily fatal termination ? The answer to either of these questions must depend on the circumstances of each case, and the witness's ability to draw a proper conclusion from these circumstances. The maliciously accelerating of the death of another already laboring under disease is criminal ; for in a legal WHICH OF TWO WOUNDS CAUSED DEATH, 319 sense that which accelerates, causes. In Reg. v. Timms (Oxford Lent Ass. 1870), it was proved that prisoner had struck deceased some blows on the head with a hatchet. In twelve days, under treatment, he had partly recovered from the effects, but in six weeks afterwards he was seized with inflammation of the brain, with convulsions, and died. On inspection, disease of the kidneys was found, of which there had been no symptoms. Death was referred to this disease, and inflammation of the brain as the result of the blows. The learned judge directed the jury, that if they believed the blows conduced in part to the death of the deceased, it was manslaughter, notwithstanding that other causes combined with the blows to account for death. The prisoner was convicted. Lord Hale, in remarking upon the necessity of proving that the act of a prisoner caused the death of a person, says: " It is necessary that the death should have been occasioned by some corporeal injury done to the party by force, or by poison, or by some me- chanical means which occasion death ; for although a person may, in foro conscientice, be as guilty of murder by working on the pas- sions or fears of another, and as certainly occasion death by such means, as if he had used a sword or pistol for the purpose, he is not the object of temporal punishment." (I. 247.) Several acquittals have taken place of late years, in cases in which the deaths of persons have been occasioned by terror, or dread of impending danger, produced by acts of violence on the part of the prisoners ; not, however, giving rise to bodily injury in the deceased. Which of two wounds caused death. — It is possible that a man may receive two wounds on provocation, at different times, and from different persons, and die after receiving the second : in such a case, the course of justice may require that a medical witness should state which wound was the cause of death. Let us take the following illustration : A man receives during a quarrel a gunshot wound in the shoulder. He is going on well, with a prospect of recovery, when in another quarrel he receives a severe penetrating wound in the chest or abdomen from another person, and after lingering under the effects of these wounds for a longer or shorter period, he dies. If the gunshot wound was clearly shown to have been the cause of death, the second prisoner could not be convicted of man- slaughter; or if the stab was evidently the cause of death, the first prisoner would be acquitted on a similar charge. It might be pos- sible for a surgeon to decide the question summarily, when, for instance, death speedily followed the second wound ; and on inspec- tion of the body, the heart or a large vessel is discovered to have been penetrated ; or, on the other hand, extensive sloughing suffi- cient to account for death, might take place from the gunshot wound, and on inspection, the stab might be found to be of a slight nature — not involving any vital parts. In either of these cases, all would depend upon the science, skill, and judgment of the medical practitioner ; his evidence would be so important that no correct decision could be arrived at without it ; he would be, in fact, called upon substantially to distinguish the guilty from the innocent. On 320 DEATH FOLLOWING SLIGHT PERSONAL INJURIES. some occasions death may appear to be equally a consequence of either or both of the wounds ; in which case, probably both parties would be liable .to a charge of manslaughter. (See " Ann. d'Hyg." 1835, vol. 2, p. 432.) The second wound, which is here supposed to have been the act of another, may be inflicted by a wounded person on himself, in an attempt at suicide, or it may have an acci- dental origin. The witness would then have to determine whether the wounded person died from the wound inflicted by himself, or from that which he had previously received. It may happen that the wounded person has taken poison, and has actually died from its efl:'ects, and not from the injuries or mal- treatment. Again, a wounded person may have been the subject of subsequent ill-treatment, and the question will arise — to which of the two causes his death was really due. It is to be observed of these cases, that the supervening disease, the poison, or the sub- sequent ill-treatment, should be of such a nature as to account for sudden or rapid death ; since it would be no answer to a charge of death from violence, to say that there were marks of chronic disease in the body, unless it was of such a nature as to account for the sudden destruction of life under the symptoms which actually pre- ceded death. In the medical jurisprudence of wounds, there is probably no question which so frequently presents itself as this : It is admitted that the violence was inflicted, but it is asserted that death was due to some other cause, and the onus of proof lies on the medical evidence. Among numerous cases which have occurred in England during the last twenty years, I find that the latent causes of death in wounded persons have been chiefly inflammation of the thoracic or abdominal viscera, apoplexy, diseases of the heart and large bloodvessels, phthisis, ruptures of the stomach and bowels from disease, internal strangulation, and the rupture of deep- seated abscesses. In some of these cases the person was in a good state of health up to the time of the violence, and in others there was a slight indisposition. The history is nearly the same in all : it was only by careful conduct on the part of the medical witnesses that the true cause of death was ascertained. It is obvious that questions of malapraxis and life-insurance, giving rise to civil actions, may have a close relation to this subject. Death following slight personal injuries. — An imputation has oc- casionally been thrown on the mastfer of a school, when a' boy has died soon after he has been punished in an ordinary way, and when there has been no suggestion that an undue amount of violence was used. In such cases there has been commonly some unhealthy state of the body to explain the fatal result. When the disease which gives rise to doubt is seated in a part which is remote from that which sustained the violence, all that is required is that the exami- nation of the body should be conducted with ordinary care. If the disease should happen to be in the part injured (the head or chest), the case is more perplexing. The difficulty can then be removed only by attentively considering the usual consequences of such inju- ries. The violence may have been too slight to account for the DEATH AFTER A LONG PERIOD. 321 diseased appearance ; and the disease itself, although situated in the part injured, may be regarded as an unusual consequence of such an injury. On the other hand, the presence of chronic disease will form no exculpation of acts of violence of this nature. Death from wounds after long periods. — Cei-tain kinds of injuries are not immediately followed by serious consequences, but a wounded person may die after a longer or shorter period of time, and his death may be as much a consequence of the injury as if it had taken place on the spot. The aggressor, however, is just as responsible as if the deceased had been directly killed by his vio- lence, provided the fatal result can be traced to the usual and probable consequences of the injury. Wounds of the head are especially liable to cause death insidiously ; the wounded person may in the first instance recover — he may appear to be going on well, when, without any obvious cause, he will suddenly expire. It is scarcely necessary to observe that in general an examination of the body will suffice to determine whether death is to be ascribed to the wound or not. In severe injuries affecting the spinal maiTOw, death is not an immediate consequence, unless that part of the organ which is above the origin of the phrenic nerves (supplying the dia- phragm) is wounded. Injuries affecting the lower portion of the spinal column do not commonly prove fatal until after some days or weeks ; but the symptoms manifested by the patient during life, as well as the appearances observed in the body after death, will sufficiently connect the injury with that event. Death may follow ^ wound, and be a consequence of that wound, at. almost any period after its infliction. It is necessary, however, in order to maintain a charge of homicide, that death should be strictly and clearly traceable to the injury, and not be dependent on any other cause. A doubt on this point must, of course, lead to an acquittal of the accused. Many cases might be quoted in illustration of the length of time which may elapse before death takes place from certain kinds of injuries — the injured person having ultimately fallen a victim to their indirect consequences.', A case is related by Sir A. Cooper of a gentleman who died from the effects of an injury to the head re- ceived about two years previously. The connection of death with the wound was clearly made out by the continuance of the symp- toms of cerebral disturbance during the long period which he sur- vived. Another case is mentioned by Hoff bauer, in which a person died from the effects of concussion of the brain as the result of an injury received eleven years before, ("Ueber die Kopfverletzun- gen," 1842, p. 57.) There is a singular rule in our law relative to the period at which a fierson dies from the wound — namely, that the assailant shall not be adjudged guilty of homicide,*unless death takes place within a year and a day after the infliction of the wound. (Archbold, p. 345.) In practice, the existence of this rule is of little importance, but in principle it is erroneous. Most wounds leading to death generally destroy life within two or three months after their inflic- 9.1 322 SECONDARY CAUSES OF DEATH. tion ; sometimes the person does not die for five or six months, and in more rare instances, death does not ensue until after the lapse of twelve months, or even several years. These protracted cases occur especially in respect to injuries of the head and chest. Strict jus- tice demands that the responsibility of a person who has inflicted a wound should depend upon its having really caused death, and not upon the precise period at which death takes place ; for this must be a purely accidental circumstance. Secondary causes of death. — A person who recovers from the im- mediate eflects of a wound may die from fever, inflammation or its consequences, pyaemia, erysipelas, delirium tremens, tetanus, or gangrene ; or an operation required during the treatment of a wound may prove fatal. These are what may be called secondary causes of death, or secondary consequences of a wound. The power of deciding on the responsibility of an accused person for an event which depends only in an indirect manner on an injury originally inflicted by him, rests of course with tlie authorities of the law. But it is impossible that they can decide so difficult and nice a question in the absence of satisfactory medical evidence ; and on the other hand, it is right that a medical witness should under- stand the importance of the duty here required of him. I^ever or erysipelas may follow many kinds of serious wounds, and in some few instances be distinctly traceable to them ; but in others, the constitution of a person may be so broken up by dissipated habits as to render a wound fatal which in a healthy subject might have run through its course mildly, and have healed. When the fever or erysipelas can be traced to a wound, or there is no other appa- rent cause of aggravation to which either of these disordered states of the body can be attributed, they can scarcely be regarded by a medical practitioner as unexpected and unusual consequences, espe- cially when the injury is extensive, and seated in certain parts of the body, as in the scalp. If death take place under these circum- stances, the prisoner will be held as much responsible for the result as if the wound had proved directly mortal. This principle has been frequently admitted by our law, and indeed, were it other- wise, many reckless ofl'enders would escape, and many lives would be sacrificed with impunity. It is, however, difficult to lay down general rules upon a subject which is so liable to vary in its rela- tions in every case ; but when a wound is not serious, and the secondary cause of death is evidently due to constitutional peculi- arities from acquired habits of dissipation, the ends of justice are probably fully answered by an acquittal ; in fact, such cases do not often pass beyond a coroner's inquest. The secondary causes of death may be arranged under the follow- ing heads : — 1. 77ie cause is unavoidable. — Of this kind are tetanus, following laceration of tendinous and nervous structures — erysipelas follow- ing lacerated wounds of the scalp — peritoneal inflammation follow- ing blows on the abdomen with or without rupture of the bladder or intestines, and effusion of their contents — strangulation of the AVOIDABLE AND UNAVOIDABLE CAUSES. 323 intestines (phrenic hernia) following rupture of the diaphragm, and others of a like nature. Here, supposing proper medical treat- ment and regimen to have been pursued, the secondary cause of death was unavoida|)le, and the fatal result certain. 2. The cause avoidable by good medical treatment. — There are, it is obvious, many kinds of wounds which, if properly treated in the first instance, may be healed and the patient recover, but when im- properly treated they prove fatal. In the latter case, it will be a question for a witness to determine how far the treatment aggra- vated the effects of the violence, and from his answer to this the jury may have to decide on the degree of criminality which attaches to the accused. Let us suppose, for instance, that an ignorant person has removed a clot of blood, which sealed up the extremity of a bloodvessel, in consequence of which fatal bleeding has ensued ; or that he has caused death by unnecessarily interfering with a penetrating wound of the chest or abdomen ; it would scarcely be just to hold the aggressor responsible, since, but for the gross igno- rance and unskilfulness of his attendant, the wounded person might have recovered from the eft'ects of the wound. When death is really traceable to the negligence or unskilfulness of a surgeon who is called to attend on a wounded person, this circumstance ought to be, and commonly is, admitted in mitigation, supposing that the wound was not originally of a mortal nature. Lord Hale observes: " It is sufficient to constitute murder, that the party dies of the wound given by the prisoner, although the wound was not origi- nally mortal, but became so in consequence of negligence or unskil- ful treatment ; but it is otherwise where death arises, not from the wound, but from unskilful applications or operations used for the purpose of curing it." (1, 428.) The medical jurist will perceive that a very nice distinction is here drawn by this great judge, be- tween death as it results from a wound rendered mortal by improper treatment, and death as it results from improper treatment, irres- pective of the wound. In the majority of cases such a distinction could scarcely be established, except upon speculative grounds; and in no case, probably, would there be any accordance in the opinions of medical witnesses. In slight and unimportant wounds, it might not be difficult to distinguish the effects resulting from bad treat- ment froni those connected with the wound, but there can be few cases of severe injury to the person, wherein a distinction of this nature could be safely made ; and the probability is that no con- viction of murder would now take place, if the medical evidence showed that the injury was not originally mortal, but only became so by unskilful or improper treatment. In such a case, it would be impossible to ascribe death to the wound, or to its usual or probable consequences ; and without this it is not easy to perceive on what principle an aggressor could be made responsible for the result. [In Commonwealth v. Hackett, 2 Allen (Massachusetts) 136, it was held that one who has wilfully inflicted upon another a dangerous wound, with a deadly weapon, from which death ensues, is guilty of murder or manslaughter, as the evidence may prove, 824 DEATH FEOM IMPRUDENCE OR NEGLECT. although through want of care or skill, the improper treatment of the wound by surgeons may have contributed to the death. See also Commonwealth v. Oreen, 1 Ash. 289. — P.] 3. Comparative skill in treatment. — If death has been caused by a wound, the responsibilitj' of a person is not altered by the allega- tion that under more favorable circumstances and with more skilful treatment, a fatal result might have been averted. At the same time, it is obvious that a serious responsibility is thrown on practi- tioners who undertake the management of cases of criminal wound- ing. Any deviation from ordinary practice should therefore be made with the greatest caution, since novelties in practice will, in the event of a fatal result, form one of the best grounds of defence in the hands of a prisoner's counsel. On these occasions, every point connected with the surgical treatment will be the subject of rigorous inquiry and adverse professional criticism. In the case of a severe lacerated wound in the hand or foot, followed by fatal tetanus, it may be said that the wounded person would not have died had amputation been at once performed. In this instance, however, a practitioner may justify himself by showing either that the injury was too slight to require amputation, or that the health or other circumstances connected with the deceased would not allow of its being performed with any reasonable hope of success. On the other hand, if the priactitioner performed amputation, and the patient died, then it- would be urged that the operation was prema- ture, or wholly unjustifiable, and that it had caused death. Here the surgeon is bound to show that the operation was necessary according to the ordinary rules of practice. The treatment of severe incised wounds of the throat, when the windpipe is involved, sometimes places a practitioner in an embarrassing position. If the wound is left open, death may take place from bleeding; if it be prematurely closed, blood may be infused into the windpipe and cause death by suftbcation. 4. The cause avoidable but for imprudence or neglect on the part of a wounded person. — A man, who has been severely wounded in a quarrel, may obstinately refuse medical assistance, or he may insist upon taking exercise, or using an improper diet, contrary to the advice of his medical attendant ; or by other imprudent practices, he may thwart the best conceived plans for his recovery. Let us take a common case as an illustration. A man receives a blow on the head in a pugilistic combat, from the first effects of which he re- covers ; but after having received surgical assistance, he indulges in excessive drinking, and dies. The aggressor is tried on a charge of manslaughter, and found guilty. Death, under these circumstances, is commonly attributed by the medical witness to effusion of blood on the brain; but it cannot be denied that the excitement produced by intoxicating liquors, will sometimes satisfactorily account for the fatal symptoms. In the case which we are here supposing, such an admission might be made, and the prisoner receive the benefit of it; for the imprudence or negligence of a wounded person ought not, morally speaking, to be considered as adding weight to the offence DEATH FROM IMPRUDENCE OR NEGLECT, 325 of the aggressor. If the pymptonis were from the first unfavorable, or the wound likely to prove mortal, circumstances of this kind could not be received in mitigation. Our judges have shown them- selves at all times unwilling to admit them. The legal responsi- bility of the assailant is the same, whether the deceased die on the spot, or some days, weeks, or months afterwards, unless it can be distinctly proved that his death was immediately connected with the imprudence or excess of which he was guilty, and wholly indepen- dent of the wound. But, although a prisoner should be found guilty of manslaughter under these circumstances, the punishment is so adjusted by our law as to leave a considerable discretionary power in the hands of a judge. This is, indeed, tantamount to a direct legal provision, comprehending each different shade of guilt ; a man is held responsible for a wound rendered accidentally mortal by events over which he could have no control, but which in them- selves ought to be regarded as in some degree exculpatory. The punishment attached to his offence may be severe or slight, accord- ing to the representation made by a medical witness of the circum stances which rendered the wound mortal ; if he neglect to state the full influence of imprudence or excess on the part of the wounded person, where either has existed, over the progress of the wound, he may cause the prisoner to be punished with undue severity. The humanity of our judges is such, that when medical evidence is clear and consistent on a point of this nature, and there are no circum- stances in aggravation, they commonly pass a mild sentence. (See case by M. Ollivier, "Ann. d'Hyg.," 1842, p. 128.) The neglect to call in a medical practitioner, or the refusal to receive medical ad- vice, will not, however, according to the decision in Reg. v. Thomas (Gloucester Aut. Ass. 1841), be considered a mitigatory circumstance in favor of the prisoner, even although the wound was susceptible of being cured. A man may receive a lacerated wound of a limb, which is followed by tetan us or gangrene, and thus proves fatal ; he may have declined receiving medical advice, or have obstinately refused amputation, although proposed by his medical attendant. This would not operate as a mitigatory circumstance on the part of an assailant, because a wounded person is not compelled to call for medical assistance, or to submit to an operation, and a medical wit- ness could not always be in a condition to swear that the operation would have positively saved his life ; he can merely affirm that it might have afforded him a better chance of recovery. Again, a person may receive a blow on the head, producing fracture, with great depiression of bone, and symptoms of compression of the brain ; a surgeon may propose the operation of trephining to elevate the depressed bone, but the friends of the wounded man may not per- mit the operation to be performed. In such a case, his line of duty will be to state the facts to the court, and it is probable that in the event of conviction there would be some mitigation of punishment ; because such an injury, if left to itself, must in general prove mor- tal, and no doubt could exist in the mind of any surgeon, as to the absolute necessity for the operation. But the neglect or improper 326 UNHEALTHY STATE OF BODY. conduct of a person who receives a wound thus rendered fatal, does not exculpate the aggressor. The crime is either murder or man- slaughter. 5. The cause avoidable hut for an abnormal or unhealthy state of the body of the wounded person. — "Wounds which are comparatively slight sometimes prove indirectly fatal, owing to the person being in an unhealthy condition at the time of their infliction. In bad constitutions, compound fractures or slight wounds, which in a healthy person would have a favorable termination, are followed by gangrene, fever, or erysipelas, proving fatal. Here the responsibility of an assailant for the death may become reduced, so that, although found guilty of manslaughter, a mild punishment might be inflicted. The consequence may be, medically speaking, unusual or unex- pected, and, but for circumstances wholly independent of the act of the accused, would not have been likely to destroy life. In general, in the absence of malice, this appears to be the point to which the law closely looks, in order to make out the responsibility of the accused — namely, that the fatal secondary cause must be something not unusual or unexpected as a consequence of this particular injury. The medico-legal question presents itself under this form : Would the same amount of injury have been likely to cause death in a per- son of ordinary health and vigor? Men who have suddenly changed their habits of living, and have passed from a full diet to abstemi- ousness, are sometimes unable to bear up against comparatively slight injuries, and often sink from the secondary consequences. So a man otherwise healthy laboring under rupture, may receive a blow on the groin, attended with laceration of the intestine, gangrene, and death ; another with a calculus in the kidney may be struck in the loins and die, in consequence of the calculus perforating the bloodvessels and causing fatal bleeding or subsequent inflammation. It must be evident that there exist numerous internal diseases, such as aneurism and various morbid affections of the heart and brain, which are liable to be rendered fatal by slight external vio- lence. The law, as applied to these cases, is thus stated by Lord Hale : " It is sufficient to prove that the death of a person was accel- erated by the malicious act of the prisoner, although the former labored under a mortal disease at the time of the act." (1, 428.) In most of these cases there is an absence of intention to destroy life, but the nature of the wound, as well as the means by which it was inflicted, will often suffice to develop the intention of the prisoner. An accurate description of the injury, if slight, may afford strong evidence in favor of the accused, since the law does not so much regard the means used by him to perpetrate the violence, as the actual intention to kill, or to do great bodily harm. Serious injury, causing death by secondary consequences, will ad- mit of no exculpation when an assailant was aware, or ought to have been aware, of the condition of the person whom lie struck. Thus, if a person notoriously ill, or a woman while pregnant, be maltreated, and death ensue from a secondary cause, the assailant will be held re- sponsible; because he ought to have known that violence of any kind DEATH UNDER ABNORMAL CONDITIONS. 327 to persons so situated, must be attended with dangerous consequences. So, if the person maltreated be an infant or a decrepit old man, or one laboring under a mortal disease, it is notorious that a compari- tivel}^ slight degree of violence will destroy life in these cases, and the prisoner would properly be held responsible. A wound which accelerates death causes death, and may therefore render the aggres- sor responsible for murder or manslaughter, according to the circum- stances. The commissioners appointed to define the criminal law on the subject of homicide thus express themselves : " Art. 3. It is homicide, although the eftect of the injury be merely to accelerate the death of one laboring under some .previous injury or infirmity, or although, if timely remedies or skilful treatment had been applied, death might have been prevented." This is conformable to the decision of our judges. According to Lord Hale, if a man has a disease which in all likelihood would terminate his life in a short time, and another give him a wound or hurt which hastens his death, this is such a killing as constitutes murder. (Archbold, p. 346.) 6. Abnormal conditions. — "When an assailant could not have been aware of the existence of a diseased or an abnormal condition of parts in the wounded person, the question is somewhat diiferent. In many persons the skull is preternaturally thin, and in most persons it is so in those places corresponding to the glandulse Pac- chioni. In a case of this kind, a moderate blow on the head might cause fracture, accompanied by effusion of blood, depression of bone, or subsequent inflammation of the brain and its membranes, any of which causes might prove fatal. In some persons all the bones of the body are unusually brittle, so that they are fractured by the slightest force. Inflammation, gangrene and death may follow, when no considerable violence has been used ; but these being unexpected consequences, and depending on an abnormal condition of parts unknown to the prisoner, his responsibility may not, cceteris paribus, be so great as under other circumstances. This condition of the bones car^ be determined only by a medical practitioner. Facts of this kind show that the degree of violence used in an assault cannot always be measured by the effects, unless a careful examination of the injured part is previously made. Some German medical jurists have contended that an unnatural transposition of parts should become a mitigating circumstance— as when, for example, the heart or some large vessel is not in its usual position, and is there wounded ; but this doctrine will receive no sanction from an English court of law, as the responsibility of persons for these criminal offences does not rest upon the perfect anatomical structure of the deceased ! At the same time it might become a question whether, if death occurred from a superficial wound, whereby a large artery taking an abnormal course was divided — there might not be, cceteris paribus, some ground for di- minishing the degree of responsibility. 7. Difficulty of proof in death from secondary causes. — When a person is charged with having caused the death of another through 328 DEATH FROM TETANUS. violence terminating in some fatal disease, the case often admits of a skilful defence, and this in proportion to the length of time after the violence, at which the deceased dies. The disease, it may be urged, is liable to appear in all persons, even the most healthy ; or it may arise from causes unconnected with the violence. In ad- mitting these points, it must be remembered that death may be proved to have been indirectly a consequence of the wound by the facts; 1, that the supervention of the secondary cause, although not a common event, lay in the natural course of things ; 2, that there did not exist any accidental circumstances which were likely to have given rise to this secondary cause independently of the wound. The proof of the first point amounts to nothing, unless the evidence on the second point is conclusive. CHAPTERS XXIX. WOUNDS INDIEECTLT FATAL. — TETANUS FOLLOWING WOUNDS. — ERYSIPE- LAS. — DELIRIUM TREMENS. — GANGjlENE. — DEATH FROM SURGICAL OPERATIONS. — PRIMARY AND SECONDARY CAUSES OF DEATH. — UNSKIL- FULNESS IN OPERATIONS. — PYEMIA. — MEDICAL RESPONSIBILITY IN REFERENCE TO OPERATIONS. — ACTIONS FOR MALAPRAXIS. Tetanus following wounds. — Tetanus frequently presents itself as a secondary fatal consequence of wounds, especially of those which are lacerated or contused, and affect nervous and tendinous struc- tures. It has often occurred as a result of slight bruises or lacera- tions, when the injury was so superficial as to excite no alarm ; and it is a disease which gives no warning of its appearance. Tetanus may come on spontaneously, i. e., independently of the existence of any wound on the body. Cases have been brought into the Lon- don hospitals, in which the only c^use of this disease appeared to be exposure to cold or wet, or, in some instances, exposure to a current of air. (" Lancet," Dec. 14, 1844, 351.) It is scarcely pos- sible to distinguish, by the symptoms, tetanus from wounds (trau- matic) from that which occurs spontaneously as a result of natural causes (idiopathic). In endeavoring to connect its appearance with a particular wound or personal injury, it will be proper to observe — 1, whether there were any symptoms indicative of it before the maltreatment ; 2, whether any probable cause could have inter- vened to produce it, between the time of its appearance and the time at which the violence was inflicted ; 3, whether the deceased ever rallied from the effects of the violence. The time at which tetanus usually makes its appearance, when it is a result of a wound, is from the third to the sixth day ; but it may not appear until three or four weeks after the injury, and the exciting cause may still be traced to the wound which may have healed. When resulting from a wound, it is generally fatal. DEATH FEOM SURGICAL OPERATION'S. 329 A medical practitioner is bound to exercise great caution before be pronounces an opinion that a fatal attack of tetanus has arisen either from spontaneous causes, or from slight blows or personal injuries. A rigorous inquiry should be made into all the attendant circumstances. Slight punctured wounds, operating as a cause of tetanus, have been overlooked or only discovered by accident after death, and it is highly probable that many cases have been set down as idiopathic tetanus in which, by proper inquiry, the disease might have been traced to a wound or some personal'injury. In one in- stance the tetanus was at first considered to be idiopathic; but shortly before death a small black mark was observed on the thumb nail. On making inquiry, it was found that a few days previously to the attack a splinter of wood had accidentally penetrated the thumb. The patient attached so little importance to the accident that he did not mention the circumstance to his medical attendant. This was no doubt the sole cause of the disease. Many trials for murder have occurred in this country, in which tetanus was the immediate cause of death ; and the defence has generally rested upon the probable origin of the disease from accidental causes. JErysipelas, like tetanus, may be a fatal result of slight injuries. Wounds affecting the scalp are liable to be followed by this disease. Burns and scalds sometimes prove fatal through this secondary cause. Some constitutions are particularly prone to erysipelatous inflammation, and thus, wounds comparatively slight may have a fatal termination. When a wounded person has died from this disease, an assailant cannot be made responsible for the fatal result, unless the erysipelas is clearly traced to the injury. The medical facts that the person assaulted has never recovered from the effects of the violence, and that the inflammation set up has suddenly assumed an erysipelatous chai'acter, are sufiicient to establish this connection. If there has been recovery, and an interval of some days has elapsed, a doubt may arise respecting the connection of the erysipelas with the violence inflicted. This disease is occasion- ally idiopathic, i. e., it appears like tetanus without any assignable cause. It is sometimes difficult to establish the connection of erysipelas with a wound, especially when the disease occurs after some time and in a remote part of the body, not implicated in the wound. When this connection cannot be distinctly made out, there will be an acquittal. Delmum tremens is a disease which frequently presents itself as a secondary consequence of injuries to persons of intemperate habits. Whether the injury be slight or severe, this disease may equally supervene and prove fatal. It is observed occasionally as a consequence of operations required for the treatment of wounded persons. The remarks made at p. 326 upon the influence of un- healthy constitutions on wounds, apply with especial force to cases of this description. Death from, surgical operations. — In the treatment of wounds, surgical operations are frequently resorted to, and a wounded per- 330 DEATH FROM SDRGICAL OPEBATI'OXS. son may die either during the performance of an operation, or from its consequences. A question will thence arise, whether the person w^ho inflicted the wound should be held responsible for the fatal result. The law regards a surgical operation as part of the treat- ment, and if undertaken bona; fide, and performed with reasonable care and skill, the aggressor will be held responsible, whatever may be the result. The necessity for the opeiration and the mode of performing it, will be left to the operator's judgment. As the de- fence may turn upon the operation having been performed unneces- sarily, and in a bungling and unskilful manner, it will be right for a practitioner, if possible, to defer it until he has had the advice and assistance of other practitioners. According to Lord Hale, if death takes place from an unskilful operation, performed for the cure of a 'wound, and not from the wound, the responsibility of the prisoner ceases ; but this eminent lawyer does not appear to have considered that death may take place as a consequence of the most skilful operation required for the treatment of a wound, and yet be wholly independent of the wound itself. If the operation has been performed by the medical witness him- self, and the necessity for its performance is questioned by counsel for the prisoner, it is open to the witness to give the requisite ex- planation in his evidence. It would appear from a recent case, tried before Shee, J., that the necessity for an operation will not be as- sumed ; but if called in question, it must be proved by witnesses for the prosecution. In Meg. v. Moreland (C. C. C, Sept. 20, 1865), the prisoner threw deceased on the ground and fractured his leg. The limb was amputated at the London Hospital, and the man sub- sequently died. Counsel for the prisoner asked the surgeon from the hospital who spoke to the death of the deceased whether an operation was necessary. The witness said he could not tell, as he had not charge of the case previous to the operation. Counsel then raised the question whether prisoner or the doctors had caused the man's death. The counsel for the prosecution suggested that the court might accept as a fact that amputation, would not have been performed had it not been necessary : but the learned judge said that would not do. They must deal with the case on the evidence before them. He then observed to the jury that, although undoubt- edly amputation would not be adopted at such a place as the London Hospital without the necessity for it, yet evidence to that eifect must be before them on oath. They could not act on what they had every reason to believe ; therefore they must, acquit the prisoner. The failure of justice in this case rested with those who were concerned for the prosecution. The operator, who could pro- bably have satisfied the CDurt that he had not cut off the wrong leg, and that there were good reasons for performing the operation, was not called as a witness: but in his place a gentleman was su.n- moned who could not answer these necessary questions. Death is by no means an unusual result of severe operations, the secondary consequences under which the patient may die being very numerous, even when the case is most skilfully managed. DEATH FROM SURGICAL OPERATIONS. 331 Sometimes the patient will die on the table, although but little blood may have been lost. Fear, pain and sudden shock to the nervous system have caused death under these circumstances. The most common indirect causes of death after severe operations, are secondary hemorrhage, erysipelas, tetanus, delirium tremens, pyaemia and hectic fever, with gangrene of the stump. Mr. Travers observes, that " a pre-existing disease of the liver, kidney, or testicles, though chronic, and in itself not alarming to the con- stitution, becomes a drag upon its elasticity, and stand's in the way of recovery. Inspection of the body after death frequently explains the unfavorable result of operations that promise well, by discover- ing one or more organs in a state of chronic disease, which had not previously deranged the health in a degree sufficient to give notice of its existence, and which might, therefore, have remained quiet for years to come, had no extraordinary call been made upon the powers of the system." (" On Constitutional Irritation," p. 45, 121, et seq.) Should an operation be unnecessarily or unskilfully performed, the responsibility of an aggressor would, it is presumed, cease, if the death of a wounded party should be clearly traced to it. Thus, if in carelessly bleeding a wounded person, the brachial artery should be laid open_ ("Ann. d'Hyg.," 1834, t. 2, p. 445), or if, in performing amputation, a large artery be improperly secured, so that the patient in either case dies from loss of blood, the prisoner could not be equitably held responsible ; because it would be pun- ishing him for an event depending on the unskilfulness of a medical practitioner. According to Piatt B. a prisoner will be held re- sponsible, if the original wound were likely to produce death, although unskilfully treated. Supposing the bleeding or amputa- tion to be performed with ordinary care and skill — and yet, in the one case, inflammation of the veins, and in the other erysipelas, tetanus, gangrene, or fever should destroy life, the prisoner will be liable for the consequences. The practice of the law is strictly con- sistent with justice. Should the operation be considered to be absolutely required for the treatment of a wound, which, according to all probability, would prove mortal without it — should it be per- formed with ordinary skill, and still death ensue as a direct or in- direct consequence, it is only just that the person who inflicted the injury should be held responsible for the result. It is presumed in these cases, that were the patient left to himself, he would, in all probability, die from the effects of the wound. If, therefore, a surgeon, knowing that an operation would give a chance of saving life on such an occasion, did not perform it, it might be contended in the defence, that the deceased had died, not from the wound, but from the incompetency and neglect of his medical attendant. Hence it follows that if, during this necessary treatment, unfore- seen though not unusual causes cut short life, no exculpation should be admitted, if it went to attack the best-directed efforts made for the preservation of life. (See "Ann. d'Hyg." 1835, t. 1,_ p. 231.) If an operation is rendered necessary by reason of the improper 332 OPERATIONS UNDER A MISTAKEN OPINION. treatment of the wound, the responsibility of an assailant for a fatal result ceases. Medical responsibility in the administration of chloroform. — In a large number of operations it is now the general practice among surgeons to administer chloroform vapor, not only to allay pain but to prevent that exhaustion to the patient which is likely to arise from protracted surgical proceedings. In spite of care on the part of the operator, this vapor is liable to destroy life in an unexpected manner, and the patient may die either before the operation is com- menced or during its performance. The facts may leave no (^oubt that the wounded person died from chloroform, and not from the wound or the operation. On inspection of the body, the heart may be found in an unhealthy state, a fact which is usually considered sufficient to account for the fatal effects of chloroform vapor. In a case of this kind — What becomes of the responsibility of the person who inflicted the original wound ? !N"o decision, so tar as I know, has ever been given on this point. Was the use of chloroform vapor in a professional view a necessary part of the treatment? Was it skilfully and properly administered ? Could the diseased condition of the heart which rendered the effects of the vapor more fatal than usual have been detected by the operator, so as to show the impropriety of administering it in this case? Tliese questions should receive satisfactory answers before the aggressor is rendered responsible for death under such peculiar circumstances. By an operation being absolutely required, are we to understand that it is necessary to preserve life, i. e., that the wound will prob- ably prove fatal without it ? Bleeding and cupping may be neces- sary as part of the treatment of a wounded person ; but unless it could be sworn that this treatment was required, in the judgment of the surgeon, for the preservation of life from the injury inflicted, it is doubtful whether, in the event of death occurring from these simple operations, the assailant would be held responsible for the fatal result. From cases hitherto decided, it would appear that the law regards three circumstances in death following surgical operations: 1st, the necessity of the operation itself; 2d, the com- petency of the operator ; and 3d, the fact that the wound would be likely to prove mortal without it. Operations under a mistaken opinion. — It may happen that the wound is not of a mortal nature, and that, although an operation was skilfully performed, it was not necessary to save life ; in other words, the wounded person may die from the immediate results of a serious operation, performed under a mistaken view of the case. It is well known to surgeons that a cancerous tumor has been occa- sionally mistaken for aneurism, an artery has been secured, and death has followed. Let us assume that a man laboring under a slight aneurismal dilatation of a large artery receives a blow on the part ; the tumor gradually increases, and is mistaken for an abscess by three or four surgeons, whose professional standing would permit their general competency from being questioned. Under a wrong diagnosis, it FATAL RESULT FROM PYiBMIA. 833, 18 opened, and the patient dies on the spot ; in such a case it would be unjust to make the aggressor liable ; for, even admitting that the aneurism resulted from the blow, and that a competent surgeon acted with bona fides, the treatment would be unskilful, and the case would fall under the rule laid down by Lord Hale (ante, p. 330). The real facts, however, may not transpire until after the death of the wounded person ; and it may then be alleged by a prisoner's counsel that the operation was not necessary to save life, and that the wounded man might have recovered without it. From the ruling of our judges on various occasions in which this question has arisen, it would appear that the relative degree of skill possessed by medical men is not a question for a jury in a criminal case ; although in a civil case, as in an action for malapraxis, the whole of the medical facts are invariably submitted to their judgment. This difference can only be justified by the assumption, that a man who inflicts a wound must take all the consequences, good or bad. No operation would have been required but for the injury, and the prisoner ought not to escape on account of want of skill in a surgeon, or of a mistake made by a skilful operator. It was decided in the cases of Hex v. Quain and Heg. v. Pym, that although the indict- ment alleged that the deceased died of the wound, while in fact he died from the results of an operation, yet it was good in point of law. Fatal diseases following operations. — When a wounded person is taken to an hospital in which gangrene or erysipelas is diffusing itself by infectious propagation, and he is attacked by one of these diseases before or after the performance of an operation, and dies, a prisoner may be held responsible for the fatal result. It might be contended that the transportation of the wounded man to such a locality was not absolutely necessary for his treatment, or for the preservation of his life, and that he would not have died, but for the accidental presence of an infectious disease. Oases of this kind cannot be easily determined by any general rules. Pymmia. — In addition to erysipelas and tetanus, there is another cause of death which is liable to follow personal injuries and ope- rations, namely, 'pymmia, or the introduction of pus into the blood by absorption or by the mouths of divided bloodvessels. The puru- lent matter appears to act as a poison, and one of its marked effects is to coagulate the blood either in the large vessels or in the capil- laries. According to Dr. Wilks's observations, pyaemia is seldom observed after superficial injuries during the process of healing, or after wounds resulting from simple operations, but it occurs fre- quently when a bone is involved eithe;: in the injury or as the result of an operation. Inflammation of the cellular membrane surround- ing bone is a condition highly favorable to its occurrence. It has been stated that the cause of death in one-half of the cases of am- putation is pyaemia. (See a paper on this subject by Dr. Wilks, "Guy's Hospital Reports," 1861, p. 119.) The medical witness must remember that pyaemia, like tetanus and erysipelas, may arise 334 MEDICAL RESPONSIBILITY IN OPEKATIONS. from causes totally irrespective of wouhlIs or personal injuries. (Cases by Dr. Habershon, " Guy's Hospital Reports," 1859, p. 179.) Medical responsibility in operations. ' Malapraxis. — Tliis is a very wide subject, but it can here be only glanced at in a few of its lead- ing features. It was held by Lord Ellenborough, that if a person acting in a medical capacity be guilty of misconduct arising either from gross ignorance or criminal inattention, by which a patient dies, he is guilty of manslaughter. Faults, such as omissions, or errors in judgment, to which all are liable, are not visited with this amount of criminality. The same rule applies to the licensed as to the unlicensed practitioner ; but it would appear, from the charge of Williams, J. (Winchester Spring Ass. 1847), that a degree of un- skilfulness which might lead to the conviction of a licensed, would justify the acquittal of an unlicensed person. This was in the case of a midwife, aged 72, alleged to have caused the death of a woman on whom she had been called to attend. " The charge," said the learned judge, "appeared to be that by want of skill or attention to her duties, she had caused the death of the woman upon whom she was attending. In order to constitute this oftence, it must be shown that the party was guilty of criminal misconduct, either arising from gross ignorance, or want of skill, or gross inattention. With respect to the degree of want of skill, he must say, that it was not to be expected that a midwife, who was called in to attend a person in the humble class of the deceased, a soldier's wife, should exhibit what a regular medical pi-actitioner would call competent skill. It was enough if she applied that humble skill which, in ordinary cases, would lead to a safe delivery. She was not bound to have skill sufficient to meet peculiar and extraordinary exi- gencies, although in the case of a regular medical man, such skill might be required. The class of this humble practitioner was ab- solutely necessary for the poorer classes, and, although on the one hand it was fit the law should protect a patient, by punishment for gross want of skill, yet he thought there would be much to be lamented if it was applied with such severity as to render a party not possessing skill of this kind liable to punishment for man- slaughter !" Charges of manslaughter have frequently been brought against medical practitioners in cases of midwifery. In some instances gross mismanagement has been proved ; the uterus, and even parts of the viscera, have been torn away, and in such cases convictions have very properly followed. It is well known, however, that much dift'erence of opinion exists among the most eminent practi- tioners of midwifery respecting the treatment to be pursued in certain cases of difficulty, as where the after-birth presents (placenta praevia). There are eminent accoucheurs who advise in this case entirely opposite modes of practice, and who look upon that pur- sued by the other as of the most dangerous kind. When death is not a result of medical treatment, an action "for damages may be brought against the practitioner for malapraxis. From the evi- dence given on some of these occasions, it appears that an action of MEDICAL RESPONSIBILITY IN OPERATIONS. 335 this kind is occasionally resorted to as a very convenient way of settling a long account. It has been a question whether slight deviations from the ordi- nary mode of performing operations" should involve a practitioner in a charge of malapraxis. I am not aware that this question has been raised in England ; but a remarkable instance occurred in the United States a few years since, in which an action was brought and damages were recovered against a medical man for alleged negligence in vaccinating a young woman (case of H. L. London). Some inflammation of the skin followed, the operation, which, it was alleged, was performed nearer to the elbow-joint than was usual. The plaintift" soon recovered from the eftects. . The most singular feature of this case was the ruling of the judge: he said— " In performing the operation of vaccination or inoculation, the physician is liable for all consequences if he neglects the usual pre- cautions, or fails to insert the virus in that part of the arm usually selected for the purpose ; notwithstanding many other parts of the body might be proved to be equally proper and even more suitable locations !" If this be law, it is a very singular specimen of trans- atlantic jurisprudence. It might as well be ruled that legs should always be amputated a^t the same spot ; and in case , of neglect of this rule, thatthe operator should be made reponsible for the result ! When, on these occasions, there is a division of opinion among men of equal experience respecting the necessity for an operation, or the proper performance of it, a practitioner who is made de- fendant has a right to expect that a verdict will be returned in his favor ; since it is not to be supposed that in order to recover pay- ment for a bill, or to answer a charge of unskilfulness, a man's practice should receive the unanimous approval of the whole of his jjrofessional brethren, especially in cases in which there is an acknowledged difference of opinion respecting the treatment. On this showing, a man would never be able to recover his charges for the treatment of a case of severe burn or scald, since some practi- tioners consider it malapraxis to adopt the stimulating, while others equally regard it as malapraxis to adopt the cooling plan of treat- ment ! All that appears to be expected is a reasonable accordance in treatment with received professional doctrines. 336 CICATRIZATIOISr OF WOUNDS. CHAPTER XXX. CICATRIZATION OF WOUNDS — EVIDENCE FROM CICATRICES — CHANGES IN AN INCISED WOUND — ARE CICATRICES, WHEN ONCE FORMED, INDELIBLE? — CHARACTERS OF CICATRICES — IDENTITY PROVED OR DISPROVED BY CICATRICES — COLORED CICATRICES — TATTOO MARKS. Cicatrization of wounds. — The period of time at which a particular wound was inflicted may become a medico-legal question, both in relation to the living and the dead. The identity of a person, and the correctness of a statement made by an accused party, may be sometimes determined by an examination of a wound or its cicatrix. So, if a dead body be found with marks of violence upon it, and evidence adduced that the deceased was maltreated at some par- ticular period before his death, it will be necessary for a practitioner to state whether, from the appearance of the injuries, they could or could not have been inflicted at, or about the time assigned. An incised wound inflicted on the living body gradually heals by adhesion, when no circumstances interfere to prevent the union of the edges. For eight or ten hours the edges remain bloody ; they then begin to swell, showing the access of inflammation. If the parts ai'e not kept well in contact, a secretion of a serous liquid is poured out for alDout thirty-six or forty-eight hours. On the third day, this secretion acquires a purulent character. On the fourth and fifth days, suppuration is fully established, and it lasts five, six, or eight days. A fibrous layer, which is at first soft and easily broken down, then makes its appearance between the edges ; this causes them gradually to unite, and thus is produced what is termed a cicatrix. Cicatrization is complete about the twelfth or fifteenth day, if the wound is simple, of little depth and width, and only afl:'ecting parts endowed with great vitality. The length of time required for these changes to ensue will depend — 1. On the situation of the wound ; wounds on the legs are longer in healing than those on the upper part of the body. If a wound is situated near a joint, so that the edges are continually separated by the motion of the parts, cicatrization is retarded. 2. On the extent ; a deep or wide wound is long in undergoing cicatrization. Wounds involving many and difl:erent structures are also longer in healing than those simply afl'ecting skin and muscles. 3. On the age and health of the wounded person ; the process of cicatrization is slow in old persons as well as in those who are diseased and infirm. In an incised wound, the cicatrix is generally straight and regular; but it is semilunar if the cut is oblique. It is soft, red and tender if cicatrization is recent ; it is hard, white and firm if of long stand- ing. On compressing the skin around an old cicatrix, its situation CHAEACTERS OF CICATRICES. 337 and form are well marked by the blood not readily entering into it on removing the pressure. Is a cicatrix, when once formed, ever removed, or so altered hy time as to he no longer recognizable ? — This is a question which sometimes presents itself to a medical jurist both in civil and criminal pro- ceedings. When a cicatrix has been produced by the healing of a wound involving a loss of substance in the cutis or true skin, it is permanent. In wounds involving the whole substance of the skin, the cicatrix which is once formed does not disappear, although it may undergo some changes in after life. Wounds which heal by suppuration and granulation generally leave behind them cicatrices which remain for life. The marks arising from the pustules of vac- cination, smallpox, herpes zoster, and those produced by setons and issues, leave cicatrices easily recognizable at any period. In an early stage, a cicatrix is redder than the surrounding skin, but after some months or years, it becomes white, firm and shining. The time required for these changes cannot be defined. In one person they may take place in a few months, and in another only after some years. The tissue of which a cicatrix is formed is different from that of the skin; it is harder, and contains less blood, and is destitute of a colored deposit (rete mucosum), so that its whiteness, which is remarkable on the cicatrized skin of a negro, is retained through life. If any cicatrices were easily obliterated, it would be those which are even and regular — the results of incised wounds by sharp instruments ; but I have observed that cicatrices of this kind have certainly retained their characters unchanged, in one instance for twenty, and in another for twenty-five years. According to the observations of Dupuytren and Delpech, the substance of a cica- trix is not converted into true skin — -it never acquires a rete mucosum, i. e. the membrane which gives color to the skin. Although this is generally true of incised and punctured wounds, yet contused and lacerated wounds on the legs of persons advanced in life fre^ quently present a brown discoloration — from the deposit of a brown pigment. In the cicatrices of lacerated and contused wounds, the form of the weapon with which the wound was inflicted is some- times indicated. It is not, however, easy to distinguish the cica- trix of a stab from that produced by a pistol-bullet fired from a distance. In both cases the edges may be rounded and irregular, and the cicatrix puckered, unless the stab has been produced by a broad-bladed weapon. If no mark of cutting can be perceived within a few months of the period at which a severe wound is alleged to have been inflicted, it is reasonable to infer that there has been some mistake, or that the circumstances have been greatly exaggerated. Characters of cicatrices. Their age or date. — It is important to observe that all cicatrices are of smaller size than the original wound, for there is a contraction of the skin during the process of healing. There are no appearances in a cicatrix which will allow us to fix the date at which the wound leading to its production was 338 CICATRICES FBOM WOUNDS OR DISEASE. inflicted, and it is most difficult to say how or by what means it was inflicted. If the person is living, he may give a description of the injury and the date of its production, consistent or incon- sistent with the appearances presented. As Casper justly remarks (" Ger. Med." 1, 115), it requires more than two, three, or four weeks to produce the hard white shining appearance of an old cicatrix ; but when it has once acquired these characters, there are no medical data for enabling us to say whether the injury was inflicted two,, three, or even ten years before. A proper attention to the number, situation, and appearances presented by cicatrices on the living or dead body, will, however, sometimes enable a medical witness to establish or disprove the identity of persons. Cicatrices from wounds or disease. Imputed. — As there are im- puted wounds, so there may be imputed cicatrices. It is rare to hear of frauds of this description. It is more likely that an im- postor may seek to gain his object by attributing the cicatrices of wounds accidentally received to other causes, or by ascribing cicatrices which have resulted from disease, to some particular cause occurring in early life. By a remarkable coincidence, two persons may have cicatrices on or about the same part of the body, produced by cuts, punctures, or abscesses in early life ; and serious mistakes may be made under these circumstances. A case is reported to have occurred in France in 1794, in which a man named Lesurgues was tried, convicted and executed for robbery and murder. There were some doubts at the time as to his identity, and strong exertions were made to save his life. Soon after hia execution the real murderer was discovered, between whom and Lesurgues, who had no hand or part in the crime, there existed a wonderful resemblance in stature, complexion, and features. But the most extraordinary part of the case was that Lesurgues, like the real criminal, had a cicatrix or scar on the forehead, and another on the hand ; and there is no doubt that these points of resemblance, which upon a proper scientific examination might have been proved to be really different, became the turning-point of the case, and led to the conviction of an innocent person. On the other hand, a vulgar impostor, with old scars upon his ' person, may make use of them as proofs of identity. Such scars may exist : they may be clearly proved to be of old date, and they may be assigned to causes which cannot be disproved except by a close medical examination. The scars or cicatrices may have arisen from scrofulous ulcers or abscesses, in which case it would not be difficult to distinguish them from the cicatrices of wounds. A question of this kind may occasionally present some difficulty, but a close examination of the cicatrix, with a consideration of the statement of the person as to its mode of production, will enable a practitioner to arrive at a satisfactory conclusion respecting its origin. Scrofulous ulcers are generally observed to leave irregular and deeply-furrowed cicatrices, with smooth depressions, surrounded by hard and uneven margins. According to Schneider, the scorbutic cicatrix is dark, bluish-red in color, soft to the touch, somewhat COLOEED .CICATRICES — TATTOO MARKS. 339 raised and rattier painful ; in the course of time it becomes flatter, of a reddish-brown color, approaching to green (?) in the centre, and very thin and easily injured. Syphilitic cicatrices are charac- terized by great loss of substance ; they approximate the margins of the deep ulcers before their granulations have had time to reach the surface. Glandular cicatrices are irregularly tumefied, gene- rally deep, hardened, and of a reddish-brown color. These varieties cannot easily be mistaken for the cicatrices of wounds. Cicatrices from smallpox or vaccination are well known and easily identified. Colored cicatrices. Tattoo marks. — Small punctured"wounds made into the true skin with three or four sharp needles, dipped in coloring matter, leave marks which may or may not be indelible according to the mode in which the operation is performed. This subject has been noticed by medical jurists. It has been made use of as evidence in cases of disputed identity. See papers by Dr. Tardieu, " Ann. d'Hyg." 1855, 1, 171 ; also by Dr. Horteloup, in the same journal, 1870, vol. 2, p. 440 ; and Casper's Grerichtliche Mediein, vol. 1, p. 115. The colors employed in tattooing are indigo, charcoal (gunpowder), China ink, and vermilion. Although China ink is black, its effect when introduced in a white skin is to produce a blue, or bluish-colored mark. The foreign matter thus introduced mechanically into these minute punctured wounds causes inflammation, but this soon passes off, and the coloring matter remains permanently encysted in the substance of the cutis, or below it. It has been there found after death. From researches made by competent observers, these colored marks are not necessarily indelible. They have been observed to remain for fifty years and upwards, when the coloring matter was carbonaceous, for forty years in a case in which red cinnabar was used ; but it is not so much from the lapse of time as from other causes that these marks become faint and ultimately disappear. The depth in the cutis to which the needles have been carried, and the nature of the coloring matter employed, are the chief cir- cumstances on which the durability of these marks depends. The red colors are the most disposed to fade, while the black, especially that of China ink, is among the most persistent. In one instance of a near relative I have known the marks from this color to remain unchanged, in the skin of the inside of the arm, for thirty- seven years. The thinner the skin, and the less the depth to which the needles have penetrated, the more readily do these marks fade and disappear. Something also must be set down to the skill and experience of the operator. Casper states that while he has seen the tattoo marks remaining in some cases after forty years and upwards, in two instances they had entirely disappeared after thirty-six and thirty-eight years respectively. (Op. cit. p. 116.) It is possible to remove these marks by caustic applications, or the actual cautery, but such an act is usually indicated by the pro- duction of cicatrices ; for if the tattooing is complete, the removal can be effected only by the destruction of the cutis. In one 340 WOUNDS OF THE HEAP. instance of attempted removal, a fatal result followed. (" Ann. d'Hyg." 1855, 1, 199.) Medico-legal questions connected with these colored marks on the skin, have been hitherto confined to the identity of persona charged with crime. If it is alleged that they have existed and disappeared by time or artificial means, medical evidence may be required to show how far this is probable. When found on the skin, it is impossible to assign a date for their production, for after one or two years have elapsed they will remam unchanged for life. The medical facts connected with cicatrices were made a subject of closQ investigation in the* celebrated Tichborne case ( Tichborne V. Lushington), C.P., May, 1871-2. CHAPTER XXXI. WOUNDS OF THE HEAD. — CONCUSSION. — HOW DISTINGUISHED FROM IN- TOXICATION. — EFFUSION OF BLOOD AS A RESULT OF VIOLENCE, DISEASE, OK MENTAL EXCITEMENT. — WOUNDS OF THE FACE. — DEFORMITY AS A CONSEQUENCE OF WOUNDS OF THE FACE. — INJURIES TO THE SPINE AND SPINAL MARROW. — FRACTURES OF THE VERTEBRA. The danger of wounds, and their influence in causing death, are the two principal points to which the attention of a medical jurist must be directed. "Wounds op the Head. Incised wounds, affecting the scalp, unless of great extent, rarely produce any serious effects. "When the wound is contused or accom- panied by much laceration of the skin, it is highly dangerous in consequence of the tendency which the inflammatory process has to assume an erysipelatous character. The results of these wounds are, however, such as to set all general rules of prognosis at defiance. Slight punctured wounds will sometimes terminate fatally in conse- quence of inflammation, followed by extensive suppuration ; while, on the other hand, a man may recover from a lacerated wound by which the greater part of the skin may have been stripped from the bone. There are two sources of danger in wounds of the' scalp : 1. The access of erysipelatous inflammation. 2. Inflammation of the tendinous structures, followed or not by a process of suppuration. Either of these secondary eft'ects may be a consequence of slight or severe wounds, and prove fatal. Neither can be regarded as an unusual result of a severe wound of the scalp, but when one or the other follows a slight injury, there is reason to suspect that the patient may have been constitutionally predisposed to the attack. Bad treatment may likewise lead to a fatal result from a wound not CONCUSSION OF THE BRAIN. 341 serious in the first instance, but the question — ^how far the respon- sibility of an aggressor would be affected by a circumstance of this nature has been considered in another place (ante, p. 324). Wounds of the head are dangerous in proportion as they affect the brain ; and it is rare that a severe contused wound is unaccompanied by some injury to this organ. There is, however, a difficulty which a practitioner has here to contend with — namely, that it is scarcely possible to predict from external appearances, the degree of mischief which has been produced within. These injuries, as it is well known, are capricious in their after-effects — the slightest contusions may be attended with fatal consequences, while fractures, accom- panied by great depression of bone, and an absolute loss of substance of the brain, are sometimes followed by perfect recovery. Another difficulty in the way of forming a correct opinion consists in the fact, that a person may recover from the first effects of an injury, but after some days or weeks he will suddenly die ; and on exami- nation of the body, the greater part of the brain will be found de- stroyed by suppuration, although no symptoms of mischief may have manifested themselves until within a few hours of death. Concussion. — The common effect of a violent blow on the head is to produce concussion or eflusion of blood, or both. Concussion is usually indicated by fainting, insensibility,, or sudden death oc- curring immediately after the application of external violence. In concussion the symptoms come on at once, and the patient some- times dies without any tendency to reaction manifesting itself. In the niost severe form, the person drops at the very moment when struck and dies on the- spot. (Chelius's " Surgery," vol. 1, p. 408.) In other cases, he may linger in a state of insensibility for several days or weeks and then die. In concussion there is generally more or less vomiting. It is important to remember that neither com- pression nor physical injury to the brain is necessary to render concussion fatal. This may be entirely dependent on shock to the nervous system. After death, no particular morbid change may be discovered in the body, or there may be merely the mark of a slight bruise on the head. The state of insensibility observed in concus- sion may be only apparent : some consciousness may be retained. Inflammation may follow the primary shock from concussion ; suppuration may take place, and the patient die after the lajjse of several weeks, or even months. It is necessary in a medico-legal point of view to notice that a person may move about and occupy himself, while apparently convalescent, for a week or ten days after recovery from the first shock, and then suddenly be seized with fatal symptoms, and die. This apparent recovery leads to the common supposition, that death must have been produced by some intervening cause, and not by the original violence to the head, a point generally urged in the defence of such cases. "When the in- flammation that follows concussion is of a chronic character, the person may suffer from pain in the head and vomiting, and die after the lapse of weeks, months, or even years. Concussion may sometimes take place as a consequence of a violent fall on the feet, 342 CONCUSSION DISTINGUISHED FEOM INTOXICATION. in which case the head receives a shock through the medium of the spinal column. The skull may be thereby extensively fractured at the base, and the brain may be even shattered by such a fall. This was the cause of death in the case of the Duke of Orleans. (" Med. Gaz.," vol. 36, p. 368.) Concussion distinguished from intoxication. — The symptoms under which a wounded person is laboring may be sometimes attributed to intoxication, and a medical witness may be asked what difference exists between this state and that of concussipn. The history of the case will, in general, sufBce to establish a distinction, but this cannot always be obtained. It is commonly said that the odor of the breath will enable a surgeon to detect intoxication ; but it is obvious that a man may meet with concussion after having drunk liquor insufficient to cause intoxication, or concussion may take place while he is intoxicated — a combination which frequently occurs. Under such circumstances we must wait for time to de- velop the real nature of the case. Concussion may be so slight as sometimes closely to resemble intoxication, and from the absence of all marks of violence to the head and the existence of a spirit- uous odor in the breath, the medical examiner might be easily deceived. If there be no perceptible odor in the breath, the pre- sumption is that the symptoms are not due to intoxication. On the other hand, intoxication may be so great as to give rise to the apprehension of fatal consequences, and the coexistence of a mark of violence on the head might lead to error in the formation of an opinion. What is the line of conduct to be pursued on such occa- sions ? The examiner should weigh all the circumstances, and if there be one cause for the symptoms more probable than another, he should adopt it; if there be any doubt, this should be stated to the court. There is nothing in the state of the brain in a dead body, which will enable a practitioner to distinguish whether concussion or in- toxication had existed, and had been the cause of the symptoms. The vessels may be congested in both cases. The discovery of an alcoholic liquid in the stomach might lead to a presumption that deceased had been intoxicated, while marks of violence on the head might favor the view that he had sufl'ered from concussion. When both conditions are found, the examination of the body cannot lead to a solution of the question. The answer must then depend on the special circumstances proved, and, if procurable, on the nature of the symptoms preceding death. It is to be feared that medical witnesses are not sufficiently "careful, on these occasions, to deter- mine whether there are signs of intoxication about an injured person. Subsequent proceedings may render this a material part of the inquiry. The distinction of apoplexy from drunkenness involves great diffi- culties. In these cases we have to deal with the true diagnosis of alcoholic or narcotic poisoning (p. 222). Dr. Jackson has directed attention to this medical question in a case reported in the " Med. Times and Gaz." 1871, 1, 360. Some instructive cases, in reference INJURIES TO THE BRAIN BY EFFUSION. 343 to this complication of wounds, have been published by M. Tar- dieu. (See " Med. Gaz.," vol. 44, p. 347.) Extravasation, or effusion of Blood. — A blow on the head may destroy life by causing an effusion of blood either on the surface or in the substance of the brain. In pugilistic combats, when a person is thus struck, he commonly falls, and death may take place in a few minutes. On inspection, blood may be found effused either at the base, or in the ventricles of the brain, and the ques- tion will present itself— Did the injury which caused death arise from a bloio or a fall f (See page 276.) A heavy blow on the head may cause fatal effusion of blood ; but on these occasions the effusion commonly arises from the violent concussion which the injured person sustains by the fall. A medical witness will, there- fore, in general, be compelled to admit that the fatal effusion might have taken place either from a blow or a fall. If the fall has re- sulted from accident, and not from a blow, this will, of course, absolve the accused from responsibility for the fatal results. This subject has important applications in legal medicine, for this is one of the most common causes of death from injuries to the head, and there are generally many cases of this description tried at the assizes. Effusion may occur from violence, with or without frac- ture, and it may take place without being accompanied by any external marks of injury. In cases of injures to the head proving fatal by effusion of blood on the brain, a person may recover from the first effects of the vio- lence, and apparently be going on well, when he will suddenly be- come worse and die. Effusion takes place slowly at first ; it may be arrested by the effects of stupor from concussion, by a portion of the blood coagulating around the ruptured orifices of the vessels, or by some other mechanical impediment to its escape ; but after a longer or shorter period, especially if the person be excited or dis- turbed, the bleeding will recur, and destroy life by producing com- pression of the brain. How many hours or days are required in order that such an increased effusion should take place after an accident, it is impossible to say ; but in severe cases, it is gener- ally observed to follow the injury within a short time. Sir Astley Cooper has related a case of a gentleman who was thrown out of a chaise, and fell upon his head with such violence as to stun him in the first instance. Aftec a short time he recovered his senses, and felt so much better that he entered the chaise again, and was driven to his father's house by a companion. He attempted to pass oft" the accident as of a trivial nature, but he soon began to feel heavy and drowsy, so that he was obliged to go to bed. His symptoms became more alarming, and he died in about an hour, as it afterwards appeared, from effusion of blood on the brain. When the brain has sustained laceration from violence, in addition to insensibility, convulsions are frequently observed. Effusion of blood from disease or violence. — -Blood may be found effused in various situations within the interior of the skull ; and the cause of the effusion may be either disease or violence. The 344 EFFUSION OF BLOOD. skill of a medical jurist is often required to determine which of these causes is the more probable, as where, for instance, a pugilist has died, after having received severe injuries to the head, and his adversary is tried on a charge of manslaughter. On these occa- sions it is often urged in the defence, that the bleeding might have arisen either from a diseased state of the vessels of the brain ; or, if the evidence render it probable that the blow was the cause, that the effects of the blow were aggravated by a diseased condition of the vessels, or by the excitement into which the deceased was thrown, either from the effects of intoxication, or passion. When the brain is not lacerated by violence, the blood is effused either on the surface of the hemispheres, between the membranes, or at the base. When the effusion is caused by violence, the effused blood is not always found under the spot where the blow was in- flicted, but occasionally, by counter-stroke on the surface of the brain, directly opposite to it, — a case which a medical witness has frequently been required to explain on trials, and which depends on the same cause as fracture by counter-stroke, i. e. on a separation of parts (laceration of the brain, effusion of blood, or even frac- ture of the bones) at the point of the skull directly opposite to that which sustains the violence. Thus, fracture of the base of the skull is frequently the result of severe violence applied to the top of the head (vertex). Effusions of blood from a diseased state of the vessels more commonly take place in the substance of the brain, but they sometimes occur on the surface of the organ, as a result of mere excitement or over-exertion of the muscular powers. A diseased condition of the vessels, and probably a softening of the substance of the brain, will on these occasions be apparent on inspection. If the effusion depend on disease., the arteries around may be found in a diseased condition, or the brain itself may be found softened and disorganized. The state of the brain and its vessels should be closely examined in all cases of alleged violence, since hemorrhage may take place either from excitement, or slight blows, whenever this diseased condition exists. It has occasionally hap- laened, especially in old persons, that the person has dropped down dead without a blow being struck, and that death has been wrongly imputed to violence. Cerebral hemorrhage from disease rarely occurs in persons under forty years of age. Frequent in- temperance and violent passion may, however, easilj' create a ten- dency to it in younger persons. As an effect of violence it may take place in persons of all ages, but when the marks of violence are slight, a witness must exercise great caution before he alleges that the effusion was produced by a blow, especially when it is found that the deceased was of intemperate habits. Another condition besides intoxication and passion has been said to favor a rupture of vessels and an effusion of blood .on the brain — namely, a thickened state of the substance of the left ven- tricle of the heart. According to some pathologists, this morbid condition favors the occurrence of cerebral hemorrhage by the INJUEIES TO THE BRAIN. 345 force with which the ventricle propels the blood to the brain. Unless the brain is softened and the vessels are diseased, it is, how- ever, doubtful whether this condition of the heart would have much influence. As a summary of these remarks, we may say that in effusions of blood from violence, the blood generally issues from a vessel which is plainly seen to be torn, as the middle artery of the brain, or the lateral sinus. The effused blood is commonly found on the surface of the brain, and not in its substance, unless the organ be lacerated. When situated between the dura mater and the skull, but especially when immediately below the seat of violence, or directly opposite to it by counter-stroke, this is strong evidence, cceteris -paribus, that it has proceeded from a blow. When there is a fracture of the skull, the presumption of the extravasation being due to violence is great, because there is not only a sufficient, but an obvious cause, while the idea of its having proceeded from disease only is remote and speculative. When, besides these conditions, there is no re- markable congestion of the brain and other spots — when the sub- stance of the brain is firm, and the vessels are to all appearance free from disease, we have the strongest reason to believe that the effusion must have been due to violence, and to no other cause whatever. The evidence given on some trials, when the main question has turned upon the cause of an effusion of blood on the brain, in the case of a person who has sustained violent injuries to the head, has rather tended to reflect disgrace on medical science. It has been made to appear from the mouth of the medical witness, either di- rectly or by implication, that no sort of mechanical violence ap- plied to the head of a man in a state of drunkenness or passion — of one whose cerebral vessels were probably diseased, or the sub- stance of whose heart might be thickened — could have had any effect in producing a fatal extravasation found in the head after death ! In spite of an individual having received a violent blow with a bludgeon, sufficient to have killed a stout and vigorous man, or of his having been thrown with considerable force with his head against a stone-floor, an unqualified admission is often made that excitement alone, or drunkenness alone, would account for the effusion without reference to the blow ! In putting the most favor- able construction upon these cases, when we have clear evidence of great violence having been used to the head, with the presence of the usual post-mortem appearances, our opinion should be that the excitement or drunkenness might have predisposed to, but was not the immediate cause of, the cerebral hemorrhage. There seems to be no good reason for assuming that apoplexy from natural causes always occurs, by a peculiar coincidence, just at the time that a person receives a violent blow with a bludgeon on the head, or for giving to the assailant the benefit of this hypothetical ex- planation. A mere inspection of the body does not always lead to the discovery of the cause of an effusion on the brain. The vio- lence causing an effusion of blood may have been slight, and unless 346 EFFUSION OF BLOOD FROM EXCITEMENT. attention is particularly directed to the subject, it may be over- looked. The condition of the effused blood should be accurately noticed, in order to determine whether it presents any marks indi- cative of its being recent or of old standing. Spontaneous effusions or effusions from disease are not easily dis- tinguished from those which are the result of violence to the head. Dr. "Wilks has pointed out that in most instances of severe injury attended with effusion of blood, the structure of the brain is found bruised. In meningeal apoplexy (apoplexy of the membranes), the source of the blood is a vein of the pia mater or inner membrane, and sometimes a large arterial trunk. The difficulty chiefly arises in those cases in which effusion is found after slight violence and there is, at the same time, disease of the bloodvessels of the brain. Dr. Wilks gives the result of several inspections in which effusion was owing to disease, to violence, and to a mixed condition. (See " Guy's Hospital Reports," 1859, p. 120.) Effusion of hlood from excitement. — "When engaged in the investi- gation of these cases, it is always a fair matter of inquiry whether the violence was not of itself sufficiently great to account for the effusion, without the supposition of coexisting disease or excite- ment. Admitting that the rupture of a bloodvessel, and the ex- tensive effusion of blood on the brain may take place from simple excitement and passion, yet this is an event comparatively rare, at least in the young and healthy, while nothing is more common than that these results should follow violent injuries to the head, whatever the age or condition of the person. A medical witness should remember that on these occasions, if he is unable to say positively whether the effusion was due to the excitement or the blows, he will satisfy the court if he only state clearly that which is, in his own mind, the more probable cause of death ; and by weighing all the circumstances of the case beforehand, he will rarely fail to find that one cause was more probable than the other. Thus, if a man, excited by passion and intoxication, is struck on the head, and the blow is slight — such as an unaffected person would probably have sustained without injury — yet in this case insensibility and death follow, and, on examination, a quantity of blood is found effused in the substance of the brain, can it be a matter of doubt with the practitioner that the effusion was chiefly due to the excitement under which the deceased was laboring? To take a converse instance : a man, engaged in a personal conflict with another, is struck most violently on the head, or falls with freat force on this part of his body ; on inspection it is found that eath has arisen from effusion of blood on the surface of the brain, and it would be no unexpected consequence of the violence inflicted, that a similar appearance should be met with in an individual calm and unexcited. Can the practitioner hesitate to say, under these circumstances, that the blow would satisfactorily account for the effusion, without reference to any coexisting causes of excitement? These may be allowed to have their influence in giving an increased DATE OF EFFUSIONS. 347 tendency to cerebral hemorrhage, or in aggravating tlie consequence of the blow, but no further. Date of effusions. — Recent effusions of blood are recognized by their red color, and the consistency and appearance of the clot or coagulum. After some days the clots acquire a chocolate or brown color, and this passes gradually into an ochreous tint, which may be met with in from twelve to twenty-five days after the violence. Coagula of effused blood also undergo changes in structure and consistency ; when old they are firmer, and there is much lymph, which is sometimes disposed in membranous layers of a fibrous structure, and these are adherent to the dura mater and the brain. The surface of this organ sometimes presents a mark indicative of pressure. "When a medical man is required to give an opinion of the date of an effusion found on the brain, great caution is required. A surgeon may not be able to fix the precise date, but it may be in his power to say whether the blood has been effused for a few days, weeks, or months. When a blow on the head is of a heavy, bruising kind, the whole substance of the skull may be fractured without a division of the skin. There is one remarkable circumstance connected with fractures accompanied by depression of bone, which here requires to be mentioned — namely, that the person has been sensible so long as the foreign substance which produced the fracture and depres- sion remained wedged in the brain, and that insensibility and other fatal symptoms began to manifest themselves onl}'^ after its removal. This being admitted, it may be urged in defence, that death was really caused by medical interference. But it is a sufia- cient answer to state, that the wounded person must have died from inflammation of the brain if the foreign body had been allowed to remain ; and that it is consistent with the soundest principles of practice to remove all such foreign substances without delay. In fractures of the skull with depression, it may become a question whether the surgeon raised the depressed portion of bone so soon as he ought to have done. A blow on the head may produce a fracture of the inner table of the skull, and cause death by compression as a result of the frac- ture on the effusion of blood. In Reg. v. Hadwen (Lancaster Aut. Ass. 1871), prisoner struck a boy a severe blow on the head. He became sick and unconscious, fell into a state of collapse, and died the next day. On inspection, the inner table of the skull was found to be fractured, and there was effusion of blood on the brain. In reference to persons found dead with severe injuries to the head attended with fracture and effusion of blood on the brain, a medical man may be required to say whether such an amount of violence is or is not consistent with the retention of muscular exer- tion, and power of locomotion by the deceased. For instance, a man mav fall from a height, and produce a severe compound fracture of the skull. He may, nevertheless, be able to rise and walk some distance before he falls dead. Under these circumstances, there 348 WOUNDS OF THE FACE. might be a strong disposition to assert that the deceased must have been murdered — the injuries being such that they could not have been produced by himself, there being at the same time no weapon near, and no elevated spot from which he could have fallen. The discovery, after death, of severe injury to the head, with great effu- sion of blood on the brain, must not, however, lead a surgeon to suppose that the person who sustained the violence had been imme- diately incapacitated. There are various cases recorded which show that a power to move has been retained under conditions which might be supposed to render a person incapable of moving from the spot. Full allowance must be made on those occasions for the pos- sible exercise of locomotion by the deceased. Although a large quantity of blood may be found after death pressing on the substance of the brain, it does not follow that this effusion and pressure were the* immediate result of the violence. Wou7ids of the brain. — "Wounds of the brain sometimes prove instantaneously mortal, even when slight, while in other cases, recoveries take place from contused or punctured wounds of this organ, contrary to all expectation. When a person survives the first effects of the injury, there are two sources of danger which await him : 1. The production of fungus from the exposed portion of the brain ; and 2. Inflammation and its consequences. The pro- cess of inflammation, it must be remembered, is very slowly estab- lished in this organ ; it may not manifest itself until from three to ten weeks after the injury. In one remarkable case, where a child was accidentally shot through the brain, the ball having traversed both hemispheres, no symptoms of cerebral inflammation manifested themselves for twenty-six days. The child died on the twenty- ninth day. (" Med. Gaz." vol. 39, p. 41.) [Many instances have been reported where portions of the brain have been destroyed as the result of accident, and yet life has been preserved. A remarkable case is recorded in the " Amer. Journ, Med. Sci.," July 1850, by Prof Bigelow, of Boston. A man was preparing a charge of powder for blasting rocks ; a premature ex- plosion ensued, which resulted in projecting a bar of iron weighing thirteen and a quarter pounds, three feet seven inches in length, and one and a quarter inches in diameter, directly through his head, and high into the air. The man was slightly convulsed at first, but he soon recovered his senses, riding some distance to his home, and giving a clear account of his accident. His subse- quent recovery was complete, with the exception of the loss of one eye. Wounds of the base of the brain and of the cerebellum are the most fatal. — R.] Wounds of the face. — When wounds of the face are of any extent, they ai'e usually followed by great deformity ; and when they pene- trate the cavities in which the organs of the senses are situated, they often prove fatal, either by involving the brain and its mem- branes, or by giving rise to inflammation of this organ. Wounds of the eyebrows are not of so simple a nature as might at first sight be supposed. Besides being attended by deformity when they heal, INJURIES TO THE SPINE. 349 they are liable to cause during the process of healing, serious dis- orders of the neighboring parts. Amaurosis and neuralgia are re- corded among the secondary and not unusual consequences of such wounds, when the supra-orbitar nerve has become implicated. Under certain conditions of the body, there may be inflammation of the parts within the orbit, extending by contiguity to the membranes of the brain, and proving fatal by leading to the formation of matter within that organ. Amaurosis in the right eye has been known to occur from a contused wound, not of a violent nature, on the right eyebrow. "Wounds apparently confined to the external parts of the face frequently conceal deep-seated mischief. A sharp in- strument penetrating the eyelid, and passing- upwards with any force, will produce fracture of the orbitar plate of the frontal bone, which is known to be extremely thin, and even injure the brain beyond. Deformity as a consequence of wounds of the face. — "Wounds of the face when at all extensive, are always followed, in healing, by greater or less deformity. A medical witness may, perhaps, find these questions put to him in relation to them : Is the wound likely to be attended with deformity ? Could such a wound of the face heal without deformity ? or. Could the deformity, if it exist, have been produced by any other cause than the wound ? These ques- tions are of some importance. A person may allege that he was severely wounded in the face, when the medical witness, on exami- nation, may find no trace of such a wound as that described. Again, a person may seek damages from another in a civil action, by alleg- ing that a particular deformity was produced by a wound, when the medical witness may be able to trace its origin to disease, or to some accidental cause. Injuries to the Spine. Injuries to the spine and spinal marrow seldom require medico- legal investigation ; but this organ is liable to concussion from blows, to compression from fracture of the vertebrae or the effusion of blood, with all the secondary consequences attending such accidents. Con- cussion of the spinal marrow commonly produces paralysis, affecting the bladder, rectum, or lower limbs. These symptoms may not appear at once, but come on after some hours or days. After death no traces of mechanical injury may be discovered. Blows on the spine, unattended with fracture or dislocation, may, according to the observation of Sir B. Brodie, be followed by inflammation and softening of the spinal marrow. A slight injury has thus been known to cause death, by giving rise to inflammation of the spinal marrow. This organ is also liable to compression from slight causes, and death may occur from paralysis of the nerves of re- spiration. Fractures of the vertebrce. — These fractures are generally attended by displacement, and thus produce compression of the spinal mar- row. They are the more rapidly fatal in proportion as the injury 350 INJURIES TO THE SPINE. is high up in the vertebral column. The whole of the body becomes paralyzed below the seat of injury, by the compression of the "spinal marrow. If the seat of compression is above the fourth cervical vertebra, death is commonly immediate; asphyxia results from paralysis of the nerves which supply the diaphragm, and which are necessary to respiration. In falls on the summit of the head from a height, it sometimes happens, not only that the skull is extensively fractured, but that the dentiform process of the second vertebra is broken off, owing to the head being doubled under the body. This injury to the second vertebra may be the cause of death. From a, case related by the late Mr. Phillips, it would appear that this accident is not always attended by fatal compression of the spinal marrow. (" Ed. M. & S. J." Jan. 1838.) In one instance the person survived fifteen months (ib. Oct. 1845, p. 527) ; and in another, in which the fracture was caused by the patient turning in bed while his head was pressed on the pillow, death did not take place for six- teen months. (Copland, " Diet. Pr. Med.," Paralysis.) On several criminal trials, this injury was proved to have been the cause of death : and in a case tried at Grlasgow (the King against Reid, p. 27), it became a material question, how far such a fracture might result from disease. It may happen that caries of the bone, or dis- ease of the transverse ligament will cause a separation of the denti- form process from the second cervical vertebra. [See Sir A. Cooper's case of spontaneous luxation of the second cervical vertebra, from caries of the odontoid process. (Cooper on Dislocations and Frac- tures, p. 463.) — E,.] The state of the bone in these alleged fatal accidents should, therefore, be closely examined. In fractures of the vertebras, a person is generally so disabled, whatever may be the situation of the fracture, that he cannot walk or exert himself. Injuries to the spine and its contents are generally the result of falls or blows, either on the head or the lower part of the column. The secondary consequences of these injuries are sometimes so insidious as to disarm suspicion, and death may take place quite unexpectedly some weeks after the accident. Spicula of bone sepa- rated by fractures, ra&j remain adherent for some time ; and, by a sudden turn of the head, be forced off, and destroy life by pene- trating the spinal marrow, at a long period after the infliction of the injury. This has been known to happen in fractures involving the margin of the foramen magnum, and in such cases death is imme- diate. The spinal marrow has been in some instances wounded in its upper part by sharp-pointed instruments introduced between the vertebrae. Death is an instantaneous result when the wound is above the third cervical vertebra; there is no part of the spine where a weapon can so easily penetrate as this, especially if the neck be slightly bent forward. The external wound thus made may be very small, and if produced with any obliquity by drawing aside the integuments, it might be easily overlooked, or it might be set down as superficial. "WOUNDS OF THE CHEST. 351 CHAPTER XXXII. WOUNDS OF THE CHEST. — WOUNDS AND EUPTURBS OF THE LUNGS AND HEART. — WOUNDS OF LARGE BLOODVESSELS. — WOUNDS AND RUPTURES OP THE DIAPHRAGM. DIRECTION OF WOUNDS OP THE CHEST. — -WOUNDS OP THE ABDOMEN. DEATH FROM BLOWS ON THE CAVITY. RUPTURES OP THE LIVER, GALL-BLADDER, SPLEEN, 'KIDNEYS, INTESTINES, STO- MACH AND URINARY BLADDER. — WOUNDS OF THE GENITAL ORGANS. Wounds of the chest. — Wounds of the chest have heen divided into those which are confined to the parietes or walls and those which penetrate the cavity. Incised or punctured wounds of the parietes of the chest are rarely followed by dangerous consequences. The bleeding is not considerable, and is generally arrested without much difficulty. They heal either by adhesion or suppuration, and unless their effects are aggravated by incidental circumstances, the person recovers. Contusions or contused wounds of the chest are, however, far more dangerous, and the danger is always in a ratio to the degree of violence used. Such injuries when severe, are ordi- narily accompanied by fractures of the ribs or sternum — by a rup- ture of the viscera within the cavity, including the diaphragm — by profuse bleeding — or, as an after-effect, by inflammation of the lungs, with or without suppuration. Fractures of the ribs are dangerous for several reasons: the bones may be splintered and driven inwards, thereby wounding the lungs and causing hemor- rhage, or leading to inflammation of the pleura or lungs. In frac- tures of the upper ribs, the prognosis is less favorable than in those of the lower, because commonly a much greater degree of violence is required to produce the fracture. A simple fracture of the sternum or chest-bone without displacement of the bone, is rarely attended with danger, unless the concussion has at the same time produced mischief internally, which will be known by the symp- toms. When, however, the bone is depressed as well as fractured, the viscera behind may be mortally injured. In a case of depressed fracture of the sternum, recorded by M. Sanson, the person died after the lapse of thirteen days ; and on inspection, it was found that the fractured portion of bone had produced a transverse wound of the heart about an inch in length. The cavities of the organ had not been penetrated, but the piece of bone was exactly adapted to the depression produced by it on the parietes. (Devergie, " Med. L^g." vol. 2, p. 243.) A witness will frequently be required to take into consideration the effects of contusions on the thorax, with or without fracture, in cases of death from pugilistic combats, which formerly gave rise to numerous trials on charges of manslaughter. Wounds penetrating into the cavity of the chest are generally 352 WOUNDS OF THE LUNGS AND HEART. dangerous, even when slight, in consequence- of the numerous aeci- deuts with which they are liable to be complicated. In these wounds, the lungs are most commonly injured ; but, according to the direction of the weapon, the heart, or the great vessels connected with it, as well as the oesophagus (gullet) or thoracic duct, may share in the mischief. Wounds of the lungs. — The immediate cause of danger from wounds of these organs is the consequent hemorrhage, which is jDrofuse in proportion to the depth of the wound and the size of the vessels wounded. Should the weapon divide any of the trunks of the pulmonary veins, the individual may speedily sink. The degree of hemorrhage cannot be determined by the quantity of blood which escapes from the wound ; for it may flow internally, and collect within the cavity of the pleura, impeding respiration. This is especially to be apprehended when the external orifice of the wound is small and oblique, and one of the intercostal arteries has been touched by the weapon. A wound of the lung is 'generally known, among other symptoms, by the frothiness and florid color of the blood which issues from the orifice, as well as by the expectoration of blood. The lungs may sustain serious injury from a blow or fall, and yet there may be no external marks of violence or symptonis indicative of danger for some hours. During the convalescence of a person who has survived the first effects of a penetrating wound of the chest, the surgeon should observe whether death, when it occurs, may not have been caused either by imprudence on the part of the patient, or by abuse of regimen or other misconduct ; for cir- cumstances of this natui'e may be occasionally treated as mitigatory on the trial of the assailant. It is properly recommended that in all cases where a person is progressing to recovery, a relaxation of the antiphlogistic regimen should be made with great circumspec- tion. Too much nourishment, too frequent talking, or any exer- tion are circumstances that may cause a renewal of the bleeding and extravasation. Wounds of the heart. — "Wounds of the heart are among the most fatal of penetrating wounds of the chest. It was formerly con- sidered that all wounds of this organ were necessarily and instantly mortal. Undoubtedly, when either of the cavities is laid open to a large extent, the bleeding is so profuse on the withdrawal of the weapon, that death must be immediate. But when the wound is small, and penetrates into the cavities of the heart obliquely, life may be prolonged for a considerable period ; and cases are on record in which it is probable that such wounds would have healed, and the patients have finally recovered, but for the supervention of other diseases which destroy life. [Numerous examples of wounds of the heart not directly fatal are cited by Beck (ii. 329-332) and by Stills (" Wh. and Stille," 2d ed. p. 580). "We know of at least three others, occurring in Phil- adelphia, not noted in these works, in which the victim was proved to have walked several steps after having been wounded in the heart. See " Proc. of Path. Soc. of Phila.," in " JST. A. Med.-Chir. WOUNDS OF THE HEART. 353 Rev.," March, 1859, p. 299 ; also " New York Med. Times," April, 1855, for the case of Poole, referred to above from Dr. Darling ; and in the same journal (May, 1855), " Statistical Observations on "Wounds of the Heart, and on their relations to Forensic Med. :" with a table of forty-two recorded cases, by Dr. Purple ; also " Am. Journ. Med. Sciences," July, 1861, p. 298, for a case of bullet in the wall of the heart for twenty years. See, further, a paper " On Wounds of the Heart," by Dr. Jno. Redman Coxe, " Am. Journ. Med. Sci.," Aug. 1829, 807 ; and " Archiv. G6n6r. de M^d.," Sept. 1839, for a valuable paper " On Penetrating Wounds of the Heart," by M. Jobert De Lamballe. — H.] It was the opinion of Dupuytren, that these injuries were not necessarily fatal, although I believe, with one exception, there is no case on record in which a person has recovered from a penetrat- ing wound of the cavities of the heart. (" Ed. M. and S. J." Oct. 1844, 557 ; also "Ann. d'Hyg." 1846, t. 1, p. 212.) There are few, probably, who will be inclined to consider them curable ; a remote possibility of simple wounds healing, and of the patient recovering, may be admitted, but until some clear instances of recovery from penetrating wounds of the cavities are reported, the majority of practitioners will continue to look upon them as fatal. Erom a series of cases collected by MM. Ollivier and Sanson, it appears that out of twenty-nine instances of penetrating wounds of the heart, only two proved fatal within forty-eight hours. In the others death took place at the varying periods of from four to twenty- eight days after the infliction of the wound. (Devergie, " Med. L?g." vol. 2, p. 253.) These difl^'erences in the time at which death occurs, as well as the fact that wounds of the heart do not instantly destroy life, have been ascribed to the peculiar disposition of the muscular fibres of the organ, and to the manner in which they are penetrated by a weapon. It appears from the observations of M. Ollivier and others, that the right cavities of the heart are more frequently wounded than the left, and of these the right ventricle is most commonly the seat of injury. Out of sixty-four cases of wounds of this organ, twenty-nine were situated in the right ven- tricle, twelve in the left ventricle, nine in the two ventricles, three in the right auricle, and one in the left auricle. These differences are readily accounted for by the relative situation of the cavities. It appears also that wounds of the right ventricle are not only the most frequent, but of all others they are the most rapidly fatal. It is considered that the suddenness of death in severe wounds of the cavities of this organ, is to be ascribed not merely to the loss of blood, but to the degree of compression which the heart experiences from that which escapes into the bag of the pericardium. In reference to the direction of penetrating wounds of the chest, it may be proper to state that the base of the heart corresponds to the upper margin of the third rib on the left side ; and the apex to the lower margin of the fifth rib on the same side. A penetrating wound of the heart was formerly considered to be instantaneously mortal, and the usual medical opinion at coroners' 354 WOUNDS OF LAEGE ARTERIES. inquests was, that a person so wounded, must have dropped down dead on the spot. More accurate observations have, however, shown that this is an erroneous, and in medico-legal practice, a highly dangerous doctrine. The Due de Berri, who was murdered in Paris in 1820, survived eight hours after having received a wound of the left ventricle. Other and more remarkable instances of survivorship have been recorded ; and it may be stated that, although in a surgical view, a question of this kind is of little im- portance, the case is very different in legal medicine. Upon it may depend the decision of questions relative to suicide, murder, or justifiable homicide. "When the cavities of the heart, especially the auricles, are extensively laid open, death is likely to be an im- mediate result ; but persons who have sustained wounds of this organ have frequently lived sufliciently long to exercise a power of volition and locomotion. In reference to penetrating wounds (stabs), little or no blood probably escapes from the heart in the first instance, but it may afterwards ooze gently, or suddenly burst out in fatal quantity. It must not, therefore, be supposed, when a person is found dead with a wound of the heart, attended with abundant hemorrhage, either that the flow of blood took place in an instant, or that the person died immediately, and was utterly incapable of exercising any voluntary power. The heart is liable to be ruptured either from disease or acci- dent. In the latter case the organ generally gives way towards the base, and through one of its cavities on the right side. Dr. Hope asserts that in rupture from natural causes, it is the left side of the heart, and particiilarly the left ventricle, in which a rupture is most frequently found. The symptoms are sudden pain, col- lapse, cramps, cold extremities and rapid death. According to the circumstances under which they occur, cases of rupture from dis- ease may excite a suspicion of death from violence. Sometimes the substance of the heart may be found to have undergone fatty degeneration. As a medico-legal subject, it is worthy of note, that when this alarming accident proceeds from blows or falls, it is not always accompanied by marks of external violence — or any frac ture or other injury to the exterior of the chest. The natural causes of rupture of the heart are violent mental emotions, such as anger, fright, terror, paroxysms of passion, sudden or excessive muscular efforts, or violent physical exertions in constrained posi- tions. The heart, like any other muscle, may also give way from its own powerful contraction. When the heart is in a diseased condition, any slight causes of excitement are sufficient to produce rupture and sudden death. The mere exercise of walking may thus give rise to fatal consequences. Wounds of arteries and veins. — Wounds of the large arterial and venous trunks around the heart, must be considered as mortal: death is generally instantaneous from the sudden and profuse bleeding which attends them. With regard to these fatal effusions of blood within the chest, as well as in the other great cavities, it may be proper to mention that, from whatever vessel or vessels the WOUNDS OF LARGE ARTERIES. 355 blood may have issued, it is not commonly found coagulated to any extent. The greater part of it generally preserves the liquid state ; and it is rare that so much as one-half of the quantity effused is met with in the form of coagulum. These effusions of blood in the chest may be sometimes traced to wounds of the intercostal and the internal mammary arteries, or of the vena azygos. Wounds of the carotid arteries have been considered elsewhere in reference to wounds of the throat. Questions relative to the power of locomotion perhaps more frequently occur with respect to wounds of these bloodvessels of the neck than of the heart — sui- cide and murder being more commonly perpetrated by the inflic- tion of such, wounds. Wounds of the carotid arteries are often pronounced instantaneously mortal. A witness may deliberately state that the person could not possibly have survived an instant. This is a very hazardous opinion, for it occasionally comes out on inquiry, that if such a wound had been instantaneously mortal, then, in defiance of rational probability, or of the strongest pre- sumptive evidence to the contrary, the deceased must have been murdered! A medical opinion of this kind has not only been re- futed by circumstances, but by the evidence of eye-witnesses. A medical witness is then compelled to admit that his rules for judg- ing of the mortality of wounds are erroneous, and that the person may have survived for a longer or shorter period. There are seve- ral cases on record which show that wounds involving the common carotid artery and its branches, as well as the internal jugular vein, do not prevent a person from exercising voluntary power, and even running a certain distance. There is another circumstance which requires notice in relation to severe wounds in the throat — namely, •that although a person may have the power of locomotion, he may not be able to use his voice so as to call for assistance. It some- times excites surprise at an inquest, how a murder may, in this way, be quietly committed without persons in an adjoining room hearing any noise; but the fact is well known medically, that when the windpipe is divided, as it generally is on these occasions, the voice is lost. In reference to severe wounds involving bloodvessels, while we may allow that persons may survive for a sufficient time to per- form various acts of volition and locomotion, yet the presence of a mortal wound, especially when of a nature to be accompanied by a great loss of blood, must prevent all struggling or violent exertion on the part of the wounded person ; such exertion we must con- sider to be quite incompatible with his condition. A medical jurist may thus have it in his power to determine whether a mortal wound found on the deceased has or has not beeii inflicted for the purpose of murder. Of wounds of other bloodvessels, whether arteries or veins, it is unnecessary to make any further remarks. Death is generally owing to loss of blood, and the bleeding from a comparatively small vessel may prove fatal, according to its size, situation, and the state of the wounded person. 356 KUPTURES OF THE DIAPHRAGM. Death from the entrance of air into wounded veins. — In wounds of veins there is an occasional and a peculiar cause of death which re- quires a remark, namely, the entrance of air by the open mouth of the divided vessel. It has been long known that air injected into the jugular vein would destroy life by interfering with the functions of the heart ; but the exact nature of this accident, as it occurs in operations, is not well understood. (Ferguson's " Surgery," p. 444.) According to some, the air rushes into, the cavity of the vessel owing to atmos- pheric pressure during the expansion of the heart, while others believe it to be dependent on aspiration in the act of breathing : but in some alleged cases of this kind, death has been probably caused by loss of blood. When the bleeding is slight, and the hissing sound is heard at the time of the incision, it may fairly be ascribed to the entrance of air. This opinion would be confirmed by the discovery of a frothy state of the blood in the right cavities of the heart. Wounds and ruptures of the diaphragm. — The diaphragm, or muscular partition between the chest and abdomen, is liable to be wounded either by weapons which penetrate the cavity of the chest or abdomen, or by the ribs when fractured by violent blows or falls; but, under any circumstances, wounds of this muscle are not likely to occur without implicating other important organs that are in contact with it. It is scarcely possible, therefore, to estimate the danger of these injuries abstractedly, as a medical opinion must materially depend upon the concomitant mischief of the adjoining viscera. Slight penetrating wounds of the diaphragm may heal like those of other muscular parts : and cases of this kind are on record. There is, however, especially when the wound is of a lacerated kind, a consecutive source of mischief which no remedial means can avert — namely, that after the wound has, to all appear- ance, healed, the life of a person may be cut short by the strangu- lation of a portion of the stomach or bowels in the half-cicatrized aperture. In a case of this description, when death occurs at a long period after the infliction of a wound, the witness may pro- bably be required to say — Whether the woiind was the cause of death ? or whether there were any other circumstances which would have caused or facilitated the production of a hernia. The degree of culpability of an aggressor may materially depend upon the answers returned to these questions. Phrenic hernia, as this form of internal rupture is termed, is not by any means an unusual or unexpected fatal consequence of a wound of the diaphragm ; and therefore it would appear at first sight, that death, at whatever period this event may occur, should be referred to the original wound. But the case may present some difiiculties, as it is possible that a slight blow on the stomach, received subsequently to the wound, or even any violent ex- ertion on the part of the deceased, might have produced the fatal strangulation. A person may survive with a large phrenic hernia for a considerable period, and die from some other cause. It has been stated that a person is completely incapacitated and rendered inca- WOUNDS OF THE ABDOMEN. 357 pable of exertion or locomotion by a rupture of the diaphragm. This statement, however, has been based on limited observation. The general effect of such an injuryls to incapacitate a person, but cases are recorded in which, in spite of the rupture, a person has pos- sessed the power of moving and walking to a considerable distance. The most serious injuries to the diaphragm are unquestionably those which are produced by violent contusions or falls on the abdomen, at a time when the stomach and intestines are distended. In these cases the muscular fibres may be ruptured to a greater or less extent ; but the bleeding is not considerable, rarely exceeding two, three, or four ounces. A uniform result of these ruptures, when extensive, is a protrusion of the stomach into the chest, with sometimes a rupture of the coats of this organ and extravasation of its contents. Severe lacerations of the diaphragm are more readily produced during the act of inspiration than during expi ration — the fibres of the muscles being then stretched, and receiv- ing, while in this state of tension, the whole of the force. According to Devergie, the rupture most frequently takes place in the central tendinous structure, where it is united with the left muscular por- tion above the crura. He has remarked that it occurs more com- monly on the left side than on the right. (Op. cit., vol. 2, p. 250.) It has been supposed that death would be an immediate consequence of this accident ; but this view is not supported by facts. In a case of extensive rupture of the diaphragm, related by Devergie, in which the stomach and colon were found in the chest, the person lived nine months after the only accident that could have produced it, and then died from another cause. Besides the stomach, it some- times happens that the liver, spleen, or intestines pass through the opening and, like it, these organs are liable to become strangulated ; the lungs are at the same time so compressed that respiration is stopped, and asphyxia or suffocation may be an immediate result. Direction of wounds in the chest. — In judging of the direction taken by wounds which traverse the chest from front to back, it is neces- sary to remember the great difference that exists in the level of the same rib anteriorly and posteriorly. This must be especially attended to when we are called upon to state the direction of a traversing wound from the description of it given by another. The point here referred to had an important bearing in the case of a fatal gunshot wound, which was the subject of a criminal charge some years since. (Henke's " Zeitschrift," 1836.) It must not be forgotten that a wound immediately below the chest bone, will in its fore part involve the viscera of the abdomen, in the back part those of the chest, and in its central part it will traverse the diaphragm. Wounds of the parietes of the abdomen. — Incised and punctured wounds, which affect the parietes or coverings of the abdomen without penetrating the cavity, are not quite of so simple a nature as might at first sight be imagined. The danger is immediate if the epigastric artery be wounded, for a fatal hemorrhage will, in some instances, take place from a wound of this sniall vessel. 358 WOUNDS OP THE ABDOMEN. Among the sources of danger from superficial wounds, is inflam- mation, followed by suppuration beneath the tendinous membrane which covers the abbominal muscles. The matter formed is very liable to^ accumulate within the sheath of the muscles, and this may prove fatal unlefss proper treatment be adopted. The inflam- mation will sometimes extend to the peritoneum, and thus rapidly destroy life. As improper medical treatment may, in either of these cases, cause a superficial wound of the abdomen to take a fatal ter- mination, it will be necessary for a medical witness to consider how far the consequences of the act of the prisoner have been aggravated ' by wilful neglect or unskilfulness. But when these wounds take a favorable course and heal, there is an after effect to be dreaded — namely, a protrusion of the viscera at the cicatrized spot, consti- tuting ventral hernia. When the wound has involved the mus- cular fibres transversely to their course, the cicatrix which follows is commonly far less capable of resisting the pressure of the viscera within, than any other parts of the parietes, A hernia may take place, and this, like other hernise, if neglected, is liable to become strangulated, and lead to the destruction of life. The walls of the abdomen, owing to the protrusion of this cavity, are easily pene- 'trated by pointed instruments, and it requires but a slight force to traverse them completely and wound the intestines. A slight wound may thus prove fatal, by causing peritoneal inflammation. Contusions are attended generally with far more serious effects on the cavity of the abdomen than on the chest. This arises from the coverings of the abdomen having less power to resist external shocks, in the first place, death may be the immediate result of a blow in the upper and central portions ; no particular morbid changes may be apparent on inspection, and the violence may have been so slight as not to have produced any ecchymosed mark on the skin. Death has been ascribed in these cases to a fatal shock transmitted to the system through a violent impression produced on the nerve-centre — called the solar plexus. Some remarks have already been made on sudden death from blows on this part of the abdomen. Travers, Alison, Watson, Cooper and other writers on surgical injuries, have referred to cases of this kind as of not un- frequent occurrence. They are of considerable importance in a medico-legal point of view, as, in the absence of marks of physical injury in the part struck, a jury might be led to doubt whether the blow could have been the cause of death. Some surgeons have thought that these cases have not been accurately observed, and that in those which terminate fatally, a more careful inspectioa would probably have shown visible changes in the organic struc- tures. The fact, however, remains : persons have died soon after receiving severe blows on the upper part of the abdomen, and the medical men who have examined the bodies for the express pur- pose of detecting physical injuries, have not found any to record. Moreover, they have not found in any part of the body a natural cause of sudden death. Blows on the abdomen, when they do not destroy life by shock, may cause death by inducing peritoneal in- RUPTURES OP THE LIVER. 359 flammation. Violence of a severe kind applied to the abdomen is not always indicated by ecchymosis or injury to the skin. Effusions of blood in the sheaths or tendinous coverings of the muscles may or may not be indicative of violence. One fact inust here be borne in mind, to prevent mistakes in examining a body after death, namely, that blood may be found copiously effused in and around the abdominal muscles, quite irrespective of the application of vio- lence. (Reid's " Physiological Researches," p. 511.) The absence of ecchymosis, or abrasion of the skin, in these cases, is sufficient to show that such extensive effusions are not caused by violence. Blows adequate to produce a lacei-ation of the vessels and hemorrhage, would most probably be attended with ecchymosis — -and some visi- ble injury to the skin. At any rate, when such marks of violence are not visible, and there is no evidence of a blow having been struck, a witness would act wisely in declining to attribute the mere effusion of blood to the act of another person. Deeply penetrating wounds of the abdomen are generally fatal by reason of the injury done to the intestines and other organs. Huptures of the liver. — Blows on the abdomen may prove fatal by causing a rupture of the liver or other viscera, with extravasation of blood ; and as it has been elsewhere stated, these serious injuries may occur without being attended with any marks of external vio- lence. Of all the internal organs, the liver and spleen ai'e the most exposed to rupture, owing to their compact structure, which pre- vents them from yielding to a sudden shock, like the stomach and intestines. Ruptures of the liver may occur from falls or blows ; but this organ may be ruptured merely by a sudden action of the abdominal muscles. Ruptures of the liver generally occur on the convex surface and anterior margin, seldom extending through the whole substance of the organ, but consisting of fissures, varying from one to two inches in depth. The right lobe, from its size, is more usually affected than the left. Their usual direction is from before backwards, with a slight obliquity ; they rarely intersect the liver transversely. The lacerated edges are not much separated, while the surfaces present a granular appearance. But little blood is met with in the laceration ; it is commonly found effused in the lower part of the cavity of the peritoneum, or in the hollow of the pelvis, and is only in part coagulated. Ruptures of the liver, unless they run far backwards and involve the vena cava or portal vein, are not in general attended with any considerable effusion of blood; but the bleeding, should this vessel be implicated, is sufficient to cause the instant destruction of life. Under other circumstances, a person may survive some hours, as the blood may escape only slowly, or it may be suddenly effused in fatal quantity after some hours or days, as a result of violent exertion or of fresh violence applied to the abdomen. Ruptures of the liver generally prove fatal within forty-eight hours. One case has been related in which the person survived for eight days ; and a case occurred to Dr. Wilks in which a person in Guy's Hospital survived this serious accident ten days. Wounds and ruptures of the gall-bladder are necessarily attended 360 HUPTUBES OF THE BLADDER. with the eiFusion of bile. This irritant fluid finds its way into the cavity of the abdomen, and the person dies from peritonitis. Hupture of the spleen. — Eupture of the spleen may occur either from violence or disease ; and it would appear that a slight degree of violence may in some cases cause a rupture of this organ, without any marks of injury appearing externally. Hupture fif the kidneys. — The kidneys are occasionally ruptured from violence ; but this appears to be a rare accident. A rupture of the kidney may be produced without causing any prominent symptoms, and prove fatal in a few hours. It may be remarked generally that ruptures of the liver, spleen and kidneys, unless attended with immediate and copious bleeding, are not inconsistent with a person having the power to move and walk. In a case which occurred at Guy's Hospital, a man had retained the power of walking for some distance, although on inspection after death, one kidney was found torn in halves from an accident. Ruptures and wounds of the intestines. — Ruptures of the intestines sometimes occur from disease ; and, in a case of rupture alleged to have been produced by violence, we must always take this possible objection to our opinion into account. The ruptured part of the bowel should be carefully examined, in order to see whether there are any signs of ulceration or softening about it. If not, and there is clear evidence of violence having been used, it is impossible to admit this speculative objection. If with the proof of violence there should also be a diseased condition of the bowel, we may be required to say whether this did not create a greater liability to rupture — a point which must be generally conceded. Punctured wounds, which merely touch the bowels without lay- ing open the cavity, are liable to cause death by peritonitis. These injuries to the intestines sometimes destroy life by shock ; there is but little blood effused, and the wounded person dies before perito- nitis can be set up. Severe wounds to the intestines may, however, be inflicted almost without the consciousness of the individual, and he wounded person may be able to walk a considerable distance. (" Med. Gaz." vol. 46, p. 24.) Wounds and ruptures of the stomach. — Wounds and ruptures of the stomach may cause death by shock ; ruptures commonly give rise to severe pain, which of itself is sufficient to bring about rapid dissolution. It is proper to state, however, that the stomach may be ruptured from spontaneous causes, as in cases of ulceration as a result of disease ; but sometimes there is no morbid cause apparent. Ruptures of the bladder. — This injury, which has on several occa- sions given rise to medico-legal discussion, is frequently the result of blows on the lower part of the abdomen. The principal ques- tions in reference to the accident are : Was the rupture the result of wilful violence, or of an accidental fall ? or did it proceed from spontaneous causes, as from over-distension ? The spot in which rupture commonly takes place is in the upper and back part, where the bladder is covered by the peritoneum. , The aperture is some- times large, at others small ; but the effect is that the urine is efi'used, EUPTURES OF THE BLADDER. 361 and death takes place sooner or later, from peritoneal inflammation. It is commonly stated that ruptures, when attended with extrava- sation of urine into the peritoneal cavity, are uniformly fatal ; but if the rupture occurs in the under part of the bladder, or the urine finds its way into the cellular tissue, the medical opinion is not so unfavorable. The usual period at which death occurs from this accident is in from three to seven days ; but Mr. Ellis met with a case in which the person did not die until the fifteenth day. The cause of death is obviously peritoneal inflammation ; but a person may die suddenly from this injury, as a simple result of shock. When ruptures of the bladder are produced by blows, they are rarely accompanied by marks of ecchymosis, or of injury to the skin. Thus, then, there may be no means of distinguishing, by external examination, whether a rupture was really due to violence or to spontaneous causes. They who are unacquainted with this fact, might be disposed to refer the rupture to disease, oia the supposition that violence should always be indicated by some visible external injury ; but there are numerous cases on record which show that this view is erroneous. As an attempt may be made, in cases in which death has resulted from this injury, to refer rupture of this organ to natural causes, it may be observed that this is an unusual occurrence ; a rupture is almost always the result of violence directly applied to the part while the organ is in a distended state. A spontaneous rupture may, however, occur : 1. When there is paralysis, with a want of power to expel the urine; 2. When the bladder is ulcerated or otherwise diseased ; 3. When there is an obstruction in the urethra from stricture or other causes. The causes of spontaneous rupture are easily recognizable by ascertaining the previous condition of the deceased, or examining the bladder and urethra after death. If a man were in good health prior to being struck ; if he suddenly felt intense pain, could not pass his urine afterwards, and died from an attack of peritonitis in five or six days ; if, after death, the bladder was found lacerated, but this organ and the urethra were otherwise in a healthy condition, there can be no doubt that the blow must have been the sole cause of rupture and death. In such a case, to attribute the rupture to spontaneous or natural causes would be equal to denying all kind of causation. As to the absence of marks of violence externally, this would be a difliiculty only to those who had not previously made themselves acquainted with the facts attending this and other accidents affecting the viscera of the ab- domen (p. 265). ilifevertheless, a medical witness must be prepared to hear the same line of defence continually brought forward, as it is always the object of a counsel to make the best of a case for the prisoner. With medical facts, opinions and doctrines he does not concern himself, so long as the/ do not serve his purpose. A dis- eased state of the bladder might probably diminish the responsi- bility of an accused person for the consequences ; therefore the state of this organ should be closely looked to on these occasions. A distended state of the organ can be no mitigatory circumstance. 362 WOUNDS OF THE GENITAL ORGANS. since it is only when the bladder is in this condition that rupture is liable to occur. This can hardly be regarded as an abnormal condition of the organ. An accidental fall forwards over a hard surface when the bladder is distended with urine may lead to rup- ture. The person generally experiences intense pain in the lower part of the abdomen, and there is an inability to pass the urine. Although a man is liable to be rendered powerless on sustaining a rupture of the bladder from a heavy blow or fall, there are several well-authenticated cases on record which prove that a man may walk some distance, and move about even for two or three houra afterwards. In punctured and incised wounds of the bladder, the urine is im- mediately extravasated, but in gunshot wounds, the extravasation does not commonly take place until the sloughs have separated. Thus, life may be protracted longer in cases of gunshot than under other wounds of the bladder. For the discovery of extravasated liquids or blood, in wounds and other injuries to the abdominal viscera, we must look to the cavity of the pelvis, as it is here that, for obvious reasons, such liquids have a tendency to collect. Wounds of the genital organs. — Wotmds of these organs do not often requii'e the attention of a medical j urist ; such wounds, whether in the male or female, may, however, prove fatal to life by excessive bleeding. Self-castration or mutilation is sometimes observed among male lunatics and idiots. '"When timely assistance is rendered, a fatal result may be averted. Incised, lacerated, or even contused wounds on the female genitals may prove fatal by loss of blood, not from the wound involving any large vessel, but from the numerous small vessels which are divided. When deeply incised wounds are inflicted upon the genital organs of either sex, the fact of their existence in such a situation, at once proves wilful and deliberate malice on the part of the assailant. Accident is wholly out of the question, and suicide is improbable, except in cases of confirmed idiocy and lunacy. Such wounds require to be carefully examined ; for the proof of the kind of wound, when fatal, may be tantamount to a proof of murder. A practitioner may be sometimes required to determine whether wounds affecting the female organs have resulted from accident, have been self- inflicted, or inflicted by others with homicidal intention. The re- marks elsewhere made on the subject of imputed wounds will apply to cases of this description. [In the Oyer and Terminer of Meigs County, Ohio, February Term, 1866, Mary Broderick was indicted for having caused the death of her husband by " pur- posely and maliciously with her right hand grasping and wrench- ing the penis of the said Patrick Broderick with intent to inflict a mortal wound ; by means whereof, the urethra, with the corpus spongiosum and corpus cavernosum, was broken and severed, and from the effects thereof the said Patrick Broderick died on the eleventh day thereafter." The defendant was found guilty of man- slaughter by the jury. A motion for a new trial was made, which had not, when the case was reported, been disposed of. - See "Gin- FEACTCRES — CAUSES. 363 einnati Journal. of Medicine," July, 1866, p. 316, where this case is reported, together with instances of similar injury resulting from accident, in an article by Dr. Geo. C. Blackman. — P.] Contused wounds on the female genitals may prove fatal, by the laceration of parts leading to great loss of blood. Several trials for manslaughter have taken place, in which this was proved to have been the cause of death. There may be such a loss of blood in these cases as to destroy life, although no large bloodvessel is implicated in the injury. A contused wound on the vulva may occasionally present an ambiguous appearance, and be mistaken for au incised wound. "When the soft parts of the body are struck by a blow or kick, if there is a bony surface beneath, a longitudinal rent may appear as a result of the force being received by the bone. A kick on the vulva, or a fall on this part, may produce a similar injury, and unless carefully examined may lead to the inference that a weapon has been used for its production. It is well known that some females are subject to frequent discharges of blood from the genital organs from natural causes. When the bleeding imme- diately follows a blow, and the woman has not been subject to such a discharge, the fair presumption is that violence was the cause : but when the flow of blood appears only a long time after the alleged violence, of which no traces can be seen, it is most probably due to natural causes. It may be alleged in* defence, that the injuries found on the body were inflicted after death, and not while the deceased was living. Kicks or blows on the vulva, if they destroy life at all, cause death by copious efl'usion of blood. Violence to this part after death would not produce such an efl'usion as would account for death. There are also other distinguishing characters, which have been elsewhere pointed out. CHAPTER XXXIII. fractures. — produced by a blow with a weapon or by a fall. — ■ brittleness of the bones. — fractures caused by slight muscu- lar exertion.— in the living and dead body. — has a bone ever been fractured ? — locomotion. — dislocation. — from violence or natural causes. — medical opinions. — actions for malapkaxis. Fractures. Fractures of the bones have some important bearings in relation to medical ijurisprudence. They may result from falls, blows, or the spontaneous action of muscles. Causes. — Questions are sometimes put as to whether a particular fracture was caused by an accidental fall or a blow ; and if by a 864 SPONTANEOUS FRACTURES. blow, whether by the use of a weapon or not. It. is obvious that the answers must be regulated by the circumstances of each case. In examining a fracture, it is important to determine, if possible, whether a weapon has or has not been used, and this may be some- times ascertained by the state of the parts. It is a common de- fence, on these occasions, to attribute the fracture to an accidental fall. Fractures more readily occur from equal degrees of force in the old, than in the young, and in the young rather than in the adult ; because it is at the adult period of life that the bones pos- sess their maximum degree of firmness and solidity. The bones of aged persons are sometimes very brittle, and slight violence will then produce fracture. This has been regarded as an extenuating circumstance, when the fracture produced by a slight blow was followed by death. Certain diseases, such as syphilis, arthritis, cancer, scurvy and rachitis, render bones more fragile ; but they are sometimes preternaturally brittle in apparently healthy persons, and this brittleness appears to be hereditary. In such cases, a de- fence might fairly rest upon an abnormal condition of the bones, if the violence producing the fracture was slight. Several trials have taken place in which this brittleness of the bones became a subject of inquiry. In a case of fractured skull leading to death from inflammation of the brain, it was proved that the bones of the skull were occasionally thin and brittle, and this led to a miti- gation of punishment. The orbitar plate of the frontal bone is very thin, and it may be fractured by a blow on the eye. Death may, under these circumstances, result from inflammation of the brain. Spontaneous fractures. — In a case in which there is no appearance of disease, a fracture may be ascribed to spontaneous causes. Thus bones have been fractured by moderate muscular exertion. The elbow (olecranon), heel-bone (os calcis), and knee-pan (patella) are particularly exposed to this accident. The long bones are seldom the subject of an accident of this kind ; but the arm (os humeri) in a healthy man has been broken by the simple muscular exertion of throwing a cricket-ball. (" Medical G-azette," vol. 16, 659.) Mr. May reports the case of a young lady, who fractured the neck of the scapula by suddenly throwing a necklace round her neck. (" Med. Gaz.," Oct. 1842.) In July, 1858, a gentleman, £et. 40, was in the act of bowling at cricket, when on delivering the ball he and some bystanders heard distinctly a sharp crack like the break- ing of a dry piece of wood. He fell to the ground as if he had been shot. The thigh-bone was found to be fractured, and evidently from muscular exertion only. No person can meet with an acci- dent of this kind without being instantly conscious of it. It is probable that in these instances, if there were any opportunity of examining the bone, it would be found to have undergone some chemical change in its composition, which had rendered it brittle. In fractures arising from this causae there will be no abrasion of the skin, nor any appearance to indicate that a blow has been struck ; while the marks of a blow would, of course, remove all idea of the RECENT AND OLD FEACTURES. 365 fracture having had a spontaneous origin. It is most unusual that the ribs should be fractured from muscular exertion ; but a case occurred to Dr. Groninger, which shows that this accident may really occur. It is only of medico-legal importance, inasmuch as the injury might be ascribed to violence : but the absence of any external appearance indicative of a blow would render it probable that this was not the cause. Fractures are not dangerous to life, unless, when of a compound nature, and they occur in old persons, or in those who are debilitated by disease or dissipated habits. They may then cause death by in- ducing irritative fevers, erysipelas, gangrene, tetanus, pyaemia, or delirium tremens. Fractures in the living and dead body. — ^It is not always easy to say whether a fracture has been produced before, or after death. A fracture produced shortly after death, while the body is warm, and another produced shortly before death, will present similar charac- ters, except that in the former case there might be less blood effused. A fracture caused ten or twelve hours before death would be indi- cated by a copious effusion of blood into the surrounding parts and between the fractured edges of the bones, as well as by the lacera- tion of the muscles; or if for a longer period before death, there may be the marks of inflammation. Fractures caused several hours after death are not accompanied by an effusion of blood. A medical witness may be asked. How long did the deceased survive after receiving the fracture ? This is a question which can be decided only by an examination of the fractured part. Unless the person has survived eighteen or twenty-four hours, there are commonly no appreciable changes. After this time, lymph is poured out from the surrounding structures. This slowly becomes hard from the deposition of phosphate of lime, and forms what is called a " callus." In the process of time, the callus acquires all the hardness of the original bone. The death of a person may take place during these changes, and a medical man may then have to state the period at which the fracture probably happened, in order to connect the violence with the act of a particular person. Unfortunately, we have no satisfactory data, if we except the extreme stages of this process of repair, upon which to ground an opinion. We can say whether a person lived for a long or a short time after receiving a fracture, but to specify the exact time is clearly impossible ; since this process of restoration in bone varies according to age, constitu- tion, and many other circumstances. In young persons, bones unite rapidly, in the old, slowly ; in the diseased and unhealthy, the process of union is slow, and sometimes does not take place at all. In those who are at the time affected with a mortal disease there is no attempt at reparation. According to Villerm^, the callus as- sumes a cartilaginous structure in from sixteen to twenty-five days ; and it becomes ossified in a period varying from three weeks to three months. It requires, however, a period of from six to eight months for the callus to acquire all the hardness, firmness, and power of resisting shocks possessed by the original bone. A force 366 DISLOCATIONS. applied to a recently -united bone will break it through the callus or bond of union, while aftet the period stated, the bone will break as readily through any other part. It is generally assumed, that the period required for the union of a simple fracture, is, for the thigh-bone, six weeks, for the tibia (leg), five weeks ; for the os humeri (arm), four weeks ; and for the ulna and radius (forearm), three weeks ; for the ribs about the same period : but cases have been known in which the ribs had not perfectly united in two months, and in some fractures of the other bones, it was found that union had not taken place in four months. In a case which oc- curred to Dr. Eeid, a fracture of the tibia, the principal bone of the' leg, healed in three weeks. Has a bone ever been fractured? — This question is sometimes put in reference to the living body. It is well known that a bone seldom unites so evenly that the point of ossific union is not indicated by a node or projection. Some bones are so exposed as to be well placed for this examination, as the radius, the clavicle, and tibia — these being but little covered by skin ; in others the detection is diffi- cult. It is impossible for us to say when the fracture took place ; it may have been for six months or six years — as, after the former period, the bone undergoes no perceptible change. These facts are of importance in relation to the dead is well as to the living ; since they will enable us to answer questions respecting the identity of skeletons found under suspicious' circumstances : and here medical evidence may take a_ wider range, for a fracture in any bone may be discovered, if not by external examination, at least by sawing the bone longitudinally through the suspected broken part, when, should the saspicion be correct, the bony shell will be found thicker and less regular in the situation of the united fracture than in the other parts. So, in such cases, it will be easy to say whether a fracture is recent or of old standing. Locomotion. — With respect to the power of locomotion after a frac- ture, it may be observed, that when the injury is in the arm or in the ribs-sunless many of the ribs are broken or the fractures are on both sides — a person may be able to move about, although he is un- fitted for struggling or making great exertion. Fractures of the leg generally incapacitate persons from moving except to short distances. Dislocations. Dislocations are not frequent in the old or in those persons whose bones are brittle. They rarely form a subject for medico-legal in- vestigation. A witness is liable to be asked, what degree of force, and acting in which direction, would produce a dislocation — ques- tions not difficult to answer. They are not dangerous to life, unless of a compound nature, when death may take place from secondary causes. A dislocation which has occurred in the living body may be known after death by a laceration of the soft parts in the neighbor- hood of the joint, and by the copious effusion and coagulation of DETECTION OF FEACTURES — MALAPBAXIS. 367 blood._ If of old standing, a dislocation would be identified by the cicatrices in surrounding structures. Dislocations may occur from natural causes, as from disease and destruction of the ligaments in a joint ; also from violent muscular spasm during an epileptic con- vulsion. Dr. Dymock met with an instance of dislocation of the shoulder forwards during puerperal convulsions. (" Ed. Med. and Surg. Journal," April, 1843 ; see also " Lancet," April, 1845, p. 440.) A power of locomotion may exist, except when the injury is in the lower limbs ; but it has been observed, that for some time after a dislocation of the hip-joint, considerable power over the limb re- mains ; it is only after a few hours that the limb becomes fixed in one position. Exertion with the dislocated member is in all cases out of the question. Detection of fractures. {Malaprazis.) — There are certain fractures of an qbscure kind which closely rfesemble dislocations. This has been pointed out by Sir A. Cooper, in relation to fractures of the anatomical neck of the os humeri (arm-bone). (" Guy's Hosp. Eep." No. 9. p. 272.) This accident might easily be mistaken for a dislo- cation of the shoulder. (" Med. Gaz." vol. 36, p. 88.) In attempting to reduce the bone, the head continually falls back into the axilla. In such a case an action for malapraxis might be brought against a surgeon, and heavy damages recovered. It could only be by a dis- section of the part after death that the real nature of the case would be ascertained. It is requisite, therefore, that great caution should be used in giving an opinion. The same observations apply to frac- tures of the neck of the thigh-bone, although with less force, because this is a more common accident. It is well known that fractures and dislocations, when cured, are often attended with some slight deformity of the limb, or with some impairment of its functions. This result is occasionally inevitable under the best treatment ; but it is commonly set down as a sign of unskilfulness in the medical attend- ant. An action for malapraxis is instituted, and in spite of good evi- dence in his favor, the surgeon is sometimes heavily fined for a result which could not be avoided. There is often great injustice in these proceedings, and the mischief can only be remedied by referijing the facts to a competent medical tribunal, which alone should be em- powered to decide whether or not unskilfulness had really been shown in the management of a case. The system of allowing each party to select his own medical witnesses invariably leads to a con- flict of opinion and evidence. [It should not be forgotten that shortening of the leg frequently occurs after severe contusion of the hip, without any fracture, arising from interstitial absorption of the neck of the femur. This is well illustrated by Mr. Gulliver, in "Edin. Med. Journ." vol. xlvi. 1836 ; also by Sir J. Paget, in "Brit. Med. Journ." Feb. 19, 1870. This accident has given rise to an action for alleged malapraxis. See " Philadelphia Med. Times," Dec. 1, 1870.— R.] [The proof of ordinary care and skill and judgment exercised in the treatment of a case is a suflacient defence in law against a claim for damages on account of alleged malpractice ; but it is too apt to 368 GUNSHOT WOUNBS. fail with the juries in this country, and will not protect the victim of a prosecution from its attendant expenses. Although our judges, in many instances, have done their best to secure just verdicts, the juries are notoriously stupid and unjust ; so that the only real secu- rity to the attending surgeon is an indemnity bond against all con- sequent prosecution, to be previously assumed by the patient. — H.] CHAPTER XXXIV. GUNSHOT WOUNDS. — IN THE LIVING AND DEAD BODY. — WAS THE PIECE FIRED NEAE, OR FROM A DISTANCE ? — ACCIDENTAL, SUICIDAL, OR HOM- ICIDAL WOUNDS. — POSITION OF THE WOUNDED PERSON WHEN SHOT. — WOUNDS FROM SMALL SHOT. — WOUNDS FROM WADDING AND GUNPOWDER. Gunshot wounds are of the contused kind, but they differ from other wounds in the fact that the vitality of the parts struck by the projectile is destroyed, and this leads ultimately to a process of sloughing. The medico-legal questions which arise out of gunshot wounds, are similar to those which have been examined in relation to other wounds. They are dangerous to life, especially when they penetrate or traverse any of the great cavities of the body. Death may take place directly, either from loss of blood or from shock ; although immediate or copious bleeding is not a common character of these injuries. Death from shock is occasionally witnessed. Indirectly, these wounds are attended with much danger; sloughing generally takes place uniformly throughout the whole of the parts perforated, and inflammation or fatal bleeding may cut short life. If the person survives the first effects, he may die at almost any period from sup- purative fever, erysipelas, gangrene, or from the results of operations absolutely required for his treatment. Gunshot wounds may thus destroy life after long periods of time. A medical witness may be asked whether the wound was inflicted before or after death. It is by no means easy to answer this question, unless the bullet has injured some vessel, when the eft'usion of blood and the formation of coagula will indicate that the person was living when it was received. If a gunshot wound has been produced in a dead body, no blood will be effused unless the bullet strikes a large vein. Was the piece fired near, or from a distance f — A gunshot wound produced by the muzzle of a piece being placed near to the surface of the body, has the following character : There may be two aper- tures, the one of entrance and the other of exit ; but it sometimes happens that the bullet lodges and does not pass out. The edges of the aperture of entrance are generally torn and lacerated, and appear blackened, as if they had been burnt ; this arises from the GUNSHOT WOUNDS. 369 heat and flame of the gunpowder at the moment of explosion. The skin is often ecchymosed, and is much discolored by the powder ; the clothes covering the body are blackened by the discharge, and sometimes ignited by the flame. If the muzzle of the piece was not in immediate contact with the part struck, the wound is rounded ; but if there has been direct contact, the skin, besides being burnt, is torn and much lacerated. The bleeding is usually slight, and when it occurs it is more commonly observed from the orifice of exit than from that of entrance. It should be remarked that the aperture of entrance is round only when the bullet strikes point blank, or nearly so. If it should strike obliquely, the orifice will have more or less of an oval or valvular form ; and by an ob- servation of this kind we may sometimes determine the relative position of the assailant with respect to a wounded person. Sup- posing the bullet to have been fired from a moderate distance, but so near as to have had sufficient momentum to traverse the body, then the appearance of the wound will be different. The orifice of entrance will be well defined, round or oval, according to the cir- cumstances — the skin slightly depressed — the edges presenting a faintly bruised appearance ; but the surrounding parts are neither blackened nor burnt, and they do not present any marks of bleed- ing. In these cases the orifice of exit is large, irregular, the edges somewhat everted, and the skin lacerated, but free from any ap- pearances of blackness or burning ; it is generally three or four times as large as the entrance-aperture. The orifice of entrance is, however, generally large and irregular when the bullet strikes near the extremity of its range. [Surgical authorities generally assert that the entrance-orifice is somewhat smaller than the exit-orifice. Prof. Casper, however, declares that the former is always the larger, adding that " all the more recent original observers very properly unite in this conclusion, which is the opposite of that which was formerly maintained." — R.] Under common circumstances, the entrance-aperture may have the appearance of being smaller than the projectile, owing to the elasticity of the living skin. (" Ann. d'Hyg." 1839, t. 2, p. 319.) It is the same with the aperture in the dress, when this is formed of an elastic material. According to Dupuytren, the hole in the dress is always smaller than that made by a bullet in the skin. These points should be remembered in fitting projectiles to wounds which they are supposed to have produced. The question whether a piece was fired near to, or at a distance from, the wounded person, may be of some importance either on a charge of homicide, or of alleged suicide. Two persons may quarrel, one having a loaded weapon in his hand, which he may allege to have been accidentally discharged, and to have killed the deceased. If the allegation is true, we ought to find on the body the marks of a near wound ; if, however, its characters were such that it had obviously been produced from a distance, and therefore after the quarrel, medical proof of the fact might imply malice, and involve the accused in a charge of murder. It has been said that when a 94 370 SUICIDAL OE HOMICIDAL GUIfSHOT WOUNDS. bullet is iired near, it commonly traverses the body ; and therefore it has been rather hastily assumed, that when there is only one external wound, and the bullet has lodged in the body, this is a proof that the piece has been fired from a distance. This inference is, however, erroneous. A bullet may be fired close to a person and yet not traverse the body, either from its impulsive force not being sufliciently great, or from its meeting a great resistance in its course. Many cases might be cited to show that in the near wounds pro- duced by suicides and murderers, the bullets have not always tra- versed the body. In suicide, when the piece is discharged into the mouth, the projectile often lodges in some part of the head. It is not in the power of a witness to say, from the mere fact of a bullet lodging or traversing, whether the assassin was far off or near, at the time the deceased was wounded. The latter point may be some- times readily determined by the marks of injury and burning about the skin and dress. When a gun or pistol is discharged at the dis- tance of three or four yards from the person, it will not, of course, produce those marks of blackening, burning and bruising on the skin which are found when the muzzle is within a few inches of the body. A wound which does not present these appearances may remove the suspicion of suicide, and create a strong presumption of homicide. Dr. Lach^se found that in firing a gun at the dis- tance of four feet, the skin was only partially blackened. It would be very important in a case of this kind to notice the direction of the wound, as well as the relative position of the assailant and as- sailed, as stated by witnesses, or deduced from circumstances. When a ball traverses the body, it sometimes happens that the two apertures are opposite to each other, although the ball may not have taken a rectilinear course between them, but have been variously deflected by the subjacent soft parts. This deflection of a ball from a rectilinear course is met with in those cases in which it happens to strike obliquely a curved surface, and it is found that when the ball enters and does not pass out, its course is often cir- cuitous, so that it is not always easy to say in what part of the body it will be found. A witness may be asked — When was the gunshot wound inflicted, and how long did the wounded person survive after receiving it ? Like other wounds, a gunshot wound undergoes no change for eight or ten hourp after its infliction. Our judgment in reference to these questions may be assisted by observing the parts which are involved, although we cannot always infer from the quantity of blood found near the body that the bleeding was an immediate consequence of the wound, or that the whole of the blood was effused at once. We cannot, then, always affirm that the deceased could not have moved or exerted himself in some degree, after receiving it. The exertion thus made subsequently to his being wounded may have actually caused the fatal bleeding. Suicidal, or homicidal gunshot wounds. — When it is doubtful whether the wound was the result of suicide or homicide, the point may be sometimes determined by paying attention to its situation WOUNDS PEOM SMALL-SHOT 371 and direction. Suicidal gunshot wounds are almost always directed to a vital part — to the heart or to the brain. They possess those characters which belong to wounds inflicted near to the body : the skin is discolored or burnt ; the wound wide and lacerated ; the hand which discharged the weapon often blackened, and sometimes still grasping the pistol. The ball may or may not have traversed, as this will depend on the momentum which it derived from the charge, and the resistance that it experienced. Accidental gunshot wounds bear the characters of near wounds ; they may touch vital parts, but, if the body has not been disturbed, the presence or absence of design in the infliction of a wound is commonly made apparent by the relative position of the body and the weapon. They frequently arise from persons drawing the charges of guns or pistols with the muzzle pointed towards them, and they are then situated in front ; at other times they are pro- duced by persons pulling towards them through hedges, or dragging after them, loaded guns. In the latter case the wound is behind, and it may strongly resemble a homicidal wound, although the circumstances under which the body is found generally suffice to explain the matter. (See " Ann. d'Hyg." 1860, t. 1, p. 443.) In suicide^ there is commonly strong evidence of design ; in accident, all evidence of design is wanting. Suicides sometimes make use of extraordinary weapons, or use weapons in an extraordinary manner. Position of the wounded person lohen shot. — Did the deceased receive the shot while standing, falling, or lying down ? Was the piece, when discharged, pointed from the shoulder ? These questions can only be answered by reference to the particular, circumstances of the case. In general, when a person is shot while standing, and the piece is pointed from the shoulder, the wound is more or less trans- verse ; but due allowance must be made for the deflection of balls after penetration. Was the deceased shot while running away, or when approaching the person who fired ? This question is answered by observing, in the ease of a traversing wound, in which alone any difficulty can arise, whether the entrance-orifice be situated in front or behind. Wounds from small-shot. — Death is sometimes occasioned by small- shot ; and here several medico-legal questions present themselves. Small-shot may act in two ways: 1. It either strikes without spreading, in which case the discharge is always near the person, and its action is much more dangerous than that of a single ball, because it produces extensive lacerations ; or 2. It strikes after it has spread, and here the discharge must have been distant and com- paratively little mischief is done. Dr. Lach^se ascertained, by many experiments on dead bodies, that in order to .produce with small- shot, a round opening somewhat resembling that produced by a bullet, the discharge should take place point-blank at the distance of about ten or twelve inches from the surface of the body. When the distance was from twelve to eighteen inches, the opening made was irregular, and the borders were much lacerated ; at thirty-six 372 WOUNDS FROM WADDING AND GUNPOWDER. inches, a central opening was entirely lost, and the surface of the body was covered with shot. The effect after this was fpund to depend on the distance, the goodness of the gun, and the strength of the charge (" Ann. d'Hyg." 1836, p. 386) ; but the shot is, in general, much scattered over the surface of the body, rrora these results we may form an opinion of the distance at which the piece was fired. It is difficult to conceive that small-shot can, under any circum- stances, produce a single entrance-wound, having some appearance of circularity about it, without at the same time singeing or burn- ing the skin or dress. The difficulty of laying down any general rules respecting the wounds produced by small-shot at their entrance and exit, will be apparent from the following facts, communicated to me recently by two medical gentlemen. A boy was shot in the neck by the accidental discharge of his gun, loaded with an ounce of No. 8 shot. He died instantly. He was leaning forwards on the muzzle, so that it was nearly in contact with the skin of the neck. A large round hole was produced, one inch and a half in diameter, the edges of which were slightly blackened with powder. The exit- aperture which was at the back of the neck, a little to the left of the third cervical vertebra, was a mere slit in the skin, scarcely an inch long, with the long diameter placed vertically. The small- ness of this aperture may have been owing to the greater part of the charge being lodged in that body. The entrance-aperture, although rounded, was too large to be mistaken for a bullet-Wound ; it was evidently a near wound, from the blackening of the edges. On the other hand, Dr. Lowe informs me that in some experiments performed by his brother, it was found that a round aperture might be produced by a discharge of small-shot at a much greater distance from the object than that assigned by Dr. Lach^e. Admitting such exceptional instances, and assuming the general correctness of the inference drawn by Dr. Lach^se, from the results of his experiments in discharging small-shot at dead bodies placed at different dis- tances, it does not seem probable that a wound from small-shot can, under any circumstances, be mistaken for one produced by a leaden bullet. A dicharge of small-shot, in contact with the skin or close to it, will however produce, not a round opening, but a severe lace- rated wound. Small-shot is rarely observed to traverse the body entirely unless discharged so near as to make a clean round opening ; but a single pellet reaching the body may destroy life. There may be no exit- aperture, or it may be smaller than that of entrance. Such minute wounds might be easily overlooked in the examination of a dead bodj'. Small-shot, even when wounding only the skin of the back superficially, has been known to cause death by tetanus. Woundsfrom wadding and gunpowder. — It matters not with what the piece is charged — it is capable, when fired near, of producing a wound vsrhich may prove fatal. Thus a gun loaded with wadding, or even with gunpowder only, may cause death. In these cases, au impulsive force is given by the explosion, and the substance becomes WOUNDS FROM WADDING AND GUNPOWDEB. 373 a dangerous projectile. The lighter the projectile — the shorter the distance to which it is carried ; but when discharged near to the body, it may produce a fatal penetrating wound. A portion of the dress may be carried into the wound, and lead to death from bleed- ing; or if the wounded person recover from the first effects, he may subsequently sink under an attack of tetanus or erysipelas. It is- unfortunate that so much ignorance prevails on this point; for fatal accidents frequently occur from persons discharging guns at others in sport — an act which they think they may perform without danger, because they are not loaded with ball or shot. It has been observed, that persons in attempting to commit suicide have occasionally forgotton to put a bullet into the pistol; never- theless, the discharge of a piece into the mouth has sufficed, from the effect of the wadding only, to produce a considerable destruction of parts, and to cause a serious loss of blood. Fatal accidents have frequently taken place from the discharge of wadding from cannon during reviews. It is not easy to say at what distance a weapon thus charged with wadding and powder would cease to produce mis- chief, since this must depend on the impulsive force given by the powder, and on the size of the piece. Dr. Lach&se has ascertained by experiment, that a piece charged with gunpowder, is capable of producing a penetrating wound somewhat resembling that caused by small-shot, when the piece is large, strongly charged, and fired within six inches of the surface of thetody. (" Ann. d'Hyg." 1836, p. 368.) This arises from a portion of the powder always escaping combus- tion at the time of discharge, and each grain then acts like a pellet of small-shot. Under any circumstances, a discharge of powder only contuses the skin, producing ecchymosis, and often lacerating it, if the piece be fired near. The dress is burnt and the skin scorched from the globe of flame formed by the combustion of the powder ; many particles of gunpowder may be actually driven into the true skin. All the substances here spoken of are considered to be pro- jectiles ; and the weapons are held in law to be loaded arms, so long as they are capable of producing bodily injury at the distance from which the piece containing them is discharged. It may therefore become a question as to the distance at which these light projectiles cease to be harmless. The answer must be governed by circum- stances ; but it will in all cases materially depend on the strength of the charge. Dr. Swift, U. S., has performed some experiments with a pistol loaded with gunpowder and wadding, in order to determine the effect of discharges at different distances. At twelve inches dis- tance from a dead body, he found that the clothes were lacerated and the skin abraded, but the wadding did not penetrate; at six inches, the clothes were lacerated, and the wadding penetrated to the depth of half an inch ; at two inches, the wound produced, which was two inches deep, was ragged and blackened; at one and a half inch from the chest, the wadding passed into the cavity between the ribs, and in a second experiment it carried away a portion of a rib. (" Med. Gaz." vol. 40, p. 734.) These results confirm those obtained by Dr. Lach^se. 374 IDENTITY FEOM FLASH OF GUNPOWDER. Identity from the flash of gunpowder. — Among the singular questions which have arisen out of this subject is the following: Whether the person who fires a gun or pistol at another during a dark night can be identified by means of the light produced in the discharge? This question was first referred to the class of Physical Sciences in Trance, in 1809, and they answered it in the negative. A case tending to show that their decision was erroneous was subsequently reported by Todere. A woman positively swore that she saw the face of a person, who fired at another during the night, surrounded by a kind of glory, and that she was thereby enabled to identify the prisoner. This statement was confirmed by the deposition of the wounded party. Desgranges, of Lyons, performed many experiments on this subject, and he concluded that on a dark night, and away from every source of light, the person who fired the gun might be iden- tified within a moderate distance. If the flash was very strong, the smoke very dense, and the distance great, the person firing the piece could not be identified. The question was raised in this country, in the case of Reg. v. White, at the Croydon Autumn Assizes, 1839. A gentleman was shot at while driving home in his gig during a dark night; he was wounded in the elbow. "When he observed the flash of the gun, he saw that the piece was levelled towards him, and the light of the flash enabled him to recognize at once the features of the accused. In cross-examination he said he was quite sure he could See the prisoner, and that he was not mistaken as to his identity. The accused was skilfully defended, and he was acquitted. Evidence of this kind has, however, been received in an English Court of Law. A similar case was tried at the Lewes Lent Assizes, 1862 {Reg. v. 8tafley). The prisoner shot at the prosecutor, a gamekeeper, on a dark evening in December, and the latter swore that he distinctly saw the prisoner by the flash of the gun, and could identify him by the light on his features. His evidence was corroborated by three other witnesses, who saw him not far from the spot, and by one who saw him in the act of running away. He was convicted. A case is quoted by Paris and Fonblanque {Rex v. Haines), in which some police-ofl&cers were shot at by a highwayman dui'ing a dark night. One of the officers stated that he could distinctly see, from the flash of the pistol, that the robber rode a dark-brown horse of a remarkable shape in the head and shoulders, and that he had since identified the horse at a stable in London. He also perceived, by the same flash of light, that the person had on a rough brown great-coat. This evidence was considered to be satisfactory. From the information which I have been able to collect on this point, it appears to me there can be no doubt that an assailant may be thus occasionally identified. It is widely difterent, however, in respect to the following case referred to by Miiller, in his " Phy- siology," namely, where a man declared that he recognized a robber through the light produce by a blow on his eye in the dark ! As Miiller observes, this is a clear impossibility, because the flashes thus perceived are unattended with the emission of light, and BURNS AND SCALDS. 375 therefore can never be visible to any other person than the subject of them, and it is not possible that they can ever make other objects visible. (For some remarks on this subject by Dr. Schilbach, see Henke's « Zeitschrift der S. A." 1842, 1, 197.) Dr. Kriigelstein has lately opposed the inference deduced by Miiller, and has supported his views by cases, which, however, do not appear to me to be satisfactory. (Henke's " Zeitschrift der S. A." 1845, 3, 172.) Examination of fire-arms. — An attempt has been made by French medical jurists to determine for how long a period a gun or pistol found near a dead body, may have been discharged ; but it is out of our power to lay down any precise rules on such a subject. All that we can say is, a quantity of sulphide of potassium, mixed with charcoal, is left adhering to the barrel of the piece, when recently discharged; and this is indicated by its forming a strong alkaline solution with water, evolving an odor of sulphuretted hydrogen, and giving a deep-brown precipitate with a solution of acetate of lead. After some hours or days, according to the degree of exposure to air and moisture, the saline residue becomes converted into sulphate of potash, forming a neutral solution with water, and giving a white precipitate with acetate of lead. If a considerable time has elapsed since the piece was discharged, oxide of iron with traces of sulphate may be found. (See "Ann. d'llyg." 1834, 458; 1889, 197; 1842, 368.) CHAPTER XXXV. DEATH FROM BURNS AND SCALDS. — SYMPTOMS. — STUPOR. — CAUSE OF DEATH. — POST-MORTEM APPEARANCES.— BURNS ON THE DEAD BODY. — ACCIDENT, HOMICIDE, OR SUICIDE. — WOUNDS CAUSED BY FIRE. — SCALD- ING. — BURNS BY CORROSIVE LIQUIDS. Burns and scalds. — A burn is an injury produced by the applica- tion of a heated substance to the surface of the body; while a scald results from the application of a liquid at or near its boiling point, under the same circumstances. There seems to be no real distinc- tion between a burn and a scald in reference to the effects produced on the body ; the injury resulting from boiling mercury or melted lead might take either appellation. l!fevertheless as a matter of medical evidence, it may be important to state whether the injury found on a body was caused by such a liquid as boiling water, or by a heated solid. If the former, the injury might be ascribed to accident ; if the latter, to criminal design. A scald produced by boiling water would be indicated by a sodden state of the skin and flesh, but there would be no destruction of substance. In a burn by a heated solid, the parts may be more or less destroyed, or even charred ; the cuticle may be found blackened, dry, almost of a horny consistency, and presenting a shrivelled appearance. This 376 CAUSE OF DEATH — APPEARANCES. distinction, however, would only apply to scalds from water. A scald from melted lead (620°) could not be distinguished from a burn produced by a solid heated to the same temperature. Some of the oils boil at 500°, and they produce by contact with the skin, burns as severe as those caused by melted metals. Burns from flame such as that of gas are indicated by extensive scorching of the skin, while burns from gunpowder are known not only by the scorching, but by the small particles of unburnt carbon which are imbedded in the skin. Neither a burn nor a scald appears to be considered as a wound in law ; but in the statute of wounding they are included among bodily injuries dangerous to life. Burns and scalds n}ay be regarded as dangerous in proportion to the extent of surface (of skin) which they cover, as well as the depth to which they extend. The extent of surface involved in a superficial burn, as a result of exposure to flame, is of greater importance than the entire destruction of a small part of the body through an intensely heated solid. When the burn is extensive, death may ensue either from the severity of the pain produced, or from a sympathetic shock to the nervous system. Death takes place rapidly from burns, in children and nervous females ; but in adults and old persons, there is a better chance of recovery. Cause of death. — In some instances, especially in children, stupor and insensibility have rapidly supervened, owing to sympathy with the brain ; and these symptoms have been followed by coma and death. Of the cause of death in persons exposed to fire, but little need be said. In large conflagrations persons are frequently simply suftbcated, from the want of proper air or the respiration of the products of combustion — carbonic acid or carbonic oxide. The former darkens the blood ; the latter renders it lighter in color. In other cases, where a large volume of flame suddenly falls upon the body and the person is still able to breathe, the fatal eft'ect may be due to shock — a sudden and violent impression on the nervous system. A person may recover from the first efl^'ects of severe burns, but ultimately sink from exhaustion or from an attack of tetanus. (" Med. Times and Gaz.," April 26, 1854, p. 406.) Post-mortem appearances. — In examining the body of a person found burnt, all matters connected with sex and identity should be first duly observed. Dr. Griinbaum has reported a case in which he was required to examine certain carbonized remains in which, in spite of the destruction of the sexual organs, he was able to deter- mine the sex. (Horn's " Vierteljahrshrift," Oct. 1864.) When a body has been entirely consumed by fire, the presence of a large quantity of phosphate of lime in the ashes would indicate animal remains. The bones are never completely destroyed ; they become white, and portions of them retain their form under the action of a most intense fire. When death has been caused by severe pain, no changes have been detected in the dead body ; but, in some fatal cases, it has been found on inspection that there were patches of redness on the bron- BURNS ON THE LIVING AND BEAD BODY. 377 chial mucous membrane, as well as on the alimentary canal. The brain has been found gorged, and the ventricles have contained an abundance of serosity. The serous liquids of the pericardium and pleura have also been in larger quantity than natural. In short, besides congestion, there is generally abundant serous effusion in one of the three great cavities, especially in the head. This arises from the sudden reflux of blood into the interior, as an effect of the local injury. In death from fires in houses, the persons are usually suffocated, and there are the appearances of this kind of death (see Suffocation). In a case in vsrhich a woman died on the thirteenth day from a superficial burn involving the skin of the lower part of her body, the stomach was found infiamed at its greater extremity, and the duodenum at its lower portion — the mucous folds of the intestines have a scarlet color. The other intestines as far as the caecum, were also more or less inflamed. ("Amer. Jour. Med. Sci- ences," Jan. 1861, p. 137.) If the person survives the first eftects, he may die from inflammation, suppuration, gangrene, irritation, or fever, or he may be worn out by exhaustion. Did the burning take place before or after death? — Vesication. — The production of vesication or of blisters containing serum, is commonly regarded as an essential character of a burn which has been pro- duced during life, but it is not a necessary or invariable effect of a biirn on the living body. Vesication is especially observed in scalds, or in those cases in which the skin has been burnt by flame or by the ignition of the clothes, provided the cuticle has not been de- stroyed. It is not so commonly observed in burns produced by intensely heated solids. In vesication, the cuticle is raised from the true skin beneath, and is converted into one or more blisters containing serum or a serous liquid, while the skin around is of a deep-red color. It is uncertain as to the time at which it appears ; it may be produced in a few minutes, or sometimes not for several hours ; hence death may take place before vesication occurs, and the non-discovery of this condition does not warrant the opinion that the burn could not have taken place during life. If the cuticle is removed from a vesicated part of the living body, the skin beneath will become intensely reddened, but if the cuticle is stripped off a dead body, the skin will become hard, dry, and of a horny-yellow color; it does not acquire the intense scarlet injection which is acquired by the living skin when vesicated and exposed. In cases in which persons, while living, have suffered from gen- eral dropsy, it has been found, on the application of heat to their bodies after death, blisters containing serum or a serous liquid have been formed ; hence, in drawing a conclusion from the examination of burns on the body of a person affected with general dropsy, it is necessary to be cautious. In such cases it would not be possible, from the mere presence of serous blisters, to say whether the burn took place before or after death. The late Dr. Wright found in his experiments on the dead body, that if a suflicient heat were applied to within half an hour or longer after death, blisters containing serum were sooner or later produced. In short, as long as the body 378 BURNS ON THE LIVING AND DEAD BODY. was warm and the joints were flexible, the effects of fire were simi- lar to those observed on the living. Other experimentalists have found that blisters were produced, but they did not contain serum. The result no doubt depends on the time after death at which the experiment is performed. Accident has enabled me to describe the results within a very short period after death. The body of a drowned man, within a few minutes after the accident, was removed from the water and placed in a warm (hot?) bath. It was found impossible to resuscitate him, but owing to the great heat of the water, portions of the cuticle came off, when the body was removed. On inspection there were several vesications filled with bloody serum over a considerable por- tion of the skin, especially of the extremities. There was no ana- sarca here to account for their production ; and the fact of their occurrence appears to bear out the view of Dr. Wright, that the production of a serous blister on a dead body depends on the amount of latent organic life remaining in it. In this case the man was pulseless, and to all appearance dead, when placed in the hot bath ; hence the effects of hot water on the living and recently dead body, so far as the production of serous blisters is concerned, are similar. Dr. Chambers has lately published the results of numerous experi- ments on the effects of burns on the living and dead body. These have been made on the bodies of persons, from the moment of death until twenty hours after dissolution, and some were performed before death. The general results of his researches are — that vesi- cations, or blisters, may be produced by burns both on the living and dead bodj' ; that they are produced at a lower temperature in the living than in the dead ; that in' the living a burn produces great capillary congestion, with the effusion of serum in the blis- ters, and that this serum when heated with nitric acid, sets into a nearly solid coagulum. The blisters produced in a dead body, even a few minutes after death, contain a thin watery serum, which is only rendered opaline or milky by heat and the action of nitric acid. ("Ann. d'Hyg.," 1859, vol. 1, p. 342.) When the body is cold and rigid, blisters containing air or vapor alone are produced. In burns, especially in those produced by red-hot solids, other effects besides vesication follow. The edge of the skin immedi- ately around the part burnt is commonly of a dead white, and close to this is a deep red line, gradually shaded off into the surrounding skin, which is reddened. The diffused redness is removable by pres- sure, and disappears with life ; the red line here referred to, how- ever, is not removable by pressure, and is persistent after death. This line of redness is not always met with in severe burns, and when a person survives one or two days, its production appears to depend upon a power of reaction in the system. Thus then, its absence furnishes no proof of the burn having been produced after death, for it is not a necessary accompaniment of a burn during life. Dr. Wright considered that in a low state of vitality, a line of redness might not be produced by a severe burn on the living ACCIDENTAL AND HOMICIDAL BURNS. 379 body, and that more certain reliance may be placed on the red marks found beneath the blisters and crusts of vital burns. These latter were well marked when he found the line of redness itself indistinct. (Op. cit., p. 25.) The researches of Dr. Chambert confirm this view. In a burn on a living person, if the skin has not been entirely charred and destroyed, the cutis will present a dotted or pointed redness — these dot's or points corresponding to the sudiparous (perspiratory), and hair-follicles. After complete death, a burn does not produce any such effect ; the cutis is of a dead-white on its surface and in its substance. In one experiment performed ten minutes after death, there was no redness of the skin, either beneath the blisters or in the surrounding parts. ("Ann. d'Hyg.," 1859, vol. l,p. 368.) This reddened or congested state of the bare skin is more constant than any other appearance, and forms at present the best criterion of the infliction of a burn on the living body. The conclusions which, it appears to me, we may draw from the foregoing statements, are: 1. That, as a general rule, when we discover blisters with effusion of serum, or a line of redness, or both, and a reddened or congested state of the skin about a burnt part of the body, we are justified in saying that the burn has oc- curred during life. 2. That when these appearances are not met with , it by no means follows that the burn had not been produced in the living body. When several burns are found on a dead body, it may be a ques- tion whether they were all produced at the same time. This is- a point which can be determined only by observing whether any of them present signs of gangrenous separation, of suppuration, granu- lation, or other changes thaf take place in a living body after, acci- dents of this kind. The witness may be asked. How long did the deceased suiwive the burn ? A person may die in a few minutes, or live some hours after receiving a most extensive burn ; and yet there will be no change in the part burnt, to indicate when death actually took place. There may have been no time for inflammation or its consequences to become established. Suppuration generally follows vesication, and in severe cases, it may occur on the second or third day ; but often not until a later period. In regard to gangrene, this takes place when the vitality of a part burned is destroyed. The time of its occurrence is uncertain, but it sometimes very speedily follows the accident. The subject of scalding scarcely requires a separate notice. A scald from boiling water would, when recent, be indicated by the production of serous blisters, or a sodden state of the skin, which appears white and soft. The living structures are not charred or destroyed as by the application of a red-hot solid. Accident, homicide, or suicide. — It is rare that murder is perpe- trated by burning ; the dead body is either burnt for the purpose of entirely destroying it, or the clothes are fired soon after a person has been killed, in order to conceal wounds or other violent means of death, and to make it appear as if the deceased had been acci- 380 ALLEGED SPONTANEOUS COMBUSTION. dentally destroyed by fire. Death, by burning is either the result of accident or homicide, most comnionly the former: but medical evidence may give rise to a suspicion of murder under two circum- stances : 1. When it is evident that several parts of the body have been fired at the same time, and the burns are such as not readily to be explained by the same accident, or by the accidental ignition of the clothes ; 2. When there are marks of homicidal violence on the body ; but these marks, if we except fractures of the bones, may be easily effaced when the burn is extensive. Time required for the burning of a dead body. — It may be a medico- legal question whether, on discovering a body much burnt, it could be determined from its appearance how long a period it would re^ quire to produce the amount of destruction observed. An answer to such a question may be necessary, in order to connect a person with the perpetration of an alleged crime, but the question does not admit of a precise answer. A conjecture only can be formed from the facts proved in each particular case. The human body contains a large proportion of water (72 per cent.) ; this gives to the soft structures a power of resisting combustion. At the. same time there is a quantity of fat in the body, varying in different parts, but amounting to an average of about five per cent. The fat or oil tends to increase its combustibility, and this is still further increased if the body is placed on any combustible article which can imbibe the oil, such as a rug or deal floor. The nature of the dress will also make a difference. Under a strong and active flame, which might subsequently burn out before the discovery of the body, there would be a degree of destruction in half an hour which a more slow and smothered combustion would not effect in several hours. It is from a want of due consideration of these facts that some of the older medico-legal writers have given support to the hypothesis of spontaneous combustion. It has been supposed that in certain cases the dead bodj'^ has been more destroyed than seemed consistent with the fact of ordinary combustion from articles of dress or furniture ; but this arose from want of sufficient experience on the effects of heat on the body. Then, as the means by which the dress of a person had become ignited were generally destroyed with the body, it was thought that a human being might, under certain conditions, be consumed by fire spontaneously generated within him. This extravagant hypothesis, which is on a par with the belief in witch- craft, and requires an equal amount of credulity to receive it, has, however, found advocates in modern times. In March, 1850, aman named Stauff was tried at Darmstadt for the murder of the Countess of Goerlitz. He had assaulted the deceased in her chamber, and then set fire to the furniture with a view to conceal his crime. The body and dress were partially consumed. As the means by which the fire was applied were not at once apparent, and the assassin had locked the doors of the room, some medical men took up the theory that the deceased had died from spontaneous combustion. INJURIES PRODUCED BY CORROSIVE LIQUIDS. 381 The facts of the case were referred to Prof. Liebig and Bischoff, of Giessen ; and their report was issued in March, 1850, at which date the man Stauffwas put on his trial. They found no difficulty in concluding that a murder had been perpetrated, and the body wilfully burnt after death for the purpose of concealing the crime. There was some doubt whether the deceased had died from strangu- lation, or from violence to the head. Staufl" was convicted chiefly upon circumstantial evidence. He subsequently confessed that the Countess had entered her room as he was in the act of committing a robbery. A struggle took place ; he seized her by the throat, strangled her, and afterwards placed the body in a chair, piling around it combustible articles of furniture. He set fire to these with the view of destroying the proofs of his crime. It was observed that the tongue of the deceased was protruded, as it is in violent strangulation, and that in its charred state it retained the position given to it by the act of murder. Other instances of alleged spon- taneous combustion, if properly investigated, would have turned out to be cases of accidental, or homicidal burning. Spontaneous combustion may take place in some kinds of vege- table and mineral substances, but not in the animal body, living or dead. Corrosive liquids. — Among the cases in which medical evidence is sometimes required, are those of throwing mineral acids, alka- lies, or other corrosive liquids on the person. This crime was at one time prevalent, and until the recent alteration in the criminal law there was no adequate punishment for it (24 & 25 Vict. c. 100, 8. 29). On one occasion an assailant escaped a charge of felony, because it could not be considered, in law, that sulphuric acid was capable of producing a wound — the man having been indicted for wounding ! This case clearly showed a strong necessity for some legal definition of a wound, as well as the uncertainty of medical opinions ; for while one surgeon considered that the injury pro- duced was a wound, another thought that it was not. The judges decided that it was not a wound within the meaning of the Act. The statute above mentioned, while it punishes the oft'ence, omits all reference to a definition of the word wound. The nature of the liquid thrown is merely defined, in general terms, to be " any corrosive fluid or any destructive substance" — a point which will require medical evidence for its elucidation. In common language, and according to the statute, the injury thus produced by a mineral acid such as oil of vitriol, is called a burn, but it is wholly different in its origin, as well as in its pro- gress. I do not know that there has been a single instance in which such an injury has directly destroyed life ; but great deformity and actual blindness have resulted. A medical man is sometimes required to distinguish these injuries from burns and scalds ; this may be easily done, in the first instance by the appearance of the part injured, as well as by the description of the first symptoms. The stain is brown when sulphuric acid has been used, and yellow 382 INJURIES FBODUCED BY COBROSIVE LIQUIDS. when nitric or muriatic acid has been employed. The eschar or destroyed part is soft and not dry as in a burn from a heated solid. The skin touched by a concentrated acid is destroyed and sloughs away, to the extent of the part on which tbe corrosive liquid was applied, leaving a suppurating and granulating surface. There is no capillary congestion or redness of the skin around the injury as in a burn ; but the color of the injured part may throw some light upon the nature of the corrosive substance used. Thus, while oil of vitriol (sulphuric acid) produces dark-browii stains, aqua-fortis (nitric acid) produces yellow or yellow-brown stains on the skin. Articles of dress are also differently colored by these acids. The period at which a person may recover from an injury of this kind depends on its degree and extent, as well as on the part affected by the corrosive liquid. Although a person may not die from the direct effects of the acid, yet in certain irri- table constitutions the inflammation which follows in deep-seated parts may prove fatal. In infants, or delicate nervous females, an extensive injury thus produced may readily destroy life. In one instance, sulphuric acid thrown on the face produced inflammation of the eye, for which bleeding was prescribed. The person died of phlebitis (inflammation of the vein), as the result of this bleeding. The nature of the acid may be determined by applying wetted linen to the part when the injury is recent, and examining the liquid thus absorbed. In general, however, evidence is readily ob- tained by examining the spots or stains. left on articles of clothing or furniture. Oil of vitriol is most commonly used. The caustic alkalies may be used under these circumstances, as well as numer- ous other liquids, on which the only medical opinion required would be, whether the article employed should or should not be considered as a corrosive liquid or a destructive substance. To constitute a felony, it is not now necessary that the person should have sustained, from the act of throwing, any bodily injury. Unless vital reaction has taken place, there are no means of dis- tinguishing the effects of a corrosive liquid on the living from those produced on the dead body. (" Ann. d'Hyg.," 1859, vol. 1, p. 396.) The mineral acids are sometimes used in other ways for the de- struction of life. In June, 1888, a man poured a quantity of strong nitric acid into the ear of his wife while she was lying asleep. She awoke suddenly with a violent pain in her ear, which continued for three days, whereby she became weak and exhausted. Soon afterwards there was copious bleeding, and a portion of mem- brane escaped. She lost the use of her right arm, and became completely deaf. Suppuration took place from the ear, and blood escaped daily. She gradually sank, and died six weeks after the injury, the right half of the body being convulsed before death. On inspection, a portion of the external ear was wanting, and the ear passage was much wider than natural. The brain, near the petrous portion of the temporal bone, was softened, and the bone INJURIES PRODUCED BY CORROSIVE LIQUIDS. 383 itself diseased (carious). The injury had led to death indirectly by producing disease of the brain. (" Med. G-az." ■vol. 17, p. 89.) In a ease tried at Aberdeen, the evidence proved that a woman had poured oil of vitriol down the throat of her husband, while he was lying asleep with his mouth open. She was convicted of the murder. In a more recent case, a woman killed her husband by pouring a solution of corrosive sublimate down his throat while he was sleeping. These, however, were treated as cases of poisoning, as death did not depend on the local or external mischief produced by the corrosive agent employed. 384 DEATH FBOM DROWNING. ASPHYXIA. DROWNING. CHAPTEE XXXVI. CAUSE OP DEATH. — SECONDARY CAUSES. — POST-MOBTEM APPEARANCES. — MEDICAL PROOFS OF DEATH FROM DROWNING. — SPECIFIC GRAVITY OF THE BODY. — CO-INCIDENTAL CAUSES OF DEATH. — MARKS OF VIOLENCE. — ACCIDENTAL FRACTURES. — HOMICIDAL AND SUICIDAL DROWNING. Under the term Asphyxia or Apncea are included those forms of violent death in which the act of respiration is primarily arrested (p. 58). These comprise death from drowning, hanging, strangula- tion and suffocation ; and in this section, the fatal effects of light- ning, cold and starvation will be considered. Asphyxia is induced in drowning owing to a physical impedi- ment to the introduction of air into the lungs. The medium in which the person is immersed acts mechanically, and even more effectually than a rope or ligature round the neck ; for although air escapes from the lungs, and water penetrates into the minute air- tubes, yet no air can enter to supply the place of that which has already expended its oxygen on the blood. Hence, this fluid must circulate, in the first few minutes after submersion, in a state un- fitted for the support of life (unaerated) ; but the person lives, and is susceptible of recovery within a short interval. After the entire suspension of respiration, the action of the heart gradually slackens, and finally stops. It is at this period of the arrest of circulation that asphyxia passes into death. Asphyxia is determined by the period at which respiration is completely arrested ; but the point of time at which death from drowning occurs, is fixed by the moment at which the action of the heart ceases. This varies considerably, , according to age, sex, state of health, and other circumstances. "When a person falls into water, and retains his consciousness, violent attempts are made to breathe ; at each time that he rises to the surface a portion of air is received into the lungs, but, owing to the mouth being on a level with the liquid, water also enters and passes into the throat. A quantity of water thus usually enters the mouth, which the drowning person is irresistibly compelled to DROWNING — CAUSE OF DEATH. 385 swallow. In his efforts to breath while his head is below water, a portion of this liquid is drawn into the air-tubes and cells of the lungs. The struggle for life may continue for a longer or shorter period, according to the age, sex and strength of the person ; but the result is that the blood in the lungs is imperfectly aerated, the person becomes exhausted, and insensibility follows. The mouth then sinks altogether below the level of the water ; air can no longer enter into the lungs; a portion of that which they contain is expelled, and rises in bubbles to the surface ; an indiscribable feeling of delirium, with a ringing sensation in the ears, supervenes ; the per- son loses all consciousness, and sinks asphyxiated. In the state of asphyxia, while the dark-colored blood is circulated, convulsive movements of the body take place, and the contents of the stomach are sometimes ejected by vomiting. There does not appear to be any sensation of pain, and, as in other cases of asphyxia, if the person recover, there is a total unconsciousness of suffering during the period when the access of air was cut off from the lungs. Some persons who fall into water are observed to sink at once, without making any attempt to extricate themselves. This may arise either from sudden syncope, or from the stunning produced by the fall. Should the person be intoxicated, or otherwise incapacitated, as by striking his head in falling, he may not again rise. Tiiese different conditions under which death may take place will sufficiently account for the difference in the appearances met with in the bodies of those who have died in water. A fatal result may be accelerated by the impression suddenly produced upon the skin, from the diffe- rence of temperature between the body and the water. To those who are not accustomed to water, a sudden immersion produces a great and rapid cooling of the surface, and forces the blood into the internal organs. There is difficulty of breathing, or severe spas- modic respiration, with giddiness and other symptoms, which may render a person powerless to extricate himself. The effect of cold on the skin is seen in the contracted state of the cutis in the bodies of those who have been drowned during the winter. It is calculated that in 25 per cent, of all who are drowned, the cause of death is pure asphyxia, and that in the remainder, syncope and cerebral con- gestion amounting to apoplexy may have a share in causing death. In regard to the time required for death to take place by drown- ing, it may be observed that when the mouth is so covered by water that air cannot enter, asphyxia comes on in the course of owe or two minutes at the farthest, and the time at which this occurs does not appear to vary materially. Perfect insensibility has supervened after one minute's submersion, and it is probable that in most cases a few seconds would suffice for the commencement of asphyxia. In this state the person can make no efforts to save himself, and death com- monly ensues in from two to five minutes. The power of restoring life depends not merely on the time that the body may have been submerged, but on the condition of the lungs at the time of its re- moval from the water. Experiments lately conducted by a com- mittee of the Medio-Ohirurgical Society have clearly proved that, 386 EFFECT OP WATER ON THE LUNGS. as a form of asphyxia, drowning is not only more speedily fatal to life than ordinary suffocation, but from the effects produced on the lungs by water, the chance of recovery is lessened. The committee found that the difference in the results was not owing to exhaustion from struggling, from the violent efforts made to breathe, or from the effect of cold in immersing the whole of the body, but to introduction of water by aspiration into the minute air-tubes and cells of the lungs. This conclusion was derived from the following experiments : Two dogs of the same size were sub- merged at the same moment, but one had his windpipe plugged, so that no air or water could enter, while the other had not. After two minutes they were taken out together ; the one with the wind- pipe plugged recovered at once, the other died. In three experi- ments dogs with their windpipes plugged were kept below water for /our minutes: the animals recovered perfectly when removed from the water. (Report on Suspended Animation, Med.-Chir. Trans., 1862, p. 449.) An inspection of the bodies at once revealed the difference. In animals simply deprived of air by plugging the windpipe, the lungs were merely congested ; but in those which were submerged in their ordinary condition, the lungs, besides being more congested and showing ecchymosed points on the surface and in the substance, contained in their bronchial tubes a bloody mucous froth, formed of water, blood and mucus, which completely filled the small air-tubes. The respiratory efforts made by the animal before death had caused the production of this froth, which formed a mechanical impediment to the entrance of air by the movements of the chest, as in respiration. This mucous froth or foam issuetl from the lungs on section, and appeared to penetrate their entire substance, which was saturated with water tinged with blood. The lungs were sodden with water, heavy, soft, doughy, retained an impression produced by the finger, and were incapable of collapsing. In the lungs of animals which recovered after a short submersion, little or hone of this mucous froth was found in the air-cells. In the fatal cases, the quantity was great in propor- tion to the time of submersion. There is no doubt that it is pro- duced by the violent efforts to breathe, which are made within a minute after submersion. It may be inferred from these results that the power of recovery in human beings has a direct relation to the presence of mucous froth in the air-tubes, and to the penetration of the substance of the lungs with water. The larger the amount of froth produced and the greater the penetration, the less the hope of recovery; for when the lungs have undergone these changes they are physically unfitted either to receive or expel air by respiration — they are incapable of collapsing. These circumstances will account for the fact that per- sons have been resuscitated in drowning under various and even opposite modes of treatment, and even under no treatment at all. It is right that every reasonable effort should be made to restore life, but if the lungs are sodden with water, their functions cannot be restored by any mode of treatment. The committee found that TREATMENT OF THE DROWNED. 3»7 four minutes' complete submersion effectually killed dogs, although after removal from water, the heart continued to beat from four to live minutes. The continuance of the heart's action furnishes, therefore, no criterion of the power of recovery. A human being, as a rule, dies if submersed for a period of from four to five minutes. In a few exceptional cases, persons have been resuscitated after this period, but it is most probable that iu these the lungs had sustained no damage. Treatment. — The facts above mentioned have a close relation to the treatment of the drowned. The subject is hardly of a medico- legal nature, but occasionally questions have arisen at coroners' inquest in reference to the propriety of the treatment adopted by a medical practitioner. "When it is stated that conflicting methods have been apparently equally successful, it will be preceived that there is great diflBculty in making a selection or laying down rules. Artificial inflation of the lungs appears d -priori to be the proper plan for resuscitation. The late Dr. Woolley, who had consider- able experience in treating the drowned, informed me that, as a rule, he had seen no benefit from the introduction of air by artifi- cial processes (see " Med. Gaz." vol. 17, p. 663), and that the warm bath (at 100°), with frictions to the skin, had been in his hands the most successful means of treatment. When some signs of ani- mation were not elicited by the warm bath, there was but little hope of any other plan succeeding. Artificial inflation in some form is now, however, generally employed, in addition to the application of warmth and stimulating frictions to the skin. The committee of the Medico-Chirurgical Society, discarding the use of apparatus which is rarely at hand when most required, recom- mends the method of inflating the lungs suggested by Dr. Silvester, " in which the action of the pectoral and other muscles passing from the shoulders to the parietes of the chest in deep inspiration, is imitated." This plan has been adopted by the Royal Humane Society. The committee have demonstrated by experiment that it is superior to the method recommended by the late Dr. Marshall Hall, inasmuch as it commences with the act of inspiration, while the latter begins with expiration, and it more completely fills and empties the air-cells of the lungs: 1. Remove from the neck and chest all articles of clothing ; 2. Wipe the body dry, and cover it with dry cloths; 3. Clear the nostrils, mouth, and throat of all mucous froth, or of substances likely to interfere with free respi- ration : pull forward the tongue, and keep it in this position so that it may not fall back and cover the opening of the windpipe; 4. Place the body at full length witfi the face downwards, the fore- head resting on one arm : this is for the purpose of allowing all fluids to flow readily out of the mouth ; 5. Ammonia, aromatic vinegar, snuft", or other stimulants, may be cautiously applied to the nostrils; and 6. If respiration is not quickly restored spontaneously, then the body should be placed upon its back, with the head slightly raised. The arms should be gently carried outwards and upwards from the chest, raised above the head, and maintained in 388 DEATH FROM SECONDAEY CAUSES. this position for about two seconds. By this movement air pene- trates into the lungs as during the act of inspiration. The arms are now lowered and brought closely to the sides of the chest, by which expiration is effected. Pressure on the lower part of the chest-bone (sternum) aids this expiratory action. This movement should also occupy two seconds. These alternate movements of the arms may be repeated from twelve to fourteen times in a minute. All rough handling should be avoided. So soon as any spontaneous respiratory action is observed, warmth may be ap- plied to the skin by the warm bath or otherwise, and stimulating frictions may be used, or simple frictions with warm flannel, etc. Heat should be applied especially to the region of the heart, the loins, soles of the feet, and palms of the hands. "When the power of swallowing returns, warm water alone or with a little brandy as a stimulant, may be given. The patient should then be placed in bed and allowed to sleep. This treatment should be persisted in for some hours, except in those cases in which the body has been long under water, and is taken out cold and rigid. In Dr. Douglas's case there were no signs of returning animation until after the treatment had been carried on for eight and a half hours. The tendency to restoration is indicated by the occurrence of slight flushing in the face, with convulsive twitehings in the facial muscles, warmth of the skin, grasping or sobbing respiration at intervals, and sometimes convul- sive movements of the body and limbs. The unfavorable signs are : Complete insensibility, coldness, and paleness of the body ; no spontaneous act of respiration ; entire absence of pulsation in the region of the heart ; the eyelids half-closed, the pupils dilated, the lower jaw stiff', the fingers half bent inwards, and the mouth and nostrils containing mucous froth, which is continually escaping from them. The chances of recovery are great in proportion to the shortness of the interval between the last expiratory eftbrts in the state of asphyxia and exposure to the air. In a very large •jiroportion of all cases of recovery after submersion, the act of respiration in the form of sobbing, sighing, or gasping commences spontaneously sOon after the person has reached the air, and the only treatment then required is not to interfere with this natural action of the chest. Death from, secondary causes. — Drowning may operate indirectly as the cause of death. Thus, it has been repeatedly remarked that persons who have been rescued from the water in a living state, and who have apparently recovered from the effects of submersion, have died, in spite of treatment, after the lapse of some minutes or hours ; others have lingered for one or two days, and then have sunk apparently from exhaustion. In those who perish soon atter removal from water, death may arise either from exhaustion or from the obstruction of respiration by the penetration of water into the air-cells of the lungs. Dr. Marcet states that spasm of the glottis has been among the severe secondary symptoms in persons who have been removed from water apparently drowned. A severe spasm of EXTERNAL APPEARANCES AFTER DROWNING. 389 this kind manifested itself in one case while placing the patient in a warm bath. ("Med. Times and Gazette," February, 1867, p. 148.) When death takes place at a remote period, it may be caused by disease ; and a question may thence arise, whether the disease was produced by the immersion in water or not. Such cases occasionally present themselves before our courts of assize. Post-mortem appearances.- — The external and internal appearances produced by drowning vary according to the length of time during which the body may have remained in water, and the period that may have elapsed after its removal and before it is examined. Thus, in reference to the bodies of two persons drowned by a com- mon accident, if one is removed and examined immediately, and the other is not removed from the water until after the lapse of several days, and is then inspected, the appearances will be different. So, if the two bodies are removed at the same time, and one is immediately examined, while the other is not inspected until a month after removal, the proofs of drowning which may be dis- coverable in the former, will probably have disappeared in the latter. A protracted exposure of the drowned body either to water or air, especially if the temperature is high, renders an inspection useless for the purpose of evidence. External appearances. — Supposing that the body has remained in the water only a few hours after death, and the inspection has taken place immediately on its removal, the skin will be found cold and pallid — sometimes contracted under the form of "cutis anserina." This contracted state of the skin when found furnishes strong evi- dence of the body having gone into the water living. The skin is often covered to a greater or less extent by livid discolorations ; the face is pale and calm, with a placid expression; the eyes are half-open, the eyelids livid, and the pupils dilated ; the mouth closed, or half-open, the tongue swollen and congested — frequently pushed forwards to the inner surface of the lips, sometimes indented or even lacerated by the teeth ; and the lips, together with the nos- trils, are covered with a mucous froth which issues from them. Kanzler has noticed in the male subject a remarkable retraction of the penis. In men who have gone living into the water and been drowned, this appearance has been repeatedly observed by Casper and Kanzler ; and the former states that he has not met with this condition of the male organ after any other form of death. In strong and robust men it has beea found short, and strongly retracted into the skin. (" G^er. Leich. Oefth." ii. 109.) The body and limbs of a person recently drowned are usually found relaxed, but cadaveric rigidity appears to come on quickly in cases of drowning, and the body is often stiffened in the con- vulsed or distorted attitude which it may have had at the time of death. In a case observed by Mr. Beardsley, the body of a man who was drowned under ice, was found with the arms stiffened in the attitude in which he was endeavoring to support himself on the ice. Among the casual external appearances, it has been noticed that 390 INTEENAL APPEARANCES AFTER DROWNING. the fingers and surface of the body occasionally present abrasions. Gravel, sand, mud, weeds, or other substances may be found locked within the hands or nails of drowned persons ; for in the act of drowning, as common experience testifies, a person will grasp at any object within his reach, and in his eflbrt to extricate himself, he may excoriate or wound his fingers. Substances floating in the water are also sometimes found in the nose, mouth and ears. There are, however, many cases of drowning in which such appear- ances do not exist. There may be no substances for the drowning person to grasp ; this will depend in a great degree upon the fact of the water being deep or shallow, of its being confined within a narrow channel or not, and many other contingencies. In all cases when the person is senseless before he falls in the water, or when his death is occasioned by syncope, he will, of course, be in- capable of making those exertions which are necessary to the pro- duction of this appearance ; and it is probable that this frequently occurs among women who are accidentally drovs^ned. When the body has remained several days in water, the skin of the palms of the hands and soles of the feet is found thickened, white and sod- den, as a result of imbibition. Internal appeara.nces.- — ^In a recently drowned body, the lungs and heart present the appearances usually indicative of asphyxia (p. 58). The venous sj'stem is generally gorged with dark-colored liquid blood. If death has not taken place from asphyxia, or if tlie body has i-emained a long time in water before an inspection is made, the lungs and heart will not present the character about to be described. Some physiologists have asserted that the blood re- mains fluid in the bodies of the drowned ; but more importance has been attached to this appearance than it really merits. Some observers have found the blood coagulated in the drowned, and I have seen coagula, like those usually met with after death, in the bodies of animals which were drowned for the sake of experiment. If the blood is found generally liquid, this may be due to the im- bibition of water, or to putrefactive changes. Riedell found the blood in the heart and large vessels to contain coagula, in inspec- tions made from two hours to five days after death. (" Med. G-az." vol. 46, p. 478.) Hence it follows that the blood may be found either coagulated or uncoagulated, in those who go into the water living, and die by drowning. The lungs are sometimes congested, and more generally distended than collapsed. Casper and Kanzler, as a rule, found them much increased in volume, and completely filling the cavity of the chest, so that when the chest was opened they protruded out of it ; but this did not depend onmere fulness of blood. The most accurate observations, show in recent cases of drowning that the lungs are generally distended and in a flabby condition. Owing to the pene- tration of their substance by water, they have lost their usual elasticity, so that an impression made upon them by a finger is pre- served, as in an oedematous limb. Riedell has pointed out this flabby and dilated condition of the lungs as a special characteristic POST-MORTEM APPEARANCES. 391 of drowning: although they floated,Jie found that they were three or four times as heavy as in their natural state, owing to the water in their substance. (" Med. Gaz.," vol. 46, p. 478.) On making a section of any part of the lungs, a bloody frothy liquid escapes — air and water being mixed together in the air-cells. These appear- ances are only likely to be observed, in a well-marked form, when the body is examined soon after death. The windpipe, bronchi and minute air-tubes of the lungs, in a recently drowned body, are filled more or less with a mucous froth, tinged with blood, as a re- sult of the last violent eftbrts at respiration, when the mouth has sunk below the level of the water. This appearance is not always met with. Thus it has not been found in the bodies of those who have sunk at once below the surface and have not again risen to breathe. But from recent experiments on animals, made by the committee of the Medico-Chirurgical Society, its presence in the air passage does not depend on the fact of a person rising to the surface — although this may increase the quantity — but rather upon the violent spasmodic efforts made to breath, under circumstances in which water alone can enter the lungs. These facts show that a mucous froth is produced in the air-passages even in two minutes, when there is entire submersion of the head ; and its quantity appears to be in proportion to the length of submersion, and the violence of the efforts made to breathe. The presence in the air-passages of a mucous froth, frequently tinged with blood, may be regarded as a characteristic of asphyxia by drowning. When discovered in the lungs, associated with a watery condition of these organs, it furnishes a satisfactory proof of this mode of death. As its presence depends on the retention of air in thin vesicles diffused through the air-tubes, it is obvious that, except in recent inspection, i. e., within a few hours of death, it may have wholly or partly disappeared. Water passing in and out by the windpipe may destroy it — also the exposure of the body to a high temperature. This may account for the fact that it is not always observed in the inspection of the bodies of the drowned, when removed from water. Violent efforts at respiration may, however, produce it — especially if, owing to the loss of power of swallowing, any liquid should find its way into the windpipe. Independently of the presence of water (sometimes mixed with mud, sand, or weeds) in the larger air-tubes, a portion of this liquid is generally drawn into the lungs by convulsive efforts at respiration. It fills the cells and penetrates the substance of the organs, giving to them the flabby or doughy consistency already described. In some cases the contents of the stomach may be found in the windpipe and lungs ; this occurs when a person has been drowned with a full stomach. Vomiting takes place, and the vomited matters are drawn into the lungs by the attempt to breathe. The state of the heart in the drowned has given rise to some discussion. In death from asphyxia, the right cavities generally contain blood, while the left cavities are either empty, or they 392 POST-MORTEM APPEARANCES. contain much less than the ijght. Out of fifty-three inspections made hy Dr. Ogston, the right cavities were found empty only in two cases, and the left cavities empty in fourteen. ("Med. Gaz.," vol. 48, p. 291.) In a case of drowning which was examined by Mr. Bishop, the right side of the heart contained scarcely any blood ; and in another case, communicated to me December, 1857, the only medical difficulty regarding death by drowning presented itself in an emptiness or non-distension of the right cavities of this organ. The facts and observations accumulated by my friend Dr. !N"orman Chevers, of the Calcutta Medical Board, show that a full condition of the heart, although a common, is not an invariable concomitant of asphyxia, eithei' from drowning or any other cause. (" Medical Jurisprudence for India," 1856, p. 441.) It has been elsewhere remarked, that the action of the heart continues after the stoppage of respiration, and that the period at which this organ ceases to contract is variable. Hence, in some cases there may be sufficient power in the right cavities to contract upon their contents, and to expel, more or less completely, the last traces of blood received by them from the body. Emptiness of the right cavities of the heart must not, therefore, be regarded as inconsistent with death from drowning; at the same time, it cannot be taken as a proof that the person has died from asphyxia. Dr. Riedell- states that in half the number of instances which had fallen under his observation, the two sides of the heart contained equal quantities of blood ; in the other half, the right side contained the larger proportion. In one case only, the emptiness of the left side con- trasted strongly with the fulness of tlie right. A greater or less fulness of the vessels of the brain is described as one of the appearances met with in drowning ; but this, when it exists, is probably a consequence of a congested state of the lungs. Some remarks have been already made on this subject, and from these it is evident that the state of the cerebral vessels can afford no presumption that death has taken place by drowning. In regard to the cases which I have had an opportunity of examining, the quantity of blood contained within the cerebral vessels has rarely been so great as to call for particular notice. In examining the abdomen, it will commonly be found that the stomach contains water, which appears to enter into this organ by the act of swallowing during the struggle for life. This may be salt or fresh, according to the medium in which the drowning has taken place. The quantity is subject to great variation ; sometimes it is large, at other times small, and in some instances no water whatever is to be met with. The absence of water may probably indicate a rapid death, as there could have been no power to swallow. Orfila has remarked, that the mucous membrane -of the stomach and bowels is occasionally much discolored in drowned subjects. He observed also, that when drowning took place while the process of digestion was going on, the mucous membrane of the stomach often had a pinkish-red or violet tint. When the dead body had remained a long time in water, this membrane was observed to SUBSTANCES GRASPED IN THE HANDS. 393 acquire a deep violet or brown color. A knowledo;e of this fact may be of some importance in those cases in which a person is suspected to have been poisoned previously to submersion. It has been said that the diaphragm is generally much raised towards the chest ; but this may depend on gaseous putrefaction, and the increase in the size of the abdomen by the formation of gas in the intestines. The urinary bladder in some cases contains urine ; in others it is perfectly empty. Casper found it empty in one-half of the cases which he examined. It is obvious that the state in which the bladder is found must depend upon its condition at the time at which the drowning occurred. (See, in reference to the appearances in the drowned, a paper by Dr. Ogston, " Med. GTaz.," vol. 47, pp. 763, 854, et seq. ; also another by Dr. Riedell, "Med. Gaz.," vol. 46, p. 478 ; and Casper, " Ger. Leich-Oeff.," vol. 1, p. 87 ; 2, p. 105 ; and " Klinische Novellen," 1863, p. 528.) Was death caused by drowning? — For a correct solution of this question, it will be necessary to consider the appearances met with in the drowned, and to determine how far they are characteristic of this form of death. Among the external signs of drowning, when the body is seen soon after death, are paleness of the surface, a contracted state of the skin (cutis anserina), and the presence of a mucous froth about the nostrils and lips. The absence of these appearances, however, would not prove that the person had not been drowned ; for if the body had remained some time in water, or if it had been long exposed to air before it was seen by a medical man, the skin would undergo various changes in its condition and color, and mucous froth would no longer be found adhering to the nostrils and lips. Slate of the skin. — The goose-skin, or cutis anserina., which is frequently observed in the drowned, shows that the skin possessed the living power of contractility at the time of immersion. Wagner suggests that the appearance might be produced in a dead body if thrown into cold water immediately after death, i. e., while the skin is warm. As none but assassins would be likely to resort to this proceeding, the objection would, if admitted, leave the fact of drowning still to be made out by an internal inspection. This contracted state of the skin could hardly be mistaken for a naturally rough or horny skin, as suggested by Casper. (" G-er. Leich.-Oeffn." vol. 1, p. 89.) As this condition of the skin is not invariably present, even in the recently drowned, and as it is observed chiefly in drowning during cold weather, its absence must not be taken to negative the hypothesis of drowning. Substances grasped in the hands. — Foreign substances, such as gravel, dirt, weeds, or grass, are sometimes found locked within the hand or lodged under the nails of drowned subjects. This fact may occasionally afford strong circumstantial evidence of the manner in which a person has died. If materials are found grasped within the hands of the deceased which have evidently been torn from the banks of a canal or river, or from the bottom of the water in which the body is found, we have strong presump- 394 WATER IN THE STOMACH. five evidence that the person died within the water. For although it is possible to imagine that the deceased may have struggled on the bank, and have been killed prior to submersion, yet in the value attached to this sign, we are assuming that there are no marks of violence on the person, nor any other appearances about the body sufficiently striking to load the examiner to suspect that death had occurred in any other way than by drowning. If the substance locked within the fingers or finger-nails is sand of the same character as that existing at the bottom of the river or pond, it is difficult to conceive any stronger fact to establish death from submersion. The abrasion of the fingers is a circumstance of minor importance ; no value could be attached to this state of the fingers as an indication of a person having perished by drowning, unless it were in conjunction with the appearances above described. A witness would be constrained to admit in many cases, that the fingers might become abraded or excoriated after death, or even before submersion ; while in no case could he be called upon to ' make, in regard to substances found grasped within the hands, an admission which would invalidate the evidence deducible from this condition. This must then be regarded as a satisfactory proof of a person having been alive after his body was in the water. It is well known that when two or three are drowned by the same accident, they are not unfrequently found clasped within each other's arms, — a fact which at once proves that they must have been living when submerged ; so if a dead body is discovered still holding to a rope, cable, or oar, no further evidence is required to show that the deceased must have died from drowning. The internal appearance upon which medical jurists chiefly rely as proofs of this kind of death are — first, water in the stomach ; and secondly, water with a mucous froth in the air-passages and lungs. 1. Water in the stomach. — Dr. Riedell found that in the majority of cases of drowning, water passed into the stomach. In animals previously killed, and placed for twenty-four hours in water with the mouth wide open, no fluid penetrated to the stomach. ("Med. Gaz.," vol. 46, p. 478.) Water commonly passes into the stomach of a living animal while drowning, by the act of swallowing. It has been observed that when an animal is stunned prior to sub- mersion, water does not pass into the gullet, and when syncope occurs, none will be found. As a proof that its entrance into this organ depends on the act of swallowing, it may be stated that the quantity in the stomach is greater when an animal is allowed to come frequently to the surface and respire, than when it is main- tained altogether below the surface. The power of swallowing is immediately suspended on the occurrence of asphyxia, and in this way we may satisfactorily account for the difterence observed in the two cases. The water thus found is in variable quantity ; and there are some cases of drowning in which water is not present, in the stomach. It was found by Dr. Ogston, of Dundee, in five cases out of seven. (" Ed. Med. and Surg. Journ.," Jan. 1837.) Water WATER IN THE AIR PASSAGES. 395 does not readily penetrate into the stomach of a body which has been thrown in after death ; the sides of the gullet applying them- selves too closely to each other to allow of the passage of fluid. It putrefaction has advanced to any extent, some water may enter ; but a medical man may easily judge from the general state of the body, how far this process may have been concerned in the admis- sion of fluid into the stomach and intestines. Orfila has suggested that water may be found in the stomach of a person apparently drowned, in consequence of this liquid having been drunk by the deceased, or artificially injected by another into the stomach after death. It is diflicult to conceive under what circumstances the latter objection could be made, or what purpose it would answer ; but in relying upon the presence of water in the stomach, it may be admitted that the deceased may have drunk water before his bod}' was submerged. The mere discovery of water in the stomach, except under circumstances to be presently mentioned, is not, therefore, a necessary proof that it has been swallowed during the act of drowning. It is of course presumed that the liquid contained within the stomach is of the same nature as that in which the body is im- mersed ; for it is possible that fresh water may be found in the stomach of a person drowned in salt water, and in such a case it would be obviously improper for a medical witness to affirm from the mere presence of water, that the person had died where his body was discovered. If the water contain mud, straw, duckweed, moss, or any substances like these existing in the pond or river where the drowning occurred, it is a proof, when the inspection is recent, of its having been swallowed by a living person. The ab- sence of water from the stomach cannot, however, lead to the in- ference that the person has not died from drowning, because in some instances it is not swallowed, and in others it may drain away and be lost after death before an inspection is made. 2. Water with mucous froth in. the air jpassages and lungs. — If the body is carefully removed from the water, and is examined soon after removal, these appearances, which furnish satisfactory evi- dence of death from drowning, will be found. Dr. Riedell regards the presence of a mucous froth as a constant sign of this kind of death. In all his experiments and observations, he states that he found a frothy fluid in the windpipe, bronchi and lungs ; after death it gradually disappears from the air-tubes by exosmosis, but not from the lungs. The fluidity of this froth is, he contends, a distinctive character of death from drowning, and is not met with in any other case ("Med. Graz.," vol. 46, p. 478). The presence of a frothy fluid would undoubtedly show that liquid, from some cause, had penetrated into the air-passages ; and when taken in conjunction with the presence of water in the substance of the lungs, it may be considered to furnish conclusive evidence of death from drowning. On the other hand, its absence does not neces- sarily prove that a person has not died from this cause. If none is found in a body recently after death, this may have been the 398 FOREIGN MATTERS IN THE LUNGS. result of syncope or apoplexy, and there may have been no conclu- sive efibrt at breathing prior to death. A mucous froth may not be found when the body has remained for a long period in the water after death, since by the free passage of this fluid into and out of the air-tubes, the froth, although formed in the first in- stance, may have disappeared. If, after removal from the water, the body is exposed to the air for several days before it is ex- amined, it is rare that this appearance is seen. The mucous froth may have been formed in the windpipe, but it may have entirely disappeared. 3. Waie?' and foreign substances in the lungs. — It has been else- where stated that in the act of drowning, water is drawn with con- siderable force into the lungs, by violent attempts at inspiration. The aspiratory force thus exerted by the lungs is considerable. It has been found tliat when the heads of animals are plunged below mercury, some of this fluid metal, in spite of its density, is actually drawn into the lungs, and globules of it have been found in the air- cells. A fortiori^ this takes place in a greater degree with water which is forcibly drawn into, and permeates the spongy texture of the lungs, rendering death more rapid and recovery more difficult than in other forms of asphyxia. This aspiratory force of the lungs has been measured, and is found, in small animals; to be equal to raising a column of mercury four inches in height. Not only is water thus drawn in, but sand, mud, weeds, or other substances floating in it, are also carried into the air-tubes and cells of the lungs. When the water is mixed with weeds or mud, and water presenting the same admixture is found in the throat and stomach, this is strong evidence that the body has been plunged into the medium when the power of breathing and swallowing still existed, and hence that the deceased has been drowned. All attention to the condition of the stomach and lungs together, will therefore be of importance in cases of alleged child-murder by drowning, since it may aid in proving or disproving the charge. When a dead body is thrown into water, and has remained there some time, water, with fine particles of sand, mud, or weeds, may pass through the windpipe into the lungs, and there be deposited. Dr. Chevers, of Calcutta, was required to examine the body of a child found in a tank at a distance from the house of the parents. The internal appearances showed that the child had died by drown- ing. The air-passages contained green vegetable matter, and the right air-tube was almost completely filled with so large a portion of an aquatic weed doubled together, that it appeared astonishing how such a body could have passed into the windpipe. It was proved that no weed of this kind grew in the tank where the body was found. Further inquiry led to the discovery that the body of the boy had been found by a woman in a tank near his house, in which the weed found in the air-passages grew abundantly. This female carried the corpse to the more distant tank which belonged to a person against whom she bore a grudge! Water under these circumstances, however, does not penetrate into the substance of the GENERAL CONCLUSIONS. 397 lungs as by aspirations during life, and the amount which passes through the chink of the glottis is email. If simply an after-death efl'ect, the water is found in the larger air-tubes unaccompanied by mucous froth. In most cases, however, the effect of aspiration, as a result of living power, is so manifest, that the examiner can have no difficulty in forming an opinion. From these observations it will be perceived that the only char- acters on which reliance can be placed, as medical proofs of death from drowning, are — first, the presence of a mucous froth in the windpipe and air-tubes ; secondly, of water in the air-tubes and air- cells of the lungs ; and thirdly, of water in the stomach. An early inspection of the body may thus enable a medical man to come to a satisfactory conclusion that death was or was not caused by drowning. The longer this inspection is delayed, the more ambigu- ous the evidence becomes, since the froth slowly disappears from the air-tubes, while water may penetrate into the lungs and stomach. The great cause of failure in obtaining medical proofs of drowning is generally the unavoidable delay before an inspection is made. If, in examining a body taken from water, we iind upon it marks of violence, or severe internal injuries sufficient to destroy life, there is strong ground for suspicion. Why the body of a person who has really died from natural causes should be afterwards thrown into water, it would not be easy to explain upon any hypothesis of inno- cence, but we can readily appreciate the motive when murderous violence has been used. After the lapse of five or six weeks, especially if the body has been removed from the water for 'the greater part of that period, none of the usual appearances oi' drown- ing will be met with ; in the present day, no practitioner would think of seeking for evidence under such circumstances. In consequence of the uncertainty attendant on the appearances of drowning, barristers have considerable advantage in cross-examin- ing those medical witnesses who appear to support the theory of the prosecution that death took place from this cause. Legal in- genuity is here often strained to the utmost, to show that there is no certain sign of drowning, and therefore that the deceased must have died from some other cause. The general impression among non-medical persons appears to be that, whetljer in drowning or suffocation, there ought to be some particular visible change in some part of the body to indicate at once the cause of death ; but it need hardly be said that this notion is founded on false views, and if the reception of medical evidence on the caiise of death be made to depend on the production of some such positive and visible change of structure, then it would be better at once not to place the parties charged with the crime upon their trial, because it could never be proved against them. A medical inference of drowning is founded upon a certain series of facts, to each of which, individually, it may be easy to oppose plausible objections ; but taken together they furnish evidence as strong as is commonly required for proof of any other kind of death. In death from drowning, a question respecting the specific gravity 398 SPECIFIC GEAVITT OF THE BODY. of the human body may incidentally arise. In the healthy living body, this is made up of the combined specific gravity of its difier- ent parts ; so that, as in all heterogeneous solids, it is a complex quantity. In the first place, about 72 per cent, of the weight of the body consists of water — hence the question of specific gravity can refer only to the remaining 28 per cent, of dry solids. The only- part of the body which is lighter than water is fat. The specific gravity of this is 0.9:^, and it is calculated that the proportion of fat in an adult is about five per cent, of the weight of the body, or one-twentieth part. The specific gravity of muscle is 1.085, of brain 1.04, of the soft organs generally 1.06, of the lungs containing air 0.94, and of bone, the heaviest part of the body, 2.01. The light- ness of the fatty portions is more than counterbalanced by the weight of the skeleton (about ten-and-half pounds in the male, and nine pounds in the female), so that the naked human body, placed on water, has a slight tendency to sink. This tendency diminishes just in proportion to the quantity of the body immersed ; because all those parts which are out of water, not being supported by water, become so much additional absolute weight to the portion im- mersed. Hence, the frequent cause of death by drowning. An inexperienced person exhausts himself by exertion, raises his arms continually out of the water, and as often sinks, owing to their weight having just so much efi:ect on his body as if a leaden weight had been suddenly applied to his feet to sink him. When the whole of the living body is immersed, the specific gravity, owing to the expansion of the chest, difters so little from that of water, that a very slight motion of the hands or feet will sufi[ice to keep a person on the surface. The head, owing to the weight of the bones of the skull, has always a tendency to sink below the level of water, and muscular force is required to keep it above the surface. There are two circumstances which cause the specific gravity of the body to vary. If the quantity of fat is proportionally large, it will be di- minished ; and such a person will float more readily than another in an opposite condition. On the other hand, a large proportion of bone renders a person heavier than his bulk of water, and his body will sink more rapidly than that of another. These two modifying causes of buoyancy are liable to constant variation; hence the dif- ferent accounts given by experimentalists relative to the specific gravity of the human body. The bodies of women are, cceteris paribus, of .less specific gravity than those of men; the skeleton is smaller, and there is a greater proportion of fat — hence they more readily float. Infants and young childt-en float with the greatest ease ; the quantity of fat is usually in large proportion, and the bones are light — the earthy matter being not yet fully deposited. Thus, in infanticide by drowning, the body of the child rises very speedily to the surface — if, indeed, it does not remain altogether upon it. There are some other points to be considered in relation to the buoyancy of the living human body. 1, Hespiration. — It is the fact of the lungs being filled with air that gives the general lightness to it. If these organs are emptied while the face is under water MARKS OP VIOLENCE OK THE DROWNED. 399 and the person cannot inhale again, the body remains specifically heavier than water, and will sink. Hence it follows that, ceteris paribus, a person with a large and capacious chest floats more easily than one whose chest is small and contracted. Hence also, in a living person, the body has a tendency to rise out of water during inspiration, and to sink during expiration — the quantity of water displaced under these two opposite conditions of the respiratory organs being very difl'erent. The entrance into water with the chest nearly emptied as the result of a loud scream or shriek, is very unfavorable to the buoyancy of the body. The fact of clothes being on the person may also make a difference — either, from their nature, in serving to buoy up the body, or from their weight to sink it more deeply. Women are sometimes saved from drowning by reason of their clothes floating, and thus presenting a large sur- face to the water; it is partly owing to this circumstance that the bodies of drowned women often remain floating on the water im- mediately after death. It may be laid down as a general rule, that the recently dead body unclothed is, when left to itself, heavier than water, and sinks when immersed. The expulsion of air from the lungs and their penetration by water, combined with the fact that the bones and all the soft parts, excepting the fat, are of greater specific gravity than water, offer a sufficient explanation of the sinking. After a variable period, generally not more than a few days, the body will rise again to the surface, and float. The period of its rising will depend — Ist, on the specific gravity of the body; 2dly, on the na- ture of the water — whether salt or fresh ; 3dly, on the access of heat and air in facilitating putrefaction. If the gases generated find an escape, the bod}' will sink ; more gases may form, and then it will again rise, so that the sinking and rising may become alternate phenomena. A small quantity of air collected in the abdomen, as a result of putrefaction, will suffice for the floating of the body. Thus, taking the specific gravity of the dead body at 1.08 to 1.1, it would require but little air to keep it at or near the surface ot the water. But a dead body, whether death has been caused by drowning or not, may not sink at all, owing to some one of the counteracting causes above mentioned. Several cases are reported in which the bodies of persons recently drowned have fioated. Marks of violence on the drowned. — The chief inquiry with regard to marks of violence on the bodies of the drowned is whether they have resulted from accident or design. In forming an opinion, a witness must give due value to the accidents to which a body floating loosely in water may be exposed. Bruises or ecchymoses of considerable extent are sometimes seen on the drowned, when the bodies have been carried by a current against mechanical obstacles in a navigable river or canal. If the deceased fell from a considerable height into water, his body in falling may have struck against a rock or projection, and have produced extensive marks of violence. Dead bodies taken out of wells often present con- siderable marks of violence of a vital character when the deceased 400 MARKS OF VIOLENCE ON THE DROWNED. persons have fallen in accidentally, or have thrown themselves in intentionally. The presence of these marks must not create a hasty suspicion of murder. It is manifestly impossible to lay down any specific rules for forming a decision in cases of this kind, since, probably, no two instances will be met with which will be perfectly similar in the details. In clearing up these doubtful points, every- thing must depend on the tact and experience of the practitioner who is called upon to conduct an investigation. The first question which he has to determine is, whether the injuries on the body were produced before, or after death. (See Wounds, ante, p. 261.) If after death, then they ought to be obviously of accidental origin. Accidental violence may sometimes be of a serious nature, so serious that a practitioner might well doubt whether it did not indicate that the deceased had been violently treated prior to submersion. If a dead body were taken out of water, with one or both limbs dislocated, or the vertfebrse of the neck fractured, and a surgeon was asked whether such injuries could be accidental and coincident with or consequent on drowning, the answer would probably be in the negative. But an instance has occurred in which both arms were accidentally dislocated at the shoulders in the act of drowning, as the result of a fall into the water from a great height. The great point with regard to all marks of violence on the drowned is to throw light upon the questions — 1st, whether drown- ing was really the cause of death ; and 2dly, whether, if so, the act was the result of accident, suicide, or homicide. This last question does not concern a medical witness so much as a jury, who will determine it from the facts, medical and general, proved before them. There is one case, of rare occurrence, in which a practitioner would be apt to be misled by trusting to appearances found on the drowned. If a dead body were removed from water with a deep e,echyraosed circle round the neck, evidently produced by a cord or ligature, but no traces of which could be found, it is not improbable that a suspicion would be at once raised that deceased had been murdered by strangulation, and the body afterwards thrown into water. A case occurred some years since in which a mark was produced on the neck of a woman who was accidentally drowned, as a result of the compression produced by the string of her cloak. Marks resembling those of strangulation have been produced on the necks of dead bodies floating in water, where they have been driven by a strong current against the stumps of trees or other obstacles in the stream. It might be said, that in cases of this description, circumstantial evidence would commonly show how the mark had originated. In admitting the truth of this observation, we must remember that circumstances, as matters of proof, do not always present them- selves to our notice, or occur to our judgment, at the precise time that the law stands most in need of them. While then, we use great caution in drawing an inference when there are such sti'ong HOMICIDAL AND SUICIDAL DROWNING. 401 grounds for suspicion, we should not neglect to examine carefully the most trivial appearances. Fractures are not often met with in the drowned as the result of accident. Certain fractures likely to he followed by immediate death may forbid the supposition of their having occurred after drowning, and a careful examination of the body may show that they were not likely to have arisen from accident at or about the time of submersion. The medico-legal question has arisen whether fractures of the vertebrae of the neck can occur from accident alone, at or about the time of drowning. In August, 1858, a gentleman, in jumping from a bathing-machine head-foremost into water more shallow than he had expected, caused a fracture and displacement of the cervical vertebrae, which led to death. Mr. South quotes the case of a man who threw himself into a river to bathe, from a height of seven or eight feet, the water being only three feet deep. He rose to the surface, but fell back senseless. When he recovered his conscious- ness, the account he gave of the accident was, that he felt his hands touch the bottom of the river, but to save his head drew it violently back, upon which he lost all consciousness. He died in about ten hours, and on examination the skin of the back of the neck was much ecchymosed, the interspaces of the muscles were gorged, and the spinal canal was filled with blood. The body of the fifth ver- tebra of the neck was broken across about the middle of its depth, and the two pieces were completely separated from the lateral parts. As there was no mark of contusion or dirt on the head, Reveillon, who reports the case, believes that the fracture arose from muscular action, and not from a blow received by striking the bottom; but this is doubtful. In another instance related by Mr. South, a sailor jumped headlong into the sea to bathe, a sail being spread three feet below the surface. He immediately became motionless, and died in forty-eight hours. The fourth and fifth vertebrae of the neck were found extensively fractured, and the spinal marrow was crushed and lacerated. (" Chelius's Surgery," part 6, Fractures.) In this case the fracture must have resulted from contact with the water, or the sail ; but as the latter was freely fioating, this would be a yielding medium ; hence this serious injury may occur accidentally in cases in which we might not be prepared to look for it. Was drowning the result of homicide, suicide, or accident .^-p- Al- though the question whether the act of drowning was the result of suicide or murder properly falls within the province of a jury, there are certain points in relation to it which require to be noticed by a medical witness. In the first place, it is not to be imagined that an examination of the body will develop any differ- ences in either of the three supposed kinds of death. So far as the phenomena of drowning are concerned, they are the same, and they are accompanied with the same appearances after death in each case. In drowning which is accidental or suicidal, it is not usual as it has already been observed, to meet with marks of violence on the person except such as are purely of accidental origin, and have 9« 402 ACCIDENTAL DROWNING. commooly been produced after death. In accidental drowning this is almost a constant rule ; but if the person has fallen from any height,, his body may be injured in the fall, either by projections on the bank of a river or canal, or by mere concussion on the water ; allowance for either of which we must be prepared to make, ac- cording to the situation of the spot from which the person is sup- posed to have fallen. It is calculated that in England drowning is the cause of death in nearly one-half of all suicides ; but this of course will vary ac- cording to localities. In suicidal drowning we have a difficulty to encounter, which we do not meet with in that which is accidental. A man may have attempted suicide by some other means pre- viously to throwing himself into the water ; thus then, besides the accidental violence of accidental drowning, we may meet with violence on the person evidently indicating wilful perpetration. What is the nature of this violence ? Is it to be defined ? Can it always be distinguished from that which is positively homicidal? The answers to these questions must depend on the circumstances proved in each case. Drowning in shallow water. — Homicide has been sometimes pre- sumed from the peculiar circumstances under which a body has been discovered. Thus, for instance, it has been a debated ques- tion Avhether a person intent on suicide can voluntarily drown himself in shallow water, as in a bath, hy turning upon his face, and retaining this position with his mouth below the level of the water. This question has been long since settled in the affirmative by the occurrence of well-authenticated cases. It appears to have been raised originally on the theoretical view that the resolution of a suicide would fail him in such a situation, and that, having the means of escape, he would lose no time in extricating iiimself. It need hardly be stated that the mere immersion of the mouth in water not more than a few inches deep will produce all the phe- nomena of death by drowning, with the exception that little or no water would probably be found in the stomach. A man may thus die in two or three minutes. Devergie mentions an instance which occurred in May, 1833, where a man was found drowned in a small stream, his face towards the ground, and his head just covered by the water, which was not more than a foot in depth. On dissection, there were all the appearances of drowning present, and a large quantity of sand and gravel was found occupying the windpipe and smaller air-tubes. (Op. cit., vol. 2, p. 332.) A case is mentioned by Dr. Smith, in which a woman committed suicide by' breaking a hole in the ice of a pond, during the winter, and thrusting her head into the water, the rest of her body being out. A man was found dead with his face downwards in a small stream of water only six inches deep. The water was so shallow that it did not cover the deceased's body, or his head. There was clear evidence that this was a case of suicidal drowning. Although a person has for a short time the power of removing from a position in which he must speedily die, that power is soon lost. If the ACCIDENTAL DROWNING. 403 mouth is kept below water by a strong voluntary effort for half a minute or longer, the unaerated blood is circulated through the brain, and the person becomes powerless, so that his fate is not now in his own hands. Lunatics and other persons have thus destroyed themselves in shallow baths, although left unwatched by the atten- dant for only four or five minutes. The discovery of dead bodies under these circumstances is, therefore, quite consistent with sui- cide, but it does not necessarily prove that the act was suicidal. It cannot be denied that a person if young or enfeebled by disease or age may be held by others in such a position sufliciently long to produce death from drowning ; but if he is capable of making re- sistance, we ought to find some marks of violence on the limbs or body. So again, such a position is by no means incompatible with accidental drowning ; and on this it may happen that a medical practitioner will be called to express an opinion. A man in a stare of deep intoxication, or when suddenly attacked by syncope, epi- lepsy, or apoplexy, may fall with his face in a gutter, ditch, or small pool of water ; he may die in this position, not having the power to extricate himself. Even marks of violence on the body must not be too hastily construed into proofs of murder, l^ot long since a case of this description gave rise to a trial for murder in one of our midland counties: a man was found dead with his face in some melted snow, and there were several severe contusions on his body. The evidence showed that, after a quarrel he had left a neighbor- ing inn much intoxicated ; and it was rendered extremely probable that he had perished accidentally on his way home. There was no reason to suppose that he had been murdered. Infants, from mere helplessness, may be drowned under similar circumstances ; but at the same time an assassin may select this mode of destroy- ing life in order to give the appearance of accident. Ligatures on the hands and feet. — When a drowned body is re- moved from water with the hands or the hands and feet bound with cords, it is usually considered that we have therein presumptive evidence of homicide ; but numerous cases are recorded in which suicides have actually bound themselves in this manner, or have attached heavy weights to their bodies before throwing themselves into water, for the express purpose of preventing any chance of their escaping death. 40-i HANGING — CAUSE OF DEATH. HANGING. CHAPTER XXXVII. CAUSES OF DEATH. DEATH FROM THE SECONDARY EFFECTS. — POST- MORTEM APPEARANCES. — MARK OF THE CORD OR LIGATURE. — WAS DEATH CAUSED BY HANGING? — HANGING AFTER DEATH. — SUMMARY OF MEDICAL EVIDENCE. MARKS OP VIOLENCE ON THE HANGED. WAS THE HANGING THE RESULT OP ACCIDENT, SUICIDE, OR HOMICIDE? — THE POSITION OF THE BODY. Cause of death. — By hanging, we are to understand that kind of death in which the body is wholly or partially suspended by the neck, and the constricting force is the weight of the body itself; while in strangulation, the constricting force is due to some other cause. In both cases death commonly results from asphyxia (p. 68), although this must depend in a great measure upon the position of the ligature on the neck, as well as on the degree of pressure pro- duced. If the cord is loose, or applied to the upper part of the neck, a small quantity of the air may still reach the lungs, and then the cerebral circulation may become interrupted by the com- pression of the great vessels of the neck. In this case, apoplexy of the congestive kind is induced, and operates as the immediate cause of death. It is easy to conceive that there may be a mixed con- dition of asphyxia and apoplexy, and according to the observa- tions of Professors Casper and Remer, this is actually met with in a great number of cases of death from hanging. According to the former, out of 83 cases 68 were of the mixed condition ; according to the latter, there were 62 mixed, out of a total of 85. It has been observed in the execution of criminals, that death takes place at different intervals of time after suspension. This difference is probably dependent on the greater or less degree of constriction produced by the ligature. If the rope should press upon the larynx, or above this qrgan, the closure of the air passages will not be so complete as if pressed upon the windpipe imme- diately below the cricoid cartilage. A slight degree of respiration might in the former case continue for a short interval, by which the life of a person would be prolonged, while in the latter, death would be immediate. If -the windpipe is in part ossified, the pres- sure of the ligature is less perfect, and death will then take place more slowly. Louis found that an occasional cause of death in hanging was a displacement of the second vertebra of the neck, whereby the spinal marrow was suddenly compressed. As a gene- HANGING — LOSS OF CONSCIOUSNESS. 405 ral rule, this cause of death is only likely to be observed in corpi- lent or heavy bodies, when a long fall is given to the cord, and when much violence has been at the same time employed by the executioner. Fractures of the vertebrae may occasionally occur, and prove fatal by compressing the spinal marrow. Death may also be caused by the effusion of blood on the spinal membranes (sheath), thereby giving rise to fatal compression. This is likely to happen when the head falls, or is bent suddenly backwards, so that the weight of the body is supported on the back of the neck. Death from hanging appears to take place very rapidly, and without causing any suffering to the person. It is observed that in those who are criminally executed, there are often violent con- vulsions of the limbs and trunk. There is no reason, however, to believe that the individual suffers pain, any more than in the con- vulsions of an epileptic fit. On recovery, there is an entire loss of consciousness of pain in both cases. The circulation of dark- colored blood through the brain and spinal cord may account for these effects. Efforts to inspire are made for one or two minutes after the closure, or compression of the windpipe. The diaphragm and intercostal muscles act spasmodically, but no air enters the lungs; and it is probable that in the act of hanging, part of the air contained in the organs is convulsively expelled. When the sul- pension of the body has only continued a few minutes, it has often, been found impossible to restore life ; and indeed the period at which resuscitation may take place varies according to circum- stances. Supposing the hanging to be unattended with violence to parts about the neck, some persons might be resuscitated after five minutes' suspension or longer ; but then it has been observed that they have subsequently died from secondary causes affecting the brain and nervous system. Others, again, may not be recovered when they are cut down immediately after suspension — -a fact- which depends probably on the different degrees to which asphyxia or apoplexy has extended. "When the ligature is so placed as to pre^s on the windpipe below the larynx, insensibility and death are almost instantaneous. We learn from those who have been resuscitated, as well as from experiments performed by persons upon themselves, that the insei;- sibility of asphyxia comes on in the most insidious manner, in death from hanging, and that a slight constriction of the windpipe will speedily produce loss of consciousness and muscular power. (" De- vergie," 2, 370.) The only symptoms of which the hanged persons have been conscious, were a ringing in the ears, a flash of light before the eyes, then darkness and oblivion. The only profitable inference, in a medico-legal view, which can be drawn from obser- vations of this kind is, that asphyxia is not only rapidly induced, but that it supervenes under circumstances where it would not be generally expected to occur — i. e., when the weight of the body is in great part supported. M. Fleischmann found that a cord might be placed around his neck between the chin and os hyoides, and 406 EXTERNAL APPEARANCES. tightened either laterally or posteriorly without perceptibly inter- rupting respiration; but while the respiratory process was thus carried on, his face became red, his eyes prominent, and his head felt hot. These symptoms were followed by a sense of weight, a feeling of incipient stupefaction, and a hissing noise in the ears. On the occurrence of this last symptom, the experiment, he says, should be discontinued, or the consequences may be serious! His first experiment on himself lasted two minutes ; but in the second, owing to the cord by its pressure more completely interrupting respiration, the noise in the eara appeared in half a minute. When the pressure was applied on the windpipe the effect was instanta- neous, but when on the cricoid cartilage it was not immediate. If it was applied between the os hyoides and the thyroid cartilage, or on the OS hyoides itself, the period during which a person could breathe was extremely short ; and this result was more striking when the act of expiration was performed at the moment of ap- plying the pressure. The death of Scott, the American diver, iu January, 1840, shows how readily asphyxia may be induced by a slight compression of the throat, even when a person might be sup- posed to have both the knowledge and the power to save himself. This man was in the habit of making public experiments on hang- ing, and had frequently before gone through them without danger; but on the last occasion, it is probable that a slight shifting of the ligature from under the jawbone caused so much compression on the throat between the chin and the lai-ynx, as speedily to produce asphyxia. No attempt was made to save him until it was too late, and he was not brought to a hospital until thirty-three minutes had elapsed. He was allowed to hang thirteen minutes — the spec- tators thinking that the deceased was only prolonging the experi- ment for their gratification ! The very insidious and painless manner in which a person who is suspended passes from life into death, is also well illustrated in the report of the caseof Hornshav), published by Dr. Chowne. ("Lancet," April 17, 1847, p. 404.) This man was on three occasions resuscitated from hanging^a feat which, like Scott, he had performed in London for public gratifi- cation. He stated that on the last occasion he lost his senses almost at once ; it seemed as if he could not get his breath, and that some great weight was attached to his feet ; he felt that he/ could not move his hands or legs to save himself, and that the power of thinking was gone. It is not improbable that many persons have thus lost their lives by privately attempting these experi- ments, and their cases have been wrongly set down to acts of suicide. There is reason to believe that boys have thus frequently but uninten- tionally destroyed themselves, from a strange principle of imitation or curiosity. Post-mortem appearances. — The external appearances met with in the hanged have been generally taken by medico-legal writers from those seen in the bodies of persons who have been criminally exe- cuted, or who have been violently hanged. Thus among them are the following: Lividity and swelling of the face, especially of the EXTERNAL APPEABANCES. 407 lips, which appear distorted ; the eyelids are swollen, and of a bluish color ; the eyes red, projecting forwards, and sometimes partially forced out of their cavities ; the tongue enlarged, livid, and either compressed between the teeth or sometimes protruded, the lower jaw is retracted, and a bloody froth sometimes exists about the lips and nostrils. There is a deep and ecchymosed impression around the neck, indicating the course of the cord, the skin being occa- sionally excoriated ; laceration of the muscles and ligaments in the hyoideal region ; laceration or contusion of the larynx, or of the upper part of the windpipe. There are also, commonly, circum- scribed patches of ecchymosis, varying in extent, about the upper part of the body and the upper and lower limbs, with a deep livid discoloration of the hands ; the fingers are generally much con- tracted, or firmly clenched, and the hands and nails, as well as the ears, are livid ; the urine and feces are sometimes involuntarily ex- pelled at the moment of death. Such appearances will rarely be found in those cases of suicidal hanging which are likely to come before a medical practitioner. In these, the face is generally pale, and the mark on the neck is a simple depression in the skin, usually without ecchymosis, and acquiring a horny or parchment color only after some time. Esquirol found, in one instance, that when the body was examined immediately after death, the face was not livid ; but it first began to assume a violet hue in eight or ten hours. He thought that when the cord was left round the neck the face would be livid, but if removed immediately after suspension, pale. This view is not, however, borne out by observation. The tongue is not always protruded. Devergie found that there was protru- sion of this organ in eleven cases out of twenty-seven. This pro- trusion was formerly supposed to depend upon the position of the ligature : thus, it was said, when this was below the cricoid car- tilage, the whole of the larynx was drawn upwai'ds, and the tongue carried forwards with it, while when above the os hyoides the tongue was drawn backwards. The protrusion or non-protrusion of the tongue does not depend upon any mechanical effect of this kind, but simply upon congestion ; for it is occasionally met with thus protruding in cases of drowning and suffocation. Besides, the protrusion has not been found to have any direct relation to the position of the ligature. There is another appearance on which a remark may be made — namely, the state of the hands. As a general rule, in violent hang- ing or strangulation, the hands are clenched. This appearance may not always be found, as it may exist and be destroyed before the body undergoes medical inspection. When the constriction of the neck is produced suddenly, and with great violence, we may expect to meet with it. Thus, it is found in the cases of executed crimi- nals, and in strangulation attended with great violence, whether the act be due to homicide or suicide. In cases in which the con- striction is gradually produced, the clenched state of the hands may not be found. Convulsions generally attend violent hanging 408 INTERNAL APPEARANCES. or strangulation. The influence of these on the attitude or dress may not be apparent unless the body be sitting or lying. Internally^ we meet with the appearances of asphyxia — i. e. en- gorgement of the lungs and venous system generally with dark- colored fluid blood ; the lungs otherwise present no particular appearances. The right side of the heart and the great vessels connected with it are commonly distended with blood. But when the inspection has been delayed for several days, this distension may not be observed. The mucous membrane of the windpipe is more or less congested, and is sometimes covered with a fine bloody mucous froth. This may be owing to imperfectly obstructed respi- ration, and to spasmodic efl[brts at breathing. The vessels of the brain are commonly found congested; and in some rare instances, it is said extravasation of blood has been met with on the membranes or in the substance of the organ. Efli'usion of blood is, however, so rare that Remer found this appearance described only once among one hundred and one cases; and in one hundred and six cases re- corded by Casper it was not found in a single instance. In one case of death from hanging. Sir B. Brodie found a large efi"usion of blood in the substance of the brain, and he refers to another case in which there was a considerable effusion between the membranes. (" Lectures on Pathology," p. 58.) The venous congestion of the cerebral vessels is, however, rarely greater than in other cases of asphyxia, and is probably depeujdent on the degree in which the lungs have become engorged. In most instances there is increased redness of the substance of the brain, so that, on making a section of the hemispheres a greater number of bloody points (puncta cru- enta) than usual will appear. The kidneys have been, found much congested. A more important circumstance has been noticed by Dr. Yelloly — namely, that in examining the stomachs of five crimi- nals who have been hanged, he found great congestion in all, while there was blood coagulated upon the mucous membrane in two. Such an appearance might, it is obvious, be attributed in a suspi- cious case to the action of some irritant substance. (See " Ann. d'Hyg." ISaO, p. 166 ; 1835, p. 208 ; 1838, p. 471.) In the case of Good, who was executed for murder some years since, the stomach was found on inspection to present over its whole surface a well- marked redness, resembling the effect produced by an irritant poison. The redness was especially observed at the pyloric end, where it assumed a somewhat striated character. A drawing representing the appearance of the interior of the stomach is preserved in the Museum collection of Guy's Hospital. In a case examined by Mr. Stuart, of Azimghur, in 1854, the stomach a'nd intestines, especially the inner coat of the former, were much congested and inflamed, as if the man had died from poisoning. The contents of the stomach were analyzed, but no poison was found. Dr. Chevers, who quotes this case, states that he has more than once verified Dr. Yelloly's observation, and has found the mucous membrane of the stomach much congested in death from haiiging, (" Medical Jurisprudence for India,'^ p. 397.) APPEARANCES OF THE NECK. 409 The most striking external appearance, however, is the mar/i: pro- duced on the neck by the ligature. The skin is commonly depressed, and sometimes ecchymosed, but rarely throughout its whole extent ; it is frequently free from all traces of discoloration as the result of ecchymosis, the skin in the depression being then hard, brown, or of a parchment color and consistency ; or there may be only a thin line of blue or livid color in the upper or lower border of the depression, and chiefly in front. The course of the mark is gene- rally oblique, being lower in the fore-part than behind, and it is often interrupted. It is most commonly above the larynx. If the noose should happen to be in front, the mark may be "circular, the jaw preventing the ligature from rising upwards in the same degree before as it commonly does behind. The mark is generally single, but we may meet with it double, as when the ligature has been formed into two circles or loops previously to its application. Its other characters will depend upon, the nature of the ligature em- ployed. Thus, a large and wide ligature rarely produces ecchy- mosis — the mark is wide and superficial ; but a small ligature pro- duces a narrow and deep impression, sometimes accompanied with laceration of the cuticle and effusion beneath the skin. The ligature or cord should always be examined for blood, hair, or other suspicious substances. It was formerly believed that the impression on the skin produced by the cord was invariably discolored from efi'usiou of blood, or ecchymosis; but more correct observation has shown that this con- dition is an exception to the general rule. When ecchymosis does exist, it is commonly superficial and of slight extent. There is rarely, if ever, eft'usion of blood in the cellular tissue. In the bodies of persons who have been criminally executed, it is not unusual to find ecchymosis, but even here it is not always present, or only in front of the neck. Dr. Crpker King, in examining the neck of an executed criminal, did not discover the smallest efl'usion of blood in the course of the cord, although in this case the body had been allowed to fall from a height of seven feet and a half, with a fearful jerk. (" Dublin Quarterly Journal," No. 35, Aug. 1854, p. b6 ; and "Cases of Euptured Intestine," 1855, p. 12.) The theory of the production of ecchymosis has heen carried so far that a livid mark in the course of the cord was formerly said to be the best criterion for distinguishing hanging in the living from hanging in the dead body ! This statement, however, is not in accordance with facts. In a large number of cases the skin, instead of being blue or livid, or presenting an elFusion of blood in the cellular tissue beneath, is hard, and of a yellow color, resembling parchment. It has that appearance which the cutis commonly assumes when the cuticle has been removed from it two or three days ; and, on dissecting it off, the cellular membrane beneath often appears condensed and of a silvery whiteness. Dr. Chevers states that in cases of death from hanging, he has not met with any ecchymosis in the skin along the course of the mark. (Op. cit. p. 406.) In some instances the mark has presented itself simply as a white depression ; this has been 410 IN"JURy TO THE MUSCLES. chiefly observed in fat subjects. The observations of Casper on this point are as follows : out of seventy -one cases, there was no ecchy- mosis produced by the cord in fifty, and thus in two-thirds of all the cases examined, it was entirely absent. He also found that there was no difference in the appearance whether the ligature was removed sooner or later after death. Injuries to the muscles and deep-seated parts of the neck are, of course, only likely to be seen when considerable violence has been used in hanging. In one or two instances the lining membrane of the common carotid artery has been found lacerated. Congestion and swelling of the genital organs in both sexes have been set down among the common consequences of hanging ; but many observers have not met with these conditions, and it is doubtful whether, unless the body is examined speedily after suspension, any marked difference would be discovered. A more common sign, perhaps, is the discharge of the spermatic secretion in the male, by a spasmodic action, at the moment at which death takes place. It appears to me that no reliance can be placed upon evidence derivable from this appearance, and yet it has sufficed to give rise to a violent contro- versy among French medical jurists. (" Ann. d'IIyg."1839, vol. 1, pp. 169, 467 ; vol. 2, p. 393 ; 1840, vol. 2, p. 314.) Unless death from hanging is strongly established by other facts, neither the examination of the linen of the deceased, nor the application of the microscope to the mucous fluid found in the urethra, would be of any practical value in elucidating the question — at least to the satisfaction of an English jury. The following may be regarded as a summary of the appearances in hanging, when death has really taken place from asphyxia. The countenance is either livid or pale, the eyes are prominent, the tongue congested and occasionally protruded, the lower jaw re- tracted ; the skin is covered with patches of cadaveric lividity, the hands are livid and clenched ; an oblique mark is found on the neck — sometimes presenting traces of ecchymosis ; commonly, how- ever, the skin is only brown in color and hardened. The larynx, windpipe and subjacent muscles are lacerated, depressed or dis- colored. The vessels of the brain are congested, as well as those of the lungs and the right cavities of the heart. A mucous froth tinged with blood is occasionally found in the windpipe. These appearances will of course be modified, or they may be altogetlier absent, when death has arisen from a disorder of the cerebral cir- culation, or from injury to the spinal marrow, either by effusion of blood, fracture, or displacement. [Dr. John Packard, of Philadelphia, has kindly furnished me with the following notes of the post-mortem examination in the case of Anton Peobst, convicted of the murder of the Dearing family, and executed June 8, 1866. " The examination was made about twenty-ninB hours after the hanging. The face was mottled purplish, in a very marked de- gree, by post-mortem change. The under or posterior portion of the body and extremities were also mottled by hypostatic con- WAS DEATH CAUSED BY HANGING? 411 gestion, but less so than the face. The eyes were not protruded, nor had the tongue been bitten. The mark of the cord was very distinct on the neck, except at a point a little below and in front of the left ear, where the knot had been ; here the skin was un- changed. The mark was purplish-brown. On the right side, the sterno-cleido-mastoid muscle was ruptured nearly through, ap- parently just where the cord had pressed it. " Both the greater cornua of the hj'oid bone were broken through obliquely, near their origins. The laryngeal cartilages, as well as the great vessels of the neck, were intact. No fracture or dislocation of the cervical vertebrae existed, nor was there any discoverable lesion of the spinal cord. (The thorax and abdomen having been opened before the sawing of the cranium, the state of the brain is not accurately known.) " The heart and great vessels were empty ; the lungs quite free from congestion. All the abdominal viscera were healthy. No evidence of priaprism or sexual excitement existed. Death seemed to have been caused by 'pressure upon the great nerves, (the pneumogastric and phrenic) distributed to the organs of circulation and respira- tion."— P.] Was death caused hy hanging? — When a person is found dead, and his body is suspended, it may be a question whether death really took place from hanging or not. In investigating a case of this kind, it is necessary to draw a distinction between the exter- nal and internal appearances of the bodj'. The former alone can assist us in returning an answer to this question; the internal appearances of the body can furnish only the general signs of as- phyxia, and enable us to say whether any latent cause of death existed or not. The mark of the cord. — Among the external appearances it is chiefly to the mark produced by the cord on the neck that medical jurists have looked for the determination of this question. As the form, position, and other characteristics of this mark have been already described, it will now be necessary to allude to it only as furnishing evidence of life at the time of its production. It has been stated, that so far from being constantly livid or ecchymosed, this condition is, in reality, not seen in more than one-half of the cases which occur. But admitting that we find ecchymosis in the course of the ligature, are we always to infer that it must have been applied while the person was living? There are cases which show that the presence of active life is not necessary for the produc- tion of ecchymosis in the mark ; and from the experiments of De- vergie, it would appear that if a body is hanged immediately or a short time after death, an ecchymosed mark may be produced on the neck by the ligature. (Op. cit. vol. 2, p. 408.) If a few hours were sufl'ered to ehipse, so that the body had become cold before suspension, no ecchymosis was produced by the ligature. Profes- sor Vrolik of Amstierdam found, however, that a slightly livid mark was produced on the neck of a dead body, which had been suspended after the lapse of an hour from the time of death. (Cas- 412 EFFECTS OF HANGING AFTER DEATH. per " Woch.," Feb. 1838.) Hence tins condition of the mark in a body found dead merely indicates, either that the deceased must have been hanged while living, or very soon after the breath had left his body. It would be for a jury to decide between these two assumptions ; and to consider why, when a man had really died from any other cause, his body should have been hanged in secrecy immediately after death. (See " Ann. d'Hyg." 1842, vol. 1, p. 134.) The circumstance that an ecchymosed mark may be produced by suspending a recently dead body bears out the statement of Merz- dorff — rhat it would be in the highest degree difficult, if not utterly impossible, to determine medically, from an inspection, whether a man had been hanged while living, or whether he had been first suffocated, and his body suspended immediately after death. In making this admission, it is proper to bear in mind that that which is difficult to a conscientious medical jurist in confining himself to the medical facts, is often easily decided by a jury from these, as well as the general evidence afforded to them. Sometimes, besides ecchymosis, there are abrasions of the skin in the course of the cord, and these are known to have been pro- duced during life by the effusion of blood which accompanies them. Devergie never met with this appearance in the hanging of a dead body, even when the hanging took place immediately after death. The discovery of effused coagula in or about the spinal column would render it probable that the deceased must have been hanged while living. Such marks of violence are, however, rare in cases of hanging ; and when they are found, it might be assumed that the effusion and coagulation of blood had been caused by violence offered to the neck immediately after death: but this assumption may be met by the question already suggested — namely, why death by hanging should be simulated in the body of a person who is alleged to have died from another cause? With regard to the other, or more common kind of mark in sui- cidal hanging, it can scarcely be said to furnish any evidence in relation to the question which we are here considering. The depression may be hard and brown, although it does not usually acquire this color until some hours have elapsed "after death ; for it appears to depend simply upon a desiccation or drying of that portion of the skin which has been compressed by the ligature. Sometimes the upper and lower borders only of the depression present a faint line of redness or lividity ; and it is worthy of remark, that when the ligature presents any knots or irregularities, those portions of skin which sustain the greatest compression are white, while those which are uncompressed are found more or less ecchy- mosed. It is in this manner that the form of a ligature is sometimes accurately brought out. It may be remarked of these depressions produced by the cord, that the characters which they present are the same whether the hanging has taken place during life or soon after death — the appearances may be similar in the two cases. The experiments performed on dead bodies by Casper and other observers show that the ordinary or non-ecchymosed mark caused SUMMARY OF MEDICAL EVIDENCE. 418 by hanging during life may be produced by a ligature applied to the neck of a subject within two hours, or at a much longer period after death ; consequently, the presence of this mark on the neck is no criterion whether the hanging took place during life, or after death. The changes in the skin beneath the mark are also destitute of any distinctive characters ; there is the same condensation of the cellular membrane whether the hanging has occurred in the living or dead. These changes are the simple result of a physical cause — mechanical compression. Summary of medical evidence. — From the foregoing considerations we draw the conclusion that there is no distinctive sign by which the hanging of a <'mn^ person can be determined from an inspection of the dead body. All the external marks may be simulated in a dead body; and the internal appearances furnish no characteristic evidence whatever. Still, when the greater number of the signs enumerated are present, and there is no other satisfactory cause to account for death, we have strong reason to presume that the deceased has died from hanging. We must not, however, abandon medical evidence on these occasions, merely because plausible objec- tions may be taken to isolated portions of it. Facts may show that however valid such objections may be in the abstract, they are wholly inapplicable in the concrete, i. e. to the particular case under investigation. Perhaps the greatest medical difficulties occur in reference to cases of suicide, owing to the slight appearances which attend this form of death ; but on these occasions, moral and cir- cumstantial proofs are so generally forthcoming, that a medical inspection of the body is scarcely ever deemed necessary by a coroner, if, then, it is admitted by a medical jurist, that it is not in all cases possible to distinguish hanging in the living from hanging in the dead, the admission must be considered as having reference to cases wherein persons destroy themselves, and not to cases in which they are destroyed by others. Even if a doubt were raised in any par- ticular instance, it is more than probable that circumstantial evi- dence would furnish data for a decision, and tlius satisfactorily make up for the want of strict medico-legal proofs. If when we found a deeply ecchymosed or livid mark around the neck of a dead subject, we said, all other circumstances being equal, that the person had most probably died from hanging, we should not be departing from a proper discharge of our duty ; since, although it is medically possible that such a mark may, by a certain amount of skill, be produced after death, yet as it would be only a murderer who would think of hanging up a recently dead body to simulate suicide, so it is certain that in this case there would be some obvious indications of another kind of violent death about the person. The absence of these, and the presence of ecchymosis in the course of the cord, would, it appears to me, leave the question of Ijanging during life decidedly settled in the affirmative. Some caution should be used in expressing an opinion that hanging took place after death, in cases in which there is no ecchymosis in tlie seat of the ligature ; because, while such an opinion would be generally 4li MARES OF VIOLENCE ON THE HANGED. correct, it might in some instances lead to the concealment of the real mode of death. Many facts already adduced show that numerous cases of hanging during life would be pronounced to be cases of hanging after death, if the absence of ecchymosis were taken as a criterion. The mere discovery of marks of violence about the person is not of itself sufficient to rebut, the presumption of death from hanging on these occasions. The violence should at least be of such a nature as to account for the immediate destruc- tion of life, or it can throw no light upon the question whether the person might not have died from hanging, in spite of the, marks of maltreatment found upon the body. If, in reference to a body found hanging, a medical jurist should assert that death had 7iot taken place from this cause, this would be tantamount to declaring that the deceased must have been mur- dered ; because it is difficult to suppose that any one but a murderer would have a reasonable motive for hanging up a recently dead person. This hanging after death has been frequently carried out with the view of concealing the real mode of death, and of making the act appear to be one of suicide. Marks of violence on the hanged.— The presence of marks of vio- lence on the body of a hanged person is important, and it will, there- fore, be proper for a witness to notice accurately their situation, extent, and direction. Having satisfied himself that they must have been received during life, he will have to consider the proba- bility of their being of accidental origin or not. These marks of violence are not always to be regarded as furnishing unequivocal proofs of murder; for it is possible that tbey may have been pro- duced by the person himself before hanging, and not succeeding in comitting suicide by these attempts, he may subsequently have re- solved to accomplish his purpose by suspending himself. Let the witness duly reflect on these circumstances before he allows his opinion to implicate any suspected individual ; let him consider that a hanged subject may bear the marks of a gunshot wound, his throat may be cut, his person lacerated or disfigured, and yet, before a suspicion of homicide is allowed to be entertained, it ought to be clearly shown that such injuries could not, by any probability, have been self-inflicted. The importance of observing caution in such a case will be still more manifest when there is no ecchymosis produced by the cord, and the face does not present the usual ap- pearances of hanging. Marks of violence on a hanged subject may in some cases be fairly ascribed to accident. If the person has precipitated himself with any violence from a chair or table in a furnished apartment, he niay have fallen against articles of furniture, and thus have caused lacerations and bruises, especially on the limbs or body. The rope may have given way, and the person, in falling, have in- jured himself; but he may afterwards have had resolution enough to suspend himself again. Such an occurrence may be rare ; but when the presence of these injuries is made to form the chief ground of accusation against another person, their possibly acci- ACCIDENTAL AND HOMICIDAL HANGING. 415 dental origin ought not to be lost sight of by a considerate witness. If we suppose the deceased to have been hanged in a state of intoxi- cation or stupefaction, medical evidence alone will rarely suffice to determine the question of homicide or suicide. The absence of all marks of violence from the body might actually lull suspicion. It is proper on these occasions to look to the hands of the deceased, since it is with those that a person defends himself; and, unless taken unawares, it is almost certain if the hanging were homicidal, that there would be traces of violence on these parts. The clothes would be torn and discomposed, and the whole appearance of the deceased would be that of one who had done his utmost to resist a violent murderous attack. There might be some injuries which could not be attributed to accident under the circumstances. Among these we may enumerate fractures, dislocations, deeply penetrating incised and gunshot wounds. !N"ow the question is — Do these serious injuries necessarily establish homicidal hanging ? The answer must be in the negative ; although when fractures or dislocations exist, there are strong grounds for suspicion. ("Ann. d'Hyg." 1842, vol. 1, p. 160.) Suicides frequently make attempts on their lives by various means, as by poison, the use of razors, knives or pistols, and still retain power to hang themselves. Such cases as these are generally determined by circumstantial evidence. A suicide may attempt to destroy himself with a knife, or pistol ; he may fail in the attempt, and ultimately hang himself. Any description of wound, provided it be such as to allow of a person surviving a sufficient time, may thus be found on a hanged subject, and yet constitute no proof whatever of murder. If there are circumstances about the wound or injury which show that it could not have been self-inflicted, this of course will aft'ect the conglusion ; but when such circum- stances are not met with, a cautious medical jurist should say, in answer to inquires respecting the origin of these wounds, that they may have been inflicted either by the deceased himself, or by another. The medical facts of the case might be consistent with either view. In one instance of suicidal hanging, there were lacerated wounds upon the head, and a handkerchief was found blocking up the mouth. Of course if, in any case, the wounds or injuries are of a decidedly mortal nature, and have probably caused death, the presumption of murder is very strong ; for who but a murderer would suspend the dead body of a person so wounded, immediately after death? ("Ann. d'Hyg." 1835, vol. 2, p. 410.) Was the hanging the result of accident, homicide, or suicide f — Most medical jurists have passed over the subject of accidental hanging, probably believing it to be impossible. In the sense commonly im- plied by the term it is certainly unusual, but although rare, it is a possible occurrence. Circumstantial evidence will always suffice for the discrimination of accidental hanging ; and we have, there- fore, merely to inquire whether, when the body of a person is found hanging under circumstances which do not allow of the suspicion of accident, the act has been the result of suicide, or of homicide. A 416 HOMICIDAL AND SUICIDAL HANGING. medical witness must remember that this is strictly a question for the jur3^ It is not for him to say whether a man has hanged him- self or been hanged by others, but merely to state, when required, those medical circumstances which support or rebut one or the other presumption. The jury, under the direction of the judge, will arrive at a conclusion, from the whole of the evidence, medical and non-medical. It has been truly observed, that of all the forms of committing murder, hanging is one of the most difficult, and it is, therefore, but seldom resorted to. In most cases when a person has been hanged by others, it has been after death, in order to avert a suspicion of homicide. Hence, the discovery of a person hanging atfbrds primd facie evidence of suicide, — supposing it to be rendered abso- lutely certain that death has taken place from this cause. We must, however, admit that a man may be murdered by hanging, and that the appearances about his body will not aftbrd the smallest evidence of the fact. The circumstances which will justify a med- ical jurist in making this admission are the following: First, when the person hanged is feeble, and the assailant a strong healthy man. Thus a child, a youth, a female, or a person at any period of life, worn out and exhausted by disease or infirmity, may be destroyed by hang- ing. Secondly, when the person hanged, although usually strong and vigorous, is at the time in a state of intoxication, stupefied by narcotics, or exhausted by his attempts to defend himself. Thirdly, in all cases, murder may be committed by hanging, when many are combined against one person. With these exceptions, then, a prac- titioner will be correct in deciding, in a suspected case, in favor of the presumption of suicide. Unless the person labored under stupe- faction, intoxication, or great bodily weakness, we must expect to find in homicidal hanging, marjcs of violence about the body ; for there are few who would allow themselves to be murdered without offering some resistance — notwithstanding the assertion of Mahon, that some might submit to this mode of death with philosophical resignation, when they saw that resistance was hopeless ! Some medical jurists have thought that the mark left by the cord on the neck would serve as a criterion of murder, on which we might depend. Thus it has been said, if the mark is circular and situated at the lower part of the neck, it is an unequivocal proof of murder. In hanging, the mark of the cord is generally oblique, being higher at the back part of the neck, in consequence of the loop formed by it yielding more in this direction than in front. But it is an error to suppose that this want of obliquity in the impression can afibrd any evidence in favor of the act having been homicidah Its form will depend in a great degree upon the fact of the body being sup- ported or not, for it is the weight of the body which causes its obli- quity ; it will also depend on the manner in which the cord is adjusted. A case of suicidal hanging is related by Orfila, in which the mark of the cord extended horizontally round the neck from behind forwards. (" M^d. L^g." torn. 2, p. 376.) The slip-knot of the cord was in front of the neck, and it is obvious that when the CIBCDMSTANTIAL EVIDENCE. 417 cord is thus adjusted by a suicide, there will be scarcely any obli- quity in the depression produced by it. Equally ill-founded is the assertion, that the existence of tioo impressions on the neck affords positive proof of homicide. One of these impressions may be at the lower part of the neck, and circular — the other at the upper part and oblique ; it is therefore contended, that the deceased must have been strangled in the first instance, and afterwards hanged. The possibility of a prior attempt being made by a suicide to strangle himself, and thus produce the mark, is not adverted to. " Si Ton observe les deux impressions," says Mahon, " I'assassinat est alors parfaitement prouv^." It is fortunate that there are facts on record to oppose to this very positive statement. One of the first cases reported by Esquirol is that of a female lunatic who committed suicide by hanging herself, and on whose neck two distinct impres- sions were seen — the one circular, the other oblique ! These appear to have arisen from the cord having been passed twice round the neck, the body being at the same time partially supported. In some instances a presumption of homicidal interference may exist if there are two distinct impressions, but it cannot be admitted that they establish the fact of murder. The injury .done to the neck by the cord or ligature can rarely afford any clue to the manner in which hanging took place, unless the circumstances under which the body is found favor the presump- tion of homicide or suicide. Thus, the laceration of the muscles and vessels of the neck, the rupture of the windpipe and the displace- ment of the larynx, the stretching of the ligaments of the spine, and effusion of blood on the sheath of the spinal marrow may be observed in suicidal, as in homicidal hanging. The presumption, however, is obviously in favor of the latter, when these violent in- juries are found to be accompanied, by fracture or displacement of the vertebrae of the neck, and the body of the deceased is not cor- pulent, the ligature by which he is suspended is not of a nature to produce them, and the fall of the body has not been great. A much-disputed question has arisen in medical jurisprudence, whether the vertebrae of the neck can become fractured or displaced in suicidal hanging. Most medical jurists deny the possibility of this accident occurring — the displacement or fracture of these ver- tebrae being rarely observed, even in criminal executions, when the greatest violence has been used by the executioner. So far as I am aware, there is no case of suicide on record in which such an injury to the neck has been found. Circumstantial evidence. — In all doubtful instances we should not lose sight of moral and circumstantial evidence. We should ascer- tain whether the individual had been previously disposed to commit suicide or not ; we should observe whether the doors and windows of the apartments had been secured on the inside, or on the outside ; whether the dress of the deceased is at all torn or discomposed, or his hair dishevelled ; whether the attitude of the body is such as to show interference after death ; whether there are marks of blood about the body, or the ligature, or in the room ; whether the hands 9,7 418 EVIDENCE PROM THE POSITION OF THE BODY. are bloody, or present marks of wounding or struggling ; whetlier the rope or ligature corresponds to the impression seen around the neck ; and lastly, whether the cord is of sufficient strength to sup- port the weight of the deceased. The strongest evidence of homi- cide is often found in the attitude and the state of the dress of the dead bod}'^; it may or may not indicate interference or change after death irreconcilable with the supposition of death from suicide or accident. On this point the minutest circumstance may become of considerable importance as medical evidence. When there are in- dications of violent struggling, the dress may be found disordered, unless it has been smoothed or arranged by the murderer after the death of the deceased. There may of course be no evidence of dis- order or discomposure of the dress, in the case of a female, when the body is freely suspended. These points fall, it is true, more within the province of the officers of justice than of a medical prac- titioner ; but the latter is generally the first who is called to see the deceased, and therefore, unless such facts are noticed by him on his visit, they may remain altogether unknown. The medical opinion of the actual cause of death, however, should be based only on medical facts, but circumstantial evidence has on various occa- sions assisted in clearing up a doubtful case. Louis states that on removing the body of a man who was found hanging, the rope was observed to' be stained with blood. This simple circumstance led to further investigation, by which it was discovered that the pereon had been murdered, and his body afterwards suspended. The presence of marks on the neck indicative of strangulation, such as the cord was not likely to have produced, may lead to a suspicion that the hanging followed death. The position of the body. — Lastly, it has been contended that the position of the dead body may serve to distinguish suicidal from homicidal hanging. This point was strenuously argued on the investigation which took place relative to the death of the Prince de Conde in 1830. This case involves two glaring errors in refer- ence to medical evidence on death from hanging : 1st, that a per- son cannot die from hanging when the body is in any way sup- ported, and therefore that murder must have been perpetrated ; 2dly, that in all cases of death from hanging, the mark produced on the neck by the cord or ligature must be discolored or ecchy- mosed. If not ecchymosed, it is assumed that death must- have taken place from some other cause, and the body have been after- wards suspended for the concealment of crime. It is scarcely necessary to state that these propositions are utterly inconsistent with well-known facts. Since this trial, many cases have been recorded in which death has taken place from hanging when the feet were in contact with the ground, or the persons were almost sitting or recumbent ; they may be regarded as mixed cases of hanging and strangulation. The reports of eleven cases of suicidal hanging or strangulation which I have collected within a few years, give the following results: in three, the deceased were found nearly recumbent ; in four, in a kneeling posture — the body being more or EVIDENCE FROM THE POSITION OF THE BODY. 419 less supported by the legs ; and in four, the persons were found sitting. In one case, the deceased, a prisoner, was found hanging to the iron bar of the window of his prison, which was so low that he was almost in a sitting posture. Remer found that among one hundred and one cases of suicidal hanging, in fourteen, the body was either standing or kneeling, and in one instance, it was in a sitting posture. Dr. Duchesne has pub- lished an account of fifty-eight cases in which the suspension of the body was partial — the feet or trunk being more or less supported. Twenty-six of these cases are new. The reporter draws the con- clusion that suicide by hanging is consistent with anyjposture of the body, even when resting upon the two feet. ("Ann. d'Hyg.," Oct. 1845, vol. 2, pp. 141 and 346.) Further evidence need not be ad- duced to show how unfounded is that popular opinion which would attach the idea of homicidal interference to cases in which a body is loosely suspended, or in which the feet are in contact with any support. We ought rather to consider these facts as removing a suspicion of homicide; for there are probably few murderers who would suspend their victims, either living or dead, without taking care that the suspension was not partial, but complete. Besides, the facts of many of these cases are readily explicable; thus, if the ligature is formed of yielding materials, or if it is only loosely attached, it will yield to the weight of the body after death, and allow the feet to touch the floor, which they might not have done in the first instance. If there is reason to believe that the body has not altered its position after suspension, we must remember the facility with which insensibility comes on, and the rapidity with which death commonly ensues in this form of asphyxia. (See p. 385, also " Med. Gaz." vol. 44, p. 85.) The limbs secured in suicidal hanging. — One or two points are worthy of notice in relation to this medico-legal question. The hands or legs, but more commonly the former, have been found tied in cases of undoubted suicidal hanging ("Ann. d'Hyg." 1832, vol. 1, p. 419) ; and yet it has been gravely debated whether it was pos- sible for a person to tie or" bind up his hands, and afterwards hang himself! It is unnecessary to examine the ingenious arguments which have been urged against the possibility of an act of this kind being performed, since they are refuted by well-ascertained facts. It has also been a debated question, whether corporeal infirmity, or some peculiarity aft'ecting the hands, might not interfere with the power of an individual to suspend himself. This question can be decided only by reference to the special circumstances of the case. In the case of the Prince de Conde, it was alleged that he could not have hanged himself, in consequence of a defect in the power of one hand ; it was said that he could not have made the knots in which the cravats, by which he was suspended, were tied. Allegations of this kind appear to have been too hastily made in this and other instances. A determined purpose will often make up for a great degree of corporeal infirmity ; and unless we make 420 EVIDENCE FROM THE POSITION OF THE BODY. full allowance for this in suicide, we shall always be exposed to error in drawing our conclusions. Blindness is no obstacle to this mode of perpetrating suicide ; and in reference to age, suicide by hanging has been perpetrated by a boy of nine, and by a man of ninety-seven years of age. [Some interesting observations and experiments with reference to the eyes of persons executed by hanging, were made at the execution of Anton Probst, by Dr. E. Dyer, of this city: " Fracture of the crystalline lens, as a result of death from violent hanging, has, I believe, never been noticed. The following case and experi- ments show that it is possible, and that it has probably been over- looked in many cases where post-mortem examinations have been made : — " Anton Probst was hung in Philadelphia, June 8th, 1866, set. 24. "Weight, 174J lbs. The drop was three feet ; length of cord five feet. There were no convulsions. Previous to the execution both eyes were examined carefully with the ophthalmoscope, and were found normal. Thirty-five minutes after the drop fell, the eyes were again examined with the ophthalmoscope by an electric light (charcoal points). In the right eye there was seen a horizontal line running across the lens ; it was not sharp, but from it miiiute lines ran up and down, some longer and some shorter. It gave exactly the appearance of a crack in a clear cake of ice. As the eyeball was rolled downwards, it was evident that there was a crack or rupture in the crystalline lens, which extended from the anterior capsule backwards to the middle of the lens. It had a remarkable opalescent or iridescent appearance. The anterior capsule was rup- tured. This fracture was about a line below the horizontal diame- ter of the lens. In the left eye the same appearances was observed, but in a less degree. The capsule was evidently ruptured, but the rupture of the lens-substance did not extend so deep. The eyes were removed and carefully dissected. All the observations made with the ophthalmoscope were entirely corroborated. The capsule of the right eye was broken from one edge of the lens to the other, and the lens itself was broken open to the centre. The left cap- sule was ruptured, and in the lens-substance the rupture extended about a line backwards. "Three large dogs were hung in the following manner: The rope was adjusted around the neck and made fast to a cross-beam. A man held the dog up to the beam and let him fall, following ' him with his hands, and as the rope became taut, the force was continued by the man pressing the dog down with all his force. This added at least twenty pounds to the weight. of the dog. All the dogs weighed over thirty pounds. Dog 'So. 1 died without struggles. Both lenses were fractured. Dog IsTo. 2 died hard, and with convulsions which lasted 8-10 minutes. So lesion of either lens was observed. Dog No. 3 died with a few spasms. The right lens was fractured ; the left was intact. " It will be observed that one man and three dogs were hung — CAUSE OF DEATH IN STRANGULATION. 421 four subjects in all. In three out of the four, fracture of the lens was found. In two of the four, in both eyes, and in one in a single eye only. The fracture was most marked on the side opposite the knot. Of the eight eyes in these four subjects, five showed a frac- ture of the capsule of the lens, and the lens-substance itself in a greater or less degree. For a more detailed account of these cases see'lSTew York Medical Journal,' vol. iii., and ' Transactions of the American Ophthalmological Society,' third year." — P.] STRANGULATION. CHAPTER XXXVIII. CAUSE OP DEATH. — APPEARANCES AFTER DEATH. — WAS DEATH CAUSED BY STRANGULATION, OR WAS THE CONSTRICTION APPLIED TO THE NECK AFTER DEATH ? — MARKS OP VIOLENCE. — ACCIDENTAL, HOMICIDAL AND SUICIDAL STRANGULATION. Strangulation. — Cause of death. — Hanging and strangulation are usually treated together, and some medical jurists have admitted no distinction in the meaning of these terms. In hanging, the phenomena of asphyxia take place in consequence of the suspen- sion of the body, while in strangulation, asphyxia may be induced not only by the constriction produced by a ligature around the neck independently of suspension, but by the simple application oi pres- sure, through the fingers or otherwise, on the windpipe. M. Tar- dieu considers that the two modes of death should be kept distinct. The external and internal appearances in some respects differ ; and while the proof of death from hanging leads to the strongest pre- sumption of suicide, the proof of death from strangulation is equally presumptive of murder. {Sur la Strangulation, "Ann. d'Hyg.," 1859, vol. 1, p. 107.) This medical jurist defines "stran- fulation to be an act of violence, in which constriction is applied irectly to the neck, either around it or in the fore-part, so as to prevent the passage of air, and thereby suddenly suspending respi- ration and life." This definition obviously includes hanging, and every person who is hanged may be said to be strangled ; but while there is only one method of producing death by hanging, there are various methods of producing death from strangulation. A person may be strangled by the use of a cord, band, or ligature drawn tight round the neck, or by manual violence to the front of the neck, whereby respiration is prevented. The cause of death is asphyxia or apncea. The rapidity with which it takes place will 422 POST-MORTEM APPEARANCES. depeod on the degree and situation of the pressure, and the com- pleteness with which the act of breathing is obstructed. M. Faure applied a ligature forcibly and suddenly to the neck of a middle-sized dog. For fifty-five seconds the animal did not ap- pear to suffer ; but he suddenly became violently agitated, his body stiffened, and he rolled convulsively on the ground. A bloody froth issued from his nostrils and throat, and he made frequent and violent efforts to respire. In three minutes and a half he was dead. In a second experiment, an elastic tube was introduced into the windpipe, which admitted of being gradually closed by pressure. The animal could bear the pressure up to the reduction of one-half of the calibre of the tube ; but beyond this he suffered greatly, and when the pressure was increased he had convulsions. The dog died, in great suffering, before the tube was completely closed. (" Ann. dllyg.," 1859, vol. 1, p. 122.) It is probable that human beings die more quickly than animals, especially from the effects of manual strangulation. A sudden and violent compression of the windpipe renders a person powerless to call for assistance and give alarm, and it causes almost immediate insensibility and death, without convulsions. When a ligature or bandage is used, the pressure is not so complete, and death takes place more slowly with convulsive movements. The circulation of dark-colored blood continues for a short interval (about four minutes), as in other cases of asphyxia. Owing to this, the face and lips in accidental strangulation have been observed to acquire a dark leaden hue. This arises partly from the arrest of the current of venous blood as the result of compression of the vessels, and partly from the circulation of unaerated blood. There is a fair chance for recovery if the cause of constriction is removed, and air is permitted to have access to the lungs within a period of five minutes; this is on the assumption that no great mechanical injury has been done to the neck. In the act of strangulation a much greater degree of violence is commonly employed than is necessary to cause death ; and heiice the marks produced on the skin of the neck will be, generally speaking, much more evident than in hanging, where the mere weight of the body is the medium by which the windpipe is com- pressed. Post-mortem, appearances. — The appearances after death are similar to those of hanging, but the injury done to the parts about the neck is commonly greater. Externally. — If much force has been used in producing the constriction, the windpipe, with the muscles and vessels in the fore-part of the neck, may be found cut or lacerated, and the vertebrse of the neck may be fractured. The face is com- monly livid and swollen, the eyes wide open, prominent, and con- gested, and the pupils are dilated. The tongue is swollen, dark- colored, and protruded ; it is sometimes bitten by the teeth, and a bloody froth escapes from the mouth and nostrils. The principal external signs of strangulation are seen in the marks on the neck, produced either by a cord or manual pressure. M. Tardieu has MARK PRODUCED BY THE LIGATURE. 423 described another appearance which might be overlooked. This consists in the presence of numerous small spots of ecchymosis upon the skin of the face, neck, and chest, as well as in the conjunctivse of the eyes. These parts present a dotted redness, which has, how- ever, been met with in other cases besides death from strangulation. ("Ann. d'Hyg." 1859, vol. 1, p. 125.) The mark on the neck wheo a ligature has been used is commonly described as a depression, wide but not deep, and corresponding in its characters to the form and thickness of the ligature and the mode in which it has been secured. Too much importance must not be attached to this supposed correspondence when the ligature is not forthcoming. In a case of accidental strangulation which I saw in l^ovember, 1864, the mark round the neck presented the appearance which might be expected from the use of a narrow cord. But, in this instance, a soft silk neckerchief was the means of con- striction, and the peculiar narrowness of the mark on one side, was owing to the great tightness with which it had been drawn. The mark or impression produced by a ligature is generally circular, from the mode in which the pressui-e is produced. It may be situated at any part of the neck, but it is more commonly below the windpipe. In manual strangulation the marks of bruising and ecchymosis will be in the front of the neck, chiefly about the larynx and below it. The circular direction of the mark produced by the ligature is not an absolute indication that strangulation has taken place without suspension of the body, since cases of hanging have occurred in which a circular mark has been observed ; and it is possible that some degree of obliquity may occasionally exist in the course of the depression produced by a ligature in strangula- tion. A medical jurist ought, therefore, to weigh all the facts con- nected with the position of the body, and the nature and direction of the ligature, before he forms an opinion, from the appearances presented by the mark on the neck, whether the person has been hanged or not. Greater importance is to be attached to the lividity, ecchymosis, and abrasion of the skin in the course of the ligature, than to the circularity or obliquity of the depression produced by it. In the strangling of a living person by a cord, it is scarcely possible that a murderer can avoid producing on the neck marks of severe injury, and in the existence of these we have evidence of the violent manner in which death has taken place. On the other hand, a person may be strangled, and yet the liga- ture, in consequence of its being soft and of a yielding nature, will not cause a perceptible depression or ecchymosis— scarcely anything more than a slight depression of the skin. If we except cases of suicide, such a condition must be rare ; because assailants usually produce a much more violent constriction of the neck than is ne- cessary to insure the death of a person. The general lividity of the body, contraction of the fingers, with clenching of the hands and swelling and protrusion of the tongue, are more marked in strangu- lation than in hanging. A thin mucous froth tinged with blood is occasionally found in the air-passages in both cases. In some 424 INTERNAL APPEARANCES. instances of strangulation, it is said, blood has escaped from one or both ears during the act ; but it is not a usual appearance. In two well-marked cases, in which I was consulted, the constriction of the neck was carried to a great degree, but there was no bleeding from the ears. Dr. Geoghegan has informed me that in one instance of suicidal strangulation which he examined, the constriction had been produced by a ribbon, and the violence applied was sufficient to produce bleeding from one ear ; on dissection, this was found to have resulted from a rupture of the membrane of the drum of the ear. There was no froth at the mouth or nostrils, and scarcely any lividity or swelling of the face. It was further observed that the mark on the neck, which was deep, almost disappeared on the re- moval of the ligature. Sir W. Wilde, of Dublin, met with a case in which rupture of the membrane of the drum of the ear, with effusion of blood, was caused by strangulation. Bleeding from the ears, as a result of rupture of the membrane of the drum, must however, be regarded as an exceptional appearance. Dr. Chevers does not mention it as having been noticed in any one of the numerous cases which he has collected in his Indian experience, although bleeding from the nostrils had been observed. (" Med. Jur. for India," 1856, p. 374.) Without rupture of the membrane of the drum, blood could not issue from the ears, and in order that this membrane should be ruptured, certain conditions not commonly met with may be required. Internally. — In a case which occurred to Dr. Fuller, the body of a woman who had been homicidally strangled presented the follow- ing appearances. The skin of the head, face, neck and chest was darker than natural, and discolored underneath, particularly that of the scalp. The brain was suffused with dark blood, the lungs gorged and of a dark color, the bowels of a dusky-red color. The eyes were somewhat protruded and blood-shot, the lips swollen and darker than natural, the tongue slightly protruding between the teeth, and froth issuing from the nostrils. There was a mark of pressure behind the right ear, and other marks on the neck and chest, with discoloration of the muscles. (Chevers's "Medical Jurisprudence for India," p. 378 ; see also p. 387.) In a case of suicidal strangulation which occurred at Liverpool, in 1863, the body of the deceased was found — dead, cold, and rigid — about seven hours after he had been seen alive. The arms were fixed, and the hands raised a little above the breast. Round the neck, just below the cricoid cartilage, was a strip of the deceased's shirt, which had been used as a ligature ; it was tied at the back of the neck. There was slight ecchymosis in the mark beneath. The skin of the face had a dark red-color, and was dotted with spots of a deeper red. The conjunctivae were ecchymosed, and some blood had escaped from the nose. The brain was congested, and much fluid effused. The heart was empty ; the lungs were deep in color (congested.) (" Lancet," Aug. 15, 1863, p. 183.) Many of the cases of strangu- lation which have presented themselves have been too superficially examined. The most complete account of the appearances is that STATE OP THE HEART AND LUNGS. 425 given by M. Tardieu. It is based on observations made in twenty- eight inspections. ("Ann. d'Hyg." 1859, vol. 1, p. 132.) The lining membrane of the larynx and windpipe was more or less red- dened from congestion ; sometimes it was livid, or of a dark-red color. There was a bloody froth extending into the air-tubes. The- state of the lungs was variable. Contrary to what is generally alleged to be characteristic of death by asphyxia, M. Tardieu found these organs to contain but little blood. Sometimes they were congested, at other times normal. There were ruptures of the superficial air-cells, producing patches of emphysema, which were seen singly or in groups. This condition, which was rarely absent, gave to the surface of the lungs the appearance of being covered with white layers of thin false membrane. When these patches were punctured, air escaped. There was an absence of that condition of the lungs which he observed in death from simple suffocation, namely, dotted ecchymosis on the surface, immediately below the investing membrane (the pleura.) Throughout the sub- stance of the lungs, effusions of blood varying in size were, how- ever, generally found, provided an early inspection of the body was made. When some days had elapsed, the lungs were found pale or congested, without any ecchymosed or mottled appearance. The ruptured air-cells with air beneath them, were still visible on the surface. The heart presents no uniform condition ; it is sometimes quite empty, and at others, it contains dark fluid blood. The brain is occasionally congested, but more commonly in its natural state. In one instance blood was found effused on the brain, but this is an unusual appearance. It has also been stated that a congested state of the sexual organs, both in males and females, was one of the appearances connected with strangulation, but this has not been confirmed by careful observers. M. Tardieu met with nothing to call for notice in this respect in the numerous cases which he ex- amined. The involuntary discharge of feces, urine and seminal fluid, described as one of the characters of death by hanging, may equally occur in death from strangulation. Ifo importance can be attached to this as a sign of death from asphyxia in any form. It frequently occurs in sudden and violent death from any cause, and there are many instances of death from asphyxia in which it is not observed. Among the occasional appearances of violent strangula- tion may be mentioned injury to the windpipe and the muscles of the neck around it. One case, in which the rings of the windpipe were split as a result of pressure, was communicated to me by Dr. Inman, of Liverpool. Several instances of laceration and rupture of the windpipe are quoted by Dr. Chevers. (Op. cit. pp. 381, 384.) In one instance, the ossified thyroid cartilage had been broken and forced inwards, causing suffocation. In Reg. v. O'Brien (Liverpool Winter Assizes, 1857), a case of alleged murder by strangulation, the cartilage of the windpipe was broken ; and in the case of Plnck- hard, the windpipe was broken longitudinally. In i-eference to frac- tures of the larynx, see Casper, " Klinische I^Tovellen," 1863, p. 497. 426 MEDICAL PROOFS OF DEATH FEOM STRANGULATION. In suspected homicidal strangulation it is always proper to examine the contents of the stomach for narcotic poison. In all cases, the cord or ligature, if forthcoming, should he carefully examined, in order to determine whether it bears upon it marks of blood, or whether hair or other substances are adhering to it. A portion of it should be reserved for the purposes of identity. In two instances of homicidal strangulation, the ligatures found round the dead bodies were proved to correspond with portions of the same mate- rial found in the possession of the persons who were charged with the murders. In removing the ligature from the neck, the precise mode in which it is tied or secured should be noticed, as this may be a fact of importance in reference to the allegation of suicide. The medico-legal questions relative to strangulation are of the same nature as those which have been already considered in treating of hanging. Thus, in examining the body of a person suspected to have been strangled, we may be required to answer the following question : — Was death caused by strangulation, or was the constricting force applied to the neck after death f Medical jurists have hitherto con- sidered that the internal appearances throw no light upon this ques- tion. This opinion probably arose from the fact that inspections have not been made until some days after death, when the peculiar appearances of strangulation have been merged in those of putre- faction. The state of the lungs, however, may be considered as characteristic. It would be impossible, by the application of a liga- ture round the neck of a; dead body to produce rupture of the air- cells on the surface of the lungs, and effusions of blood in their substance. The state of the eyes and of the inside of the larynx and windpipe in persons who have been strangled could not be imitated by any constriction of the neck after death ; no bloody mucous froth would be found in the windpipe or air-tubes. The external appearances have been considered to furnish more accurate means of distinction. Although the condition of the neck gene- rally yields the strongest evidence, it will be proper to seek for that appearance of dotted redness or ecchymosis in the skin of the face, neck and chest, described by Tardieu. The state of the eyes, as to their prominence and the congestion of the membranes, as well as the position of the tongue, should also be examined. The ecchy- mosis about the depression of the neck, when a ligature has been employed, with the accompanying swelling and lividity of the face, are phenomena not likely to be simulated in a dead body by the application of any degree of violence. When the constriction is produced within a few minutes after death, an ecchymosed depres- sion may result ; but it is improbable that there should be any lividity or swelling of the countenance. Prof. Casper found that when the constricting force was not applied to the neck until six hours after death, the mark indicative of vital strangulation could not be produced. It is doubtful whether it could be produced in the dead body an hour after death. The period cannot be deter- MEDICAL PROOFS OF DEATH FKOM STE ANGULATIOK. • 427 mined witli positive certainty ; the results would probably vary, according to the rapidity with which the body had cooled. It is difficult to conceive under what circumstances an attempt to simulate strangulation in a recently dead body could be made, unless for the purpose of throwing suspicion upon an innocent per- son connected with the deceased. "When an individual has been murdered, it is not likely that the murderer would attempt to pro- duce the appearances of strangulation on a body after death, under the idea of concealing his crime ; for strangulation is in most cases an actual result of homicide, and is rarely seen as an act of suicide. In the absence of ecchymosis from the neck, it will be difficult to form an opinion, unless from circumstantial evidence; but there may not be an ecchymosed circle ; for a person may be strangled by the application of pressure to the windpipe through the medium of the finger-nails, or of any hard or resisting substance. The ecchy- mosis in such a case will be in detatched spots or patches. In the absence of all marks of violence round the neck, we should be cau- tious in giving an opinion which may affect the life of an accused party; for it is not probable that homicidal strangulation could be accomplished without the production of some appearances of vio- lence on the skin over the larynx or windpipe. It is doubtful whether strangulation can ever take place without some mark being found on the neck indicative of the means used. The bare possibility of death being caused in this manner, without leaving any appreciable trace of violence, must be admitted ; although the admission scarcely applies to those cases which require medico- legal investigation. Suicides and murderers generally employ much more violence than is necessary for the purpose of destruc- tion — hence detection is easy. But if a soft and elastic band were applied to the neck, with a gradually regulated force, it is possible that a person might die strangled, without any external sign being discovered to indicate the manner of his death. Indian surgeons inform us that the Thugs, and other robbers met with in India, are thus accustomed to destroy their victims with the dexterity of practised murderers. A case involving this question of strangula- tion without marks of violence on the neck, was tried in France, and from the medical evidence decided in the affirmative. (" G-az. Med." 9 Mai, 1846, p. 375.) The medical witness should, how- ever, be prepared to consider whether, in the absence of any mark, death might not have proceeded from another cause, and leave it to the authorities of the law to decide, from circumstances, in favor of or against the prisoner. There is, I conceive, nothing to justify a medical witness in stating that death has proceeded from strangulation, if there should be no appearance of lividity, ecchy- mosis, or other violence about the neck or face of the deceased. Congestion in the organs of generation is an appearance which it would not be safe to take as evidence of death from strangulation. The state of the countenance alone will scarcely warrant the ex- pression of an opinion; for there are many kinds of death in which the features may become livid and distorted from causes totally 428 MEDICAL PROOFS OF DEATH FROM STRANGULATION. unconnected with the application of external violence to the throat, unless accompanied by other well-marked signs of this mode of death. So, again, the eyes and tongue may be protruded as a result of putrefactive changes. Let not a witness, then, lend himself as an instrument for the condemnation of a person against whom nothing but a strong sus- picion from circumstances may be raised, and where medical evi- dence is unable to furnish any distinct and conclusive proofs of death from strangulation. This caution is especially necessary in reference to the inspection of bodies which are in a state of putre- faction. A medical man, already provided with a theory of the cause of death by the discovery of a rope or other means of con- striction, may easily arrive at the conclusion that death lias taken place from strangulation. The absence of the usual confirmatory appearances in the body may be ascribed to decomposition, and those caused by decomposition may be set down to strangulation. "When there is obvious mechanical violence to the neck, such as fracture of the larynx or windpipe, with laceration of the muscles beneath, a visible depression, such as a cord, a ligature, or manual pressure would produce, a medical opinion may be fairly given in spite of putrefaction. But when in a putrefied body, indistinct marks on the neck, or patches of discoloration are relied upon as evidence of a homicide, there is great risk of a serious medical mistake. In cases of alleged drowning, it is sometimes the practice to ask a medical witness how far his opinion of the cause of death has been influenced by the discovery of the dead body in or near water. In cases of alleged strangulation a similar question may be put in reference to the discovery of a rope or ligature round the neck of the deceased, or in the apartment in which the dead body is found. A medical opinion should rest upon the clear and obvious efl'ects produced on the neck, and on the structures below the skin, and not upon the mere presence of a cord or ligature. This might be put round the neck of a dead body, or near to it, for a malicious purpose. The act of strangulation should be, medically speaking, as distinctlj^ provable without the production of a rope, as the act of stabbing without the production of the knife which inflicted the stab. If these principles are not strictly adhered to in practice, policemen would be as competent as medical experts to give evi- dence of the cause of death in cases of alleged strangulation. It is scarcely necessary to state that all marks of violence on the body of a supposed strangled person should be accurately noted, as the questions respecting them, however slight the marks may be, are material. The witness will be expected to state whether they were inflicted before or after death ; if before, whether they were sufficient to account for death, or whether they were such as to be explicable on the supposition of an accidental, suicidal, or homi- cidal origin. It should be observed whether there exist any morbid changes, sufficient to account for death, in either of the three great SUICIDAL STRANGULATION. 429 cavities of the body, as this kind of evidence may be essential in the progress of the case. In reference to females, whether children or adults, the surgeon should not neglect to examine the sexual oi'gans, to ascertain whether there are any marks of violation. Cases have occurred in which rape has been perpetrated, and strangulation resorted to for the purpose of concealing the crime. Strangulation, like hanging, is occasionally the result of accident, but the occurrence may be looked upon as rare. When the body is not suspended, it is commonly more in the power of a person to assist himself, and escape from the constriction ; hence cases of acci- dental strangulation are less frequent than those of accidental hang- ing. As a general rule, cases in which the constriction of the neck has been produced by some accident, present no difficulty to a medi- cal jurist, provided the relations of the body to surrounding objects and the compressing force have not been disturbed. Should it hap- pen, however, that the body has been removed from the place in which it was first discovered, or the ligature taken from the neck, we can only establish a presumption of accident from the descrip- tion given. when a charge of murder is instituted against a person, an at- tempt is not unfrequently made by counsel for the defence to show the probability that the deceased might have fallen while in a state of intoxication, and have become accidentally strangled, either by a tight cravat, or by some foreign substance exerting pressure on the windpipe. If we admit the possibility of an occurrence of this nature, we must not lose sight of the existence of other more pro- bable modes of death ; nor should we allow our judgment to be so swayed as to abandon what is probable for that which is merely possible. Suicidal stra.ngvlation. — This mode of suicide is of rare occur- rence, and except under particular circumstances, impossible. The possibility of an individual strangling himself was for a long time denied by medical jurists ; for it was presumed that when the force was applied by the hand, all power would be lost as soon as the compression of the windpipe commenced. This reasoning, which is physiologically correct, is, however, only applicable to those cases in which the windpipe is voluntarily compressed by the fingers. When a person determined on suicide allows the windpipe to be compressed, by leaning with the whole weight of his body on a cord passed round his neck and attached to a fixed point, he may perish in this manner almost as readily as if he had hanged himself; for insensibility and death will soon supervene. In the chapter on Hanging, it was stated that suicides were often found with their bodies in close contact with the- ground ; and cases are reported in which strangulation was accomplished, in the manner above de- scribed, while the suicide was in a sitting or kneeling posture (p. 418). On other occasions, the peculiar disposition or nature of the ligature has enabled a person bent on suicide to strangle himself without much difficulty. An instance is related by Orfila, in which two cravats, that were twisted several times round the neck of the 430 HOMICIDAL STEANGULATIOK. deceased, who was discovered lying on his bed, h'ad effectually served the purpose of self-destruction. ("Med. L6g." vol. 2, p. 389.) Some- times strangulation has been suicidally effected by a rough cord passed repeatedly round the neck, and tightened by being pulled with each hand. The number of coils would still cause some pres- sure to be exerted even when the grasp was relaxed by death. (See "Guy's Hospital Reports," Oct. 1851.) Other cases are related, in which suicides have succeeded in strangling themselves by tighten- ing the ligature with a stick (see " Guy's Hospital Reports," Oct. 1851) ; or when the ligature was formed of thick and rough material, by simply tying it in a knot. Although suicidal strangulation may be effected under unex- pected circumstances, yet in a case of murder by strangulation, it would not be easy to simulate suicide ; it would at any rate require great skill and premeditated contrivance on the part of a murderer, so to dispose the body of his victim, or to place it in such a rela- tion to surrounding objects, as to render a suspicion of suicide even probable. Thus, if the cord or ligature should be found loose or detached — if the ecchymosis or mark in the neck should not accu- rately correspond to the points of greatest pressure — if, moreover, the means of compression were not evident when the body was first discovered and before it had been removed from its situation, there would be fair grounds for presuming that the act was homicidal. In those cases in which strangulation has resulted froln a compres- sion of the windpipe by the fingers, and where there are fixed ec- chymosed marks indicative of direct manual violence, we have the strongest presumptive evidence of murder ; for neither accident nor suicide could be urged as affording a satisfactory explanation of their presence. , Homicidal strangulation. — Strangulation occasionally comes before our courts as a question of murder ; and when a person has been tried upon a charge of this kind, the circumstances have been com- monly so clear, as to render the duty of a medical witness one of a simple nature. "When the cause of death is contested, or when it is contended in defence that the strangulation is suicidal, a medifcal witness must be prepared to give his reasons for affirming that the act was not done by the deceased himself. He must be prepared to meet and explain the differences between the case under investiga- tion and those reported cases which are admitted to have been suicidal. The attitude of the body, the condition of the, dress, the means of strangulation, the presence of marks of violence or of blood on the person of the deceased — on his clothes, on the furniture of the room, or on the rope or ligature, are circumstances from which, if observed at the time, important medical inferences may be drawn. As a rule, whosoever attempts to imitate suicide under such a form of murder must, when the facts are properly investigated, inevitably fail in his object. The assassin either does too little, or he does too much. In one case of murder by strangulation, the woman who perpetrated the crime had been a nurse in an infirmary, and accus- tomed to lay out dead bodies. After the act of murder she appears HOMICIDAL STRANGULATION. 431 to tave carried out unthinkingly, her professional practice, by smoothing the clothes under the body, placing the legs at full length, the arms out straight by the side, and the hands open and laid out ! Such a condition of the body was quite inexplicable on the supposition of suicide, considering the amount of violence which must have attended the strangulation. In another case, the criminal had attempted to make the death appear like an act of suicide by placing the lower end of the rope near the hand of the deceased ; but he selected the left hand when the deceased was right-handed, and he did not leave enough rope free from the neck for either hand to grasp in order to produce the very violent constriction of the neck which had been caused by the two inner coils. Both of these criminals confessed their crimes before execution. It is proper to notice, in this place, the frequent occurrence within a recent period of what are called " Garotte robberies." The system of murder normally puraued by the Thugs in India appears to have been imported into England, and many lives have been destroyed in the manufacturing districts and in large towns, by the employ- ment of strangulation for the purposes of robbery. In spite of many convictions, there is reason to believe that many criminals still set the law at defiance. The rigorous proof required of facts which under these assaults can rarely admit of proof, confers complete impunity on the assailantSi The attack is made during darkness ; the person is seized by the windpipe from behind, or a bandage is thrown around his neck ; and this is suddenly tightened while accomplices are engaged in perpetrating robbery. The nature of the assault by pressure on the windpipe, renders it impossible to give an alarm or call for assistance. The person assaulted, if he should recover, is seldom able to identify an assailant ; he is attacked from behind, is rendered immediately senseless and powerless, and can rarely offer resistance. Recovery or death in such cases depends on the lapse of a few seconds, more or less, during which the con- striction of the neck is continued — on the degree of constriction, and on the age, sex and strength of constitution of the person assaulted. An attempt at strangulation, as in garotting, besides inflicting serious local injury to the windpipe and other parts near to it, may cause a state of insensibility which may continue for some hours. There is severe pain in the throat, with difficulty of speaking and swallowing, and if the larynx be seriously injured there may be loss of voice. Dumbness, however, is not one of the secondary symptoms ; and loss of voice is usually only temporary during the pressure. By the 24th and 25th Victoria, c. 100, s. 14, it is enacted, inter alia, that " whosoever shall attempt to drown, suffocate, or strangle any person with intent to commit murder, shall, whether any bodily injury be effected or not, be guilty of felony ; and being convicted thereof shall be liable, at the discre- tion of the court, to be kept in penal servitude for life, or for any term not less than three years, ... or to be imprisoned for any term not exceeding two years." As the intent in these cases is to perpetrate robbery, and not murder, another section (21) has been 432 MARKS OF VIOLENCE ON THE BODY. framed, for the prevention of the crime o"f garotting : " "Whosoever shall by any means whatsoever, attempt to choke, suffocate or strangle any other person, or shall, by any means calculated to choke, suffocate, or strangle, attempt to render any other person insensible, unconscious, or incapable of resistance, with intent, in any of such cases, to enable himself, or any other person, to commit, or with intent in any of such cases thereby to assist any other person in committing any indictable offence, shall be guilty of felony ; and being convicted thereof shall be liable, at the discre- tion of the court, to be kept in penal servitude for life, or for any term not less than three years, . . . or to be imprisoned for any term not exceeding two years," etc. Marks of violence. — It may be inquired whether marks of violence on the body, or blood-stains on the clothes, furniture, or in the apartment, do not afford strong evidence of homicidal strangulation. . The answer is — if the marks of violence are such that they could not possibly have arisen from any accident before death, or that they could not possibly have been self-inflicted, they aftbrd the strongest evidence of murder. But the cases wherein so positive an answer can be returned are exceptions to the rule. It is not always in our power to distinguish accidental or self-inflicted from homicidal violence ; and we are always bound to look to the proba- bility of accident, or of previous attempts at suicide, being the source of those personal injuries which may be apparent on a strangled body. There may be several marks on the neck, but then the person may have tried to strangle himself more than once. The throat may be cut ; there may be a deep-seated stab or gunshot wound, involving some of the important organs of the body ; or poison may be found in the stomach ; but in a purely medical point of view, how are we to know that the deceased did not actually make the marks, inflict the wounds, or take^ the poison before he succeeded in strangling himself? In the chapters on Drowning and Hanging, we have seen what suicides can do when they are desperately bent on destroying themselves. Wounds and personal injuries often create serious difliculties to a medical jurist, which it requires the greatest caution and prudence on his part to meet and explain. The prejudice of the public mind is such, that the discovery of a strangled person, with any marks of a personal injury or of poison- ing in the stomach, would, in most cases, lead to a charge of mur- der, unless the facts rendered it clearly impossible that any attempt could have been made on his life. It is against this prejudice that a medical witness must strenuously guard himself; he may be abused in not joining in the outcry of the vulgar, but the best recompense for this abuse will be the conviction that he is inter- posing the shield of science to protect a possibly innocent fellow- creature from the senseless denunciations of- ignorance. Farther, before a charge of murder by strangulation is raised against any person from marks and appearances found on a dead body, care should be taken that they admit of no other probable explanation * CIRCUMSTANTIAL EVIDENCE. 433 than the direct applicatioft of violence. Even if marks indicative of strangulation are discovered, the question arises whether they may not have been produced by the deceased upon himself in an attempt at suicide which may have failed. If the. body of a per- son is allowed to cool with a handkerchief, band, or tightly-fitting collar round the neck, a mark resembling that of strangulation will be produced. Before any opinion is given that murder has been perpetrated or attempted, the medical proofs on which reliance is placed should be clear, distinct, conclusive, and satisfactory. In the dead bodies of infants and children, in whom the neck is short, a mark is occasionally seen which arises from the bending of the head; and in short-necked persons a similar mark or depression has been noticed after death, in front of the neck. These marks are then rendered more prominently by their assuming a livid ap- pearance. They might, at first, be mistaken for marks produced by a ligature in an attempted strangulation. In one case a death from apoplexy was attributed to homicidal strangulation from a cadaveric change of this kind. ("Ann. d'Hyg." 1859, vol. 1, p. 139, and vol. 26, p. 149.) This matter was set right by the late M. OUivier. Homicidal strangulation may be perpetrated on the weak and infirm without causing any noise or creating alarm. In the first place, if the throat is at once seized and firmly compressed no cry can be made, nor any noise produced to excite the attention of those who are near. In June, 1857, an aged woman was strangled in her shop by an apprentice in so short a time and with such facility, that her husband, who was only separated from her by a slight partition, heard no noise or disturbance during this act of murder. ("Ann. d'Hyg." 1859, vol. 1, p. 157.) It cannot be disputed that in contested questions of suicidal or homicidal strangulation, rare as they are, we must be often greatly indebted to evidence founded on circumstances, as well as to moral presumptions. How far a medical jurist may be allowed to make use of these in the formation of an opinion, it will be for the court to determine. Generally speaking, his duty is rigorously confined to the furnishing of medical evidence from medical data alone ; but instances present themselves in which this rule must be departed frdm, or the course of justice will be impeded. Besides, there are numerous circumstances of a collateral nature, which may materially modify a medical opinion. Thus, the sight of a ligature, the state of the dress, and the attitude of the deceased when discovered, although not strictly medical circumstances, bear directly upon medical opin- ions ; and that evidence ought not to be objected to which is partly founded upon facts of this nature. It must occur to all, that with- out circumstantial evidence, the best medical opinion in these cases will often amount to nothing. It may be, for example, no more than this : the case is either one of homicide or suicide ; and why is such an indefinite answer to be returned? Because, in the abstract view of strangulation, it is not easy to determine whether a liga- ture was suicidally applied round the neck or not. The appearances may be in many cases the same, and where they are difterent, this 28 434 IMPUTED STRANGULATION. difference may be due to accident, so that it is a mistake to suppose that we must look to medical circumstances alone for clearing up this intricate question. On some occasions, the theory of homicide or suicide will be equally consistent with the facts. In all cases of fatal strangulation resulting from an act of suicide, the means by which strangulation was produced must be found upon the neck. The condition of the mark on the neck, the course and direction of the cord, the mode in which it was secured or fixed in order to produce effective pressure on the windpipe, the amount of injury to the muscles and parts beneath, are circum- stances from which, if observed at the time, a correct medical opinion may generally be formed. If the means of constriction are removed, or the cord or ligature is loosely applied, these facts, unless explained, are presumptive of homicidal interference. There is another condition in which a presumption of homicide will be justifiable. A man, in strangling himself, is not likely to vary the means. The act is commonly due to a sudden impulse, if we may judge from the moral proofs afforded in the instances on record. The article which is nearest to the suicide is seized, and made the instrument of self-destruction. It has already been stated as doubtful whether a person could strangle himself by the mere application of the finger to the windpipe ; the discovery of such marks only as would indicate this kind of strangulation, therefore, renders suicide in the highest degree improbable. But these marks may be sometimes ascribed to the deceased having fallen with his hand possibly applied to his neck, and the inference will be drawn that they have accidentally I'esulted from the pressure of his own fingers. This is an improbable mode of accounting for the produc- tion of ecchymosis or excoriation of the skin in the front of the neck. If, besides these marks of fingers, we find a circular mark, with a ligature still around the neck, the presumption of murder becomes very strong. It may be said that a person might at first try to strangle himself with his fingers, and, not succeeding, might afterwards employ a cord. But the degree to which the coin- cidental impressions exist will assuredly in general remove this objection. Imputed strangulation. — Hitherto the subject of strangulation has been considered in reference to the dead. But a living person may charge another with attempting murder under such circum- stances, and here a medical jurist will have the not very arduous duty of detectirfg and exposing the imposture. It has been con- sidered so improbable that any one would seriously attempt to strangle himself, and then impute the act to another, that medical jurists have given but little attention to this subject. A case which has been recently tried in France {Affaire Armand et Maurice Moux, March, 1864) has shown the great importance of it, and how easily medical men and the public may be deceived by a plausible stbrj'. As in reference to imputed wounds, so in these cases, im- postors rarely produce such injury to themselves as to place their lives in jeopardy. The cord is loose round the neck, or there would IMPUTED STRANGULATION. 435 be speedy death ; it is not so secured as to press with great force on the air-passages, to cause the tongue to protrude, or to produce lividity of the face and neck, or ecchymosis in the conjunctivas and the skin. It is either a ligature or a rope which is used by the impostor; he does not commonly resort to manual violence to his throat. The marked feature of a really homicidal attempt is in the great amount of violence done to the neck ; and the account given by the impostor will be inconsistent in its details, and not reconcilable with the ordinary effects of homicidal strangulation. Tardieu met with a case, in which a young woman of good social position, wishing to excite some public sympathy, alleged that she had been made the victim of a political conspiracy. One evening she was found at the door of her room, apparently in a very alarm- ing state ; she could not speak, but indicated, partly by gestures, and partly by writing, that as she was entering her room a man had attempted to strangle her by pressing his hand upon her neck, and at the same time had stabbed her in the chest with a dasrffer. On close examination it was found that the two stabs had pene- trated only to the outer clothing. But the most singular effect of the alleged attempt at strangulation was that, instead of producing a difficulty of speaking and alteration of the voice, it had been followed by complete dumbness ! M. Tardieu, who was officially authorized to examine the case, could find on the neck no trace of any attempt at strangulation ; and on assuring the young lady that the loss of voice under such circumstances could not last for more than a minute, she at once admitted that there was no foundation for the charge! ("Ann. d'Hyg.," 1859, vol. 1, p. 163.) On this occasion, no person was accused ; but the case is different when, for the purpose of extortion or other base motives, one or more persons are charged with ah attempt at murder. A flagrant instance of this kind occurred in France, in which a wealthy merchant of Montpellier was charged by his servant, Maurice Houx, with having attempted to murder him by strangulation. The case was tried in March, 1864, before the Court of Assizes of the Bouches du Rhone ;. and, fortunately for the interests of justice, as well as for the credit of medico-legal science in France, it ended in a complete acquittal of the accused. (Affaire Armand et Maurice lioux, Paris, 1864.. " Relation Medico-legale de I'Affaire Armand," etc., par A. Tardiea.. " Annales d'liygiene et de M^decine Legale," 1864, vol. 1, p. 415.)) It may be observed in reference to these imputed cases, that men who deliberately strangle others, either draw a cord tightly, or secure it by a knot. The pressure to the neck is not so gentle as. to leave no mark whatever, or to allow the strangled person to breathe and watch all that, goes on around him. Slight marks of violence about the neck should be viewed with great suspicion on these occasions. As a rule, a man does not half-strangle any more than he half-stabs or half-poisons another; but the impostor' stops short of this stage, as he has no intention to destroy himself. If, as is most improbable in attempted homicide, the cord is left only loosely coiled around the neck, the person assaulted necessarily 436 SUFFOCATION. — CAUSE OF DEATH. retains the power of breathing and calling for assistance ; hut if the hand of a murderer has been at work, it is effectually tight- ened, and the person dies in a few minutes. A charge of this' kind where there can be no witness but the person making it, requires to be supported, not by medical probabilities or possibilities, but by the strongest medical facts. These ought to show that there are marks of violence on the neck such as an assassin would be likely to inflict, and, at the same time, such as the person making the charge would not be likely to produce, or have the power of producing on himself. SUFFOCATION. CHAPTER XXXIX. SUFFOCATION FEOM MECHANICAL CAUSES. — CAUSE OF DEATH. — APPEAR- ANCES AFTER DEATH. — EVIDENCE OF DEATH FROM SUFFOCATION. — ACCIDENTAL, SUICIDAL, AND HOMICIDAL SUFFOCATION. — SMOTHERING. By suffocation we are to understand that condition in which air is prevented from penetrating into the lungs, not by constriction of the windpipe, but by some mechanical cause operating on the mouth externally, or on the throat, windpipe, or air-passages internally. In this sense it will be perceived that drowning is one foi-m of death from suffocation, the water being an effectual medium for prevent- ing access of air to the lungs. The term suffocation is applied to various conditions in which the symptoms and effects differ. There may be a simple privation of air ; the air respired may not be renewed for the want of proper ventilation ; or, lastly, the air which is breathed may be mixed with certain noxious gases or vapors, which, by absorption into the blood through the air-cells of the lungs, may destroy life like poisons. The symptoms preceding death, the disposition to recovery, and the post-mortem appearances in fatal cases, will differ under these cir- cumstances. It will be sufficient, at present, to consider the most simple form of suffocation Avhich is within the reach of experiment, namely, that which depends on the privation of air by substances blocking up the air-passages, or by the covering of the mouth and nostrils. The Committee of the Medico-Chirurgical Society per- formed a series of experiments on dogs, in which a tube was inserted into the windpipe, and breathing either took place or was com- pletely arrested, according to whether the tube was kept open or closed by an accurately fitting plug. When the tube was closed VABIOUS MODES OF SUFFOO ATION. 437 the animal, after a variable number of seconds, made strong efforts to breathe; and wben these ceased, unless air was speedily admitted, it died. From nine experiments on the dog, the average duration of the respiratory movements, after the animal had been completely deprived of air, was four minutes and five seconds. The average duration of the heart's action was seven minutes and eleven seconds; and it further appeared that, on an average, the heart's action con- tinued for three minutes and fifteen seconds after the animal had ceased to make respiratory ettbrts. In respect to the rapidity with which death takes place in animals, the following conclusions were drawn : 1st, a dog may be deprived of air during a period of three minutes and fifty seconds, and afterwards recover without the ap- plication of artificial means ; and 2dly, a dog is unlikely to recover, if left to itself, after having been deprived of air during a period of four minutes and ten seconds. As in drowning, the shorter the interval between the last respiratory efforts and the re-admission of air, the greater the chance of recovery. (" Med.-Chir. Trans." 1862, vol. 45, p. 454.) The results of these experiments in reference to the duration of life under privation of air may be considered applicable to a human being. It is not likely that a man would survive under these cir- cumstances longer than a dog, and it may be fairly inferred that the life of a man would be destroyed in from four to five minutes after the power of breathing had been completely arrested. There are many varieties of death by suffocation, all of which are of great medico-legal interest : 1. The close application of the hand over the mouth and nostrils, or the placing of a plaster or cloth over these parts, combined with pressure on the chest : this was for- merly not an unfrequent form of homicidal suftbcation. 2. Smoth- ering, or the covering of the head and face with articles of clothing, etc., which effectually prevent breathing. 3. The accidental or forcible introduction of foreign bodies into the mouth and throat. 4. The flow of blood into the windpipe from a severe wound in the throat, or from the bursting of a bloodvessel or aneurismal sac. 5. In wounds of the throat, when the windpipe is completely divided, the lower end may be so drawn into the wound as to produce a closure of the orifice, and intercept the passage of air. One or the other of these causes frequently operates to render a wound in the throat fatal. 6. The plunging of the face into mud, snow, dust, feathers, or similar substances. In all these cases, death takes place from asphyxia, and with great rapidity if the chest sustains at the same time any degree of forcible compression. 7. Swelling or spasm of the glottis produced by the contact of corrosive substances. A case was referred to qie, in July, 1848, in which death was probably thus caused by the application of a strong solution of pernitrate of mercury to an ulcer in the throat. Suffocation may arise from morbid causes operating mechanically to prevent respiration, such as a diseased state of the parts about the throat, an enlargement of the glands, the bursting of a tonsil- lary abscess, or the effusion of lymph, blood, or pus into the wind- 438 ACCIDENTAL SUFFOCATION FROM FOOD. pipe, or about the opening of the larynx (rima glottidis). Any of these causes may suddenly arrest the act of breathing, a fact which can only be determined by a careful examination of the air-passages. Accidental suffocation may arise from large masses of food blocking up the larynx. If the glottis (the opening of the windpipe) be completely closed by food, death may take place suddenly ; although the person so situated may be capable of making some exertion or of moving from the spot. Dr. Mackenzie relates a case in which a man was suddenly choked by swallowing a large piece of meat ; he immediately walked across the street to a chemist's shop, and soon after entering it he fell down in a state of insensibility. After death the throat was found to be filled with a piece of beef, which rested on the glottis, and had pressed the epiglottis forward. Part of the mass had entered the windpipe thi'ough the rima glottidis, and had thus caused death by suffocation. It is probable .that, in this and similar cases, the foreign body does not so completely close the aperture as to prevent some degree of respiration, but the blood being imperfectly aerated, asphyxia is speedily induced. (" Ed. Month. Journ." July, 1851, p. 68.) In a case which occurred in April, 1858, a youth, set. 17, lost his life owing to an oyster be- coming impacted in the air-passages "during the act of swallowing. Suffocation is also frequently the result of the lodgment in the air- passages of substances vomited. A person has been wrongly charged with causing the death of another, when the cause was really owing to the impaction of food in the larynx. A remarkable instance of this kind (wiiich is re- ported in the " Lancet" for March 9, 1850, p. 313), occurred at Hill- ingdon. Deceased had had a quarrel with the accused, who was his son-in-law, and they were seen to fall to the ground together, while struggling and fighting. They were separated. About two hours afterwards the deceased, who appeared quite well, was ob- served to rise from the dinner-table and leave the room. He was found leaning against the cottage, as if in a falling position, and he expired in two or three minutes! The person with whom de- ceased had been fighting was charged with manslaughter before a magistrate. At the inquest the medical witness stated that he found the organs of the body, excepting the brain, in a very healthy state. The braip was excessively congested, and he attributed death to apoplexy. The coroner desired the witness to examine the mouth and throat (which he had omitted to do at the inspec- tion), as from the suddenness of death after eating, he (the coroner) thought the man might have been choked. ■ This opinion turned out to be correct. A large piece of meat was found wedg^ed in the opening of the throat ; this had caused death by suffocation ; it had not completely closed the air-passages in the first instance; hence the man was able to move from the dinner-table. The person accused of manslaughter was discharged. A medical jurist, however, must not lose sight of the fact that a foreign substance may be homicidally impacted in the larynx, and that, except by a careful examination of the body, death may be SUFFOCATION. — MODE OF DEATH. 439 wrongly assigned to accident. A case reported by Dr. Littlejohn is in this respect instructive. In examining the body of a woman who it was stated had died suddenly, he found a quart-bottle cork inserted tightly into the upper part of the larynx. The sealed end was uppermost, and was roughened by the passage of the screw. Fractures of the ribs were found, and it was quite clear that deceased had not died a natural death. It was suggested that the deceased, while extracting the cork from the bottle with her teeth, might, by the sudden impetus of the contained fluids, have drawn it into the position in which it was found. But this theory was negatived by the sealed end of the cork being uppermost in the throat, as well as by the structure of the parts. The medical opinion was that the cork must have been forcibly placed there by another person, while the Avoraan was in a helpless state of intoxication. There was -no reason tp doubt that this was a deliberate act of murder. Five per- sons were present with the deceased at the time of her death, but it was impossible to fix with certainty upon the person who had com- mitted the act, and the man on whom the strongest suspicion fell was acquitted on a verdict of " not proven." (" Ed. Med. Journ." Dec. 1855, p. 511 ; and for a report of the trial, the same journal, p. 540.) In suffocation, death takes place from apncsa or asphyxia ; and this occurs with a rapidity proportioned to the degree of impedi- ment existing to the passage of the air. There does not seem to be any reason to attribute death to apoplexy. The congestion of the cerebral vessels may be regarded as a consequence of the dis- turbance of the functions of the lungs. If the veins of the neck were opened, so as to prevent an accumulation of blood in the vessels of the brain, it is pretty certain that the prevention of respi- ration would destroy life under the same circumstances, and within the same period of time ; therefore we may regard death from suffo- cation as resulting from pure asphyxia. In treating a case of suf- focation we have simply to allow of the renewal of air by removing, if this be possible, the mechanical obstacle to respiration. The re- sults of experiments on dogs show that, even with a perfect closure of the windpipe, an animal may recover spontaneously after nearly four minutes^ deprivation of air ; and there is every reason to believe that a human being might recover after the same length of time. If five minutes have elapsed there will be but little hope of re- covery. In drowning, the chances of recovery continue only for half the period observed in suffocation ; the lungs are injured, and the water by which they are penetrated forms a physical obstacle to the free admission of air. In hanging and strangulation, there is sometimes great violence done to the parts about the neck. In suffocation, these accidental obstacles to recovery do not exist ; the surgeon has simply to readmit the air into the lungs. All experi- ments go to show that, even in this form of asphyxia, which is most favorable for recovery, the complete suspension of respiration for Jive minutes is fatal. Hanging and strangulation prove fatal 440 POST-MORTEM APPEABANCES. from asphyxia in the same period of time, and drowning probably within half this period. Post-mortem appearances. — There are rarely any considerable marks of violence externally. When the body has become perfectly cold, there may be patches of lividity diffused over the skin ; but these are not always present. The lips are livid ; the skin of the face and neck may be pale, or present a dusky-violet tint, with small patches of ecchymosis. The eyes are congested ; there is a mucous froth about the lips and mouth. The mouth, throat and parts about the windpipe should be carefully examined for foreign substances. In- teraall3^,the lungs and right cavities of the heart may be found dis- tended with blood. The state of the lungs and heart is, however, subject to variation. The lungs are not necessarily found congested ; and sometimes, as in a case referred to me in November, 1864, one lung may be found congested and the other not. M. Tardieu states, from his observations, that the lungs are of a reddish color, some- times even pale, not distended, and presenting, occasionally, only a slight degree of congestion at the base and posteriorly. A special character which he states he has invariably noticed in these organs consists in the presence of small ecchymosed spots or patches be- neath the pleura or investing membrane. He describes these spots as of a dark color, and varying in size from a pin's head to a lentil. In the adult they are of still larger size. Their number is variable ; sometimes five or six may be found, at others twenty or thirty ; and in other cases the surface of the lungs may be so studded with them as to give to it a granite-like appearance. These spots of ecchymosis are sometimes agglomerated, at other times separated, but their outline is generally distinct and well-defined on the surface of the lungs. They are most frequently seen at the root of the lungs, at its l)ase, and about its lower margin. They are owing to small effusions of blood from ruptured vessels, like true ecchymosis. They may be distinguished so long as the tissue of the lung remains unchanged. M. Tardieu states that he has seen these subpleural ecchymoses in the body of an infant, ten months after death ! (" Ann. d'Hyg." 1855, vol. 2, p. 379.) He admits, however, that they may also be found in the bodies of children that have not breathed; hence no inference of death from suffocation should be drawn from this appearance in the lungs of children, unless they have actually received air. In three instance^, he met with this appearance in lungs which sank in water, and had all the usual characters of these organs in a foetal state. The children had been born living, prematurely, and under conditions in which life by respiration could not be perfectly established ; one of them had made several cries without effectually receiving air into the lungs (loc. cit.). (See Casper's "Klinische ITovellen," 1863, p. 471.) This struggle to breathe may have produced the appearance re- sembling that of suffocation ; in new-born children that die from suffocation, the thymus gland has been found in a similar condition. This dotted appearance of the surface of the lungs in suffocation is not attended with the apoplectic effusions in their substance POST-MORTEM APPEARANCES. 441 which are met with in death from strangulation. Emphysema, or escape of air from rupture of the air-cells, is occasionally observed. The more rapidly suffocation has taken place the more strongly marked is this appearance of ecchymosed spots. On the other hand, when the interruption of breathing has been slow and gradual, the sub^ance of the lungs is more congested with blood, and then these dots and patches are merged in the general violet color of the surface of the organs. The lining membrane of the windpipe and larger air-tubes is sometimes pale, but commonly dark-colored when the lungs are congested. In the air-passages, there is occasionally a frothy reddish-colored liquid in small vesicles. The heart presents no special appearance indicative of the mode of death, if we except the presence of small spots of ecchymosis found below the investing membrane, like those met with on the lungs. They have been found near the roots or origin of the great vessels, but are not so frequently observed in this organ as in the lungs. The blood is generally dark and fluid ; sometimes coagula are met with. The stomach and intestines have been observed to present patches of lividity. Casper has found the kidneys more strongly congested with blood than the liver, spleen, and other organs. The vessels of the brain are sometimes congested, but at other times they do not appear to be more than ordinarily full. Their condition may be affected by the congested state of the lungs, as well as by the slowness or rapidity with which death takes place. Other appearances which have been described are of an accidental nature, and are not connected with death from suffocation. In a case of alleged murder by suffocation, respecting which I was consulted in December, 1857, the following appearances were met with. The body was lying on the bed ; the right leg was drawn up towards the body — the right arm was bent, with the hand directed towards the face ; the left hand was lying upon the chest. The lips were livid, the tongue protruded and swollen, and there was a bloody fluid issuing from the nostrils. There was no mark of constriction on the neck; the eyes were half-open; the body was rigid and still warm. The face and neck were much swollen, and the skin of these parts, as well as of the chest, abdo- men, arms, and legs, was covered with dark livid patches. The brain was gorged with venous blood. The heart was soft and flaccid, and its cavities were empty. The mucous membrane, as well as the tissues of the air-passages, were much congested with dark liquid blood: the blood was everywhere liquid. The stomach contained a small quantity of a dark-colored liquid, and the greater end was reddened. The spleen was congested. The emptiness of the cavities of the heart was at first considered to be inconsistent with death from asphyxia ; but this condition of the heart is occa- sionally found. It may be stated that in this case the deceased, a female, was greatly exhausted b}'- sickness and purging. On the second day of her illness she was found dead in the state described, and her husband was charged with having suffocated her. 442 PROOFS OF DEATH FROM SUFFOCATION. Evidence of death from suffocation. — In medical jurisprudence there is not, perhaps, an instance in which we have fewer medical data upon which to base an opinion, than in a case of alleged death from suffocation. The inspection of the body of a person suffocated, if we except the peculiar condition of the surface of the lungs lately pointed out by M. Tardieu, presents so little that is peculiar, that a medical man, unless his suspicions have been roused by cir- cumstantial evidence, or by the discovery of foreign substances iu the air-passages, would probably pass it over as a case of death without any assignable cause — iu other words, from natural causes. In examining the body of the woman Campbell, who was suffo- cated by Burke in Edinburgh, Dr. Christison was unable to come to any conclusion respecting the cause of death until some light had been thrown on the case by collateral evidence. On this occa- sion, a violent death was suspected, because there were marks of violence externally, and the face of the deceased presented some of the characters of strangulation. These conditions, however, are by no means essential to death from suffocation, and when they exist they can only be regarded as purely accidental accompani- ments. Appearances similar to those found in the bodies of suffo- cated persons, if -we except the dotted ecchyraosis on the lungs, are frequently met with in inspections when death has taken place as a consequence of disease or accident. They can, therefore, furnish no conclusive evidence of the kind of death ; they scarcely permit a witness to establish a presumption on the subject, until, by ■ a careful examination of the body, he has ascertained that there is no other cause of death depending on organic disease or on violence. Medical evidence may, however, be serviceable in some instances. Thus, let the general evidence establish that a deceased person has probably been suffocated, the witness may have it in his power to state that the appearances in the body are consistent with this kind of death ; that the body is in all respects healthy and sound, and that death was probably sudden — as where, for instance, undigested food is discovered in the stomach. The presence of ecchymosis on the surface of the lungs may justify a strong opinion of death by suffocation when no other cause is apparent. In all cases of this description, we must bear in mind that an opinion relative to the supposed cause of death is to be formed from the medical circum- stances, and from what we have ourselves seen, unless it be other- wise allowed by the court. From this want of clear evidence, great difference of opinion on the cause of death frequently exists among medical witnesses. Accidental suffocation is not unfrequent ; and there are various conditions under which a person may die suffocated only discover- able after death. 1. Diseases about the tongue, larynx, or throat may have advanced to such an extent as effectually to prevent breathing. 2. The deceased may have fallen, and the mouth be- come covered with dust or other substances ; and if helpless, as in the case of an infant or an aged person, or of one who is in- toxicated, death may thus easily take place. A child was found CAUSES OF ACCIDENTAL SUFFOCATION. 443 dead in a room, with its face in the ashes undei* a grate ; it had fallen during the absence of the mother, and, from its helpless con- dition, had speedily become suffocated. Some of the ashes were found in the windpipe. (" Med. Gaz.," vol 17, p. 642.) For a case in which suffocation was caused b};' a pea, see the same journal, vol. 29, p. 146. In trials for murder or manslaughter, a medical opinon respecting the accidental suffocation of a drunken person, under similar circumstances, is occasionally required. These per- sons, it must be remembered, are generally as helpless as children ; if thej^ fall in a position so that the mouth is covered, they may may be so powerless from intoxication as not to be able to escape. 3. A portion of food may have remained fixed in the larynx or throat. Children are sometimes accidentally suffocated by drink- ing boiling water from a tea-kettle. The parts above the larynx then become swollen from the action of the hot water, and breath- ing cannot take place. 4. Accidental suffocation is not uncommon among infants, when they sleep with adult persons. A child may be in this way speedily destroyed. Even the close wrapping of a child's head in a shawl to protect it from cold may effectually kill it, without any convulsive struggles to indicate the danger to which it is exposed. Convulsions by no means necessarily attend on death from suffocation. Those incidents of accidental suffocation which depend on disease, or on the impaction of food, are easily known by a careful examination of the parts about the throat ; generally speaking, they present no difficulty. In other instances — -when a ch-ild or a drunken person is presumed to have been suffocated owing to the position in which he has fallen, evidence as to tlie position of the body, or even the actual sight of the body, is necessary before forming an opinion. The following questions may here arise : Was the position such as to be explicable on the supposition of acci- dent ? Was it not such a position as might have been given to it by a murderer ? Could not the deceased have had strength or presence of mind to escape ? Could he have been actually suffo- cated in the position in which his body was discovered ? A little reflection upon the circumstances — for here something more than medical circumstance will be required — may enable us to give satisfactory answers to these questions. Some singular cases are on record, in which persons have wilfully destroyed themselves by blocking up the throat mechanically. An instance of this form of suicide is reported in the " Edin. Med. and Surg. Journ.," April, 1842. A woman confined in prison forced a hard cotton-plug into the back of her throat. The cavities of the chest and abdomen had been already examined, and a medical cer- tificate given that the deceased had died of apoplexy ! The body was sent to one of the anatomical schools, and on reinspection it was accidentally found that the throat was firmly blocked up with a plug of spindle cotton. Homicidal suffocation is not very common, although it is a ready means of perpetrating murder. Hitherto, the oases which have 444 SMOTHERING OF INFANTS. come before our courts have been those either of infants, of the aged and infirm, or of persons enfeebled by illness. Death by suffocation is most difficult to detect, and unless the assailant has employed an unnecessary degree of violence, it is probable that the crime may pass altogether unsuspected. Homicide by suffocation would not be attempted on healthy adult persons, unless they were in a state of intoxication, and thereby rendered defenceless. It is certain that most individuals would have it in their power, unless greatly incapacitated by disease or intoxication, to ofter such a degree of resistance as would leave upon their bodies indubitable evidence of murderous violence. Death by suffocation may be considered as presumptive of homicide, unless the facts are clearly referable to accident. Accidental suftbcation is, however, so palpa- ble from the position of the body and other circumstances, that when death is clearly traced to this cause, it is not easy to conceive a case in which it would be difficult to distinguish it from one of actual murder. In some instances, the very means that have been adopted to produce suffocation may forbid the supposition of acci- dent, and clearly establish the fact of homicide. The suffocation of new-born children, by the introduction of sub- stances into the mouth, is not unfrequent. (See Infanticide.) The unnecessary force employed generally leaves traces of violence, which may be easily discovered by a careful examination, even should it happen that the substance used for the murderous purpose has been removed. It is necessary to point out a dangerous practice common among ignorant nurses, which, without exciting suspicion on the part of a coroner or medical witness, may be an occasional cause of death in infants. In order to quiet a child, and to enable a nurse to sleep without disturbance, a bag made of wash-leather or rag, containing sugar, is thrust into the child's mouth. It is thus completely gagged, and the child soon becomes quiet, respiring chiefly through the nostrils. If these by an accident become obstructed, or by the act of aspiration the bag should fall to the back of the throat, death by suftbcation must inevitably result, the infant being per- fectly helpless ! The suspension of breathing may be so gradual that the child may die without crying or convulsions. The removal of the bag from the mouth, as no violence had been used, will re- move. every trace of the cause of death ; and in order to exculpate herself, the guilty person may ascribe death to " fits." The detec- tion of this dangerous practice can only be a matter of pure acci- dent ; hence a fatal case can be rarely the subject of a coroner's inquest, and even then medical evidence may fail to throw any light upon the cause of death. According to the late Mr. Wakley, infants are frequently found dead owing to their being suckled at night while the woman is in bed. The child's face is pressed on the breast ; mother and child fall fast asleep ; the head slips beneath the clothes, and the child is then quietly suftbcated. There is no mark of pressure or violence on the body. (" Lancet," Jan. 1 6, 1858, p. 69.) A case, apparently of POST-MORTEM APPEAEAN0E3. 445 this kind, was coramuTiicated to me by Mr. Ifason, in Sept. 1860. The child (five days old) died quietly on its mother's arm while lying in bed. There was much lividity about the head, neck and back ; but there were no marks of violence. The bronchial tubes of the. right lung contained bright florid blood. The left lung was gorged with blood, but none had escaped. The heart was firmly contracted, and there was only a small quantity of blood in its right cavities. The appearances presented by the bodies of children who have died under these circumstances may be thus described from actual cases: Externally: features placid ; lips congested ; eyes not unduly prominent; conjunctivae rather reddened; hands clinched; no patches of ecchymosis to be anywhere detected. Internally : Head — patches of effused blood here and there seen beneath the peri- cranium ; great congestion of the pia mater, accompanied by num- berless efl'usions of blood, varying in size from a pin's point to a silver penny in superficial extent ; a little clear fluid in the ventri- cles; some frothy mucus in the windpipe and bronchi, with redness of their lining membrane. The lungs are much congested and crepitant, whilst beneath the pleurae, blood had been everywhere eftused, presenting numerous small bright-red patches, and fine points ; all the blood of the substance of the lungs was within its vessels. The pericardium contained some serum, and was spotted in its whole extent after the manner described ; the vasa vasorum of the heart's great vessels and thoracic aorta were minutely injected. The right cavities of the heart, in all the cases, contained dark liquid blood ; the left cavities were nearly empty ; the tissue of the organ was free from eflJ'used blood. The surface only of the thymus gland was mottled like the heart. There is a prevalent notion that congestion of the lungs is an in- variable accompaniment of death from 'suffocation, and where this was not found, it has been hastily assumed that death had taken place from some other cause. It is desirable, in reference to future cases, to point out the fallacy involved in the assumption that con- gestion of the lungs is necessarily present in death from suftbcation. Mr. Watson observes that the gorged state of the right side of the heart and lungs is greatest where the act of suftbcation (asphyxia) has been slow and gradual, by the access of air to the lungs not having been completely prevented. When, on the other hand, death has taken place quickly or suddenly froin this cause, there is little or no unusual congestion of blood in the lungs or heart. (" On Homicide," p. 115.) At page 118, he describes a case of death from suflbcation in which the lungs were natural ; and in the case of Campbell, for whose murder by suffocation Burke was convicted and executed in 1828-9, Dr. Christison and Mr. K"ewbigging found the organs within the chest perfectly natural, the lungs remarkably so, and unusually free from infiltration. The blood in the heart and great vessels, as well as throughout the body, was fluid and black. ("Ed. Med. and Surg. Journ." vol. 31, p. 239.) Again, in the case of Carlo Ferrari, for the murder of whom Bishop and Wil- 446 SUFFOCATION BY GASES. Hams were convicted and executed in London in 1831, the lungs were healthy and not congested ; the heart was rather small, con- tracted, and its four cavities were perfectly'- empty. The prisoners in this case confessed that they destroyed the deceased by suffocar tion. From these facts, it will be perceived that the actual state of the lungs and heart, in the bodies of those who have been notori- ously murdered by suftbcation, is that which has been wrongfully pronounced to be inconsistent with this mode of death. CHAPTER XL. GASEOUS POISONS. — CARBONIC ACID. — SYMPTOMS. — ■ APPEARANCES. — ANALYSIS. — EFFECTS OF CHARCOAL-VAPOR. — CARBONIC OXIDE. — COAL AND COKE VAPOR. SULPHUROUS ACID. VAPORS OP LIME, CEMENT, AND BRICK-KILNS.^CONFINED AIR. COAL-GAS. CARBURBTTED HYDROGEN. — SULPHURETTED HYDROGEN. — EFFLUVIA OF DRAINS AND SEWERS. Mode of action of gaseous poisons. — In following common language, a medical jurist is compelled to apply the term suffocation to an- other variety of death, namely, to that of poisoning by go.ses. Phys- iological accuracy must here be sacrificed, in order that we may make ourselves generally intelligible. Thus, if a person die from the effects of carbonic acid, of confined air, of sulphuretted hydro- gen, or of other noxious gases, he is commonly said to die suffo- cated. Strictly speaking, he dies poisoned — as much so as if he had taken oxalic or hydrocyanic acid. The only differences are : 1. That the poison, instead of being liquid or solid, is gaseous ; and 2. Instead of being applied to the mucous membrane of the stomach, it afi^ects that of the air-cells of the lungs. In the action of arseni- uretted hydrogen we have a clear instance of poisoning by a gas, and in the respiration of the narcotic vapors of chloroform and ether we have also illustrations of this form of poisoning. Owing to the fact that the poisonous material is in a finely divided state, and that in the air-cells of the lungs it meets at once with a large ab- sorbing surface, and instantly enters the blood, the effects are more rapid, and cceteris paribus, more powerful. It has been remarked, too, that some (and probably all) of these aerial poisons have an ac- cumulative action, i. e., their effects continue to increase for a short period, even after a persou has ceased to respire them. The cause of death mistaken. — The greater number of the poison- ous gases are chiefly complex products of art, and are never likely to be met with in the atmosphere so abundantly as to produce inju- rious consequences ; hence, fatal accidents arising from their inha- lation most commonly occur under circumstances which can leave no question respecting the real cause of death. The peculiar effects of all of these it will not be necessary to descinbe in this place ; but SUFFOCATION BY CAEBONIC ACID. 447 there are two, a knowledge of the properties and operation of which may, on certain occasions, be required of a medical jurist ; these are the CAEBONIC ACID and sulphueetted hydrogen gases. Agents of this description can rarely be employed with any certainty as in- struments of murder ; and if they were so emploj'ed, the fact could be established only by circumstantial evidence. One alleged in- stance of murder by carbonic acid is, however, reported by M. De- vergie. ("Ann. d'Hyg." 1837, vol. 1, p. 201.) Death, when arising from the respiration of any of the gases, is generally attributable to suicide or accident. In France, it is by no means uncommon for a person to commit self-destruction by sleeping in a closed apartment, in which charcoal has been suffered to burn ; while in England, ac- cidental deaths are sometimes heard of, where coal or coke has been employed as fuel in small and ill-ventilated rooms. On such occa- sions, a person may be found dead without any apparent cause to the casual observer. The face may appear pale or livid, and the skin may be covered with patches of lividity. The discovery of a body under these circumstances will commonly be sufficient, in the eyes of the vulgar, to create a suspicion of murder ; and some per- son, with whom the deceased may have been at that period on bad terms, will perhaps be pointed out as the murderer. In such a case, it is obvious that the establishment of the innocence of the accused, will depend entirely on the discrimination and judgment of a med- ical practitioner. An instance, illustrative of the consequences of this popular prejudice, occurred in London in 1823. Six persons were lodging in the same apartment, where they were all in the habit of sleeping. One morning, an alarm was given by one of them, a female, who stated that on rising she found her companions dead. Pour were discovered to be really dead, but the fifth, a married man, whose wife was one of the victims, was recovering. He was known to have been on intimate terms with the woman who gave the alarm, and it was immediately supposed that they had conspii'ed together to destroy the whole party, in order to get rid of the wife. The woman who was accused of the crime was imprisoned, and an account of the supposed barbarous murder was soon printed and circulated in the rtietropolis. Many articles of food about the house were analyzed in order to discover Avhether they contained poison, when the circumstances were explained by the man stating that he had placed a pan of burning coals between the two beds before going to sleep, and that the doors and windows of the apartment were closed. (Christison, p. 583.) A set of cases of a similar kind, in which there was at first a strong suspicion of poisoning, has been reported in the " Medical Gazette," by Mr. Smith, of Liverpool (vol. 36, p. 937 ; see also "Ann. d'Hyg." 1843, vol. 2, p. 56). Caebonic Acid. i is freely libei mentation This gas is freely liberated in respiration, combustion, and fer- lentation ; it is also produced in the calcination of chalk or lime- 448 SUFFOCATION BY CARBOlSriC ACID. stone, and is sometimes diffused through the shafts and galleries of coal-mines, where it is commonly called " choke-damp." Carbonic acid-gas is likewise met with in wells, cellars and other excavations in the earth. In these cases, it is generally found most abundantly on the soil, or at the lower part of the well ; and it appears to pro- ceed from the decomposition of animal and vegetable matters con- fined in such situations. The slow evaporation of water strongly charged with the gas, while trickling over the sides of these exca- vations, may likewise assist in contaminating the air. Damp saw- dust or straw slowly absorbs oxygen from a confined atmosphere, and sets free carbonic acid. Sir Humphrey Davy believed that carbonic acid, in a perfectly pure state, did not pass into the trachea when an attempt was made to respire it ; the glottis seemed to close spasmodically at the mo- ment that the gas came in contact with it. On diluting the car- bonic acid with about twice its volume of air, he found that he could breathe it ; but it soon produced symptoms of giddiness and somnolency. In a diluted state, there is no doubt that it penetrates into the lungs, and that it is absorbed and circulated with the blood. In estimating the effects of this gas when mixed with air, a dis- tinction must be made. The gas may be simply added to the air, or it may be produced at the expense of the oxygen in the inclosed space or apartment. In the latter case, it must be remembered that every volume of carbonic acid thus produced represents an equal volume of oxygen removed. Such an atmosphere is, there- fore, more destructive than another in which the air and gas are in simple admixture. If we assume that in each case the noxious atmosphere contains 10 per cent, of carbonic acid, then in one in- stance there will be 7 per cent, more of oxygen and 7 per cent, less of nitrogen than in the other, since the production of 10 parts of carbonic acid as a result of combustion implies the loss of 10 parts of oxygen. This difference in the proportions may not be, prac- tically speaking, correct, because there is no apartment sufficiently closed to prevent air rushing in fi'om the exterior while combustion is going on within it ; but, nevertheless, the above statement may be taken as an approximation to the truth. The statements made by chemists and physiologists, respecting the proportion of carbonic acid in air required to produce noxious or fatal effects on human beings, are very conflicting. Small ani- mals, such as birds and mice, have been generally made the subject of experiments, but the result thus obtained cannot be satisfactorily applied to show the relative action of carbonic acid on man. Ber- zelius stated that a proportion of 5 per cent, in air was not injurious, and that such a mixture might be usefully employed in the treat- ment of consumption. (" Traitede Chimie," t. 2, p. 83.) Allen and Pepys inferred, from their experimeyts on guinea-pigs, that 10 per cent, of the gas would prove fatal to man. In the more recent ex- periments of Bernard this inference is corroborated by the fact that a bird died in two and a half hours in an atmosphere consisting (in 100 parts) of 9.5 of carbonic acid, 28 of oxygen, 62.5 of nitrogen. POISONOUS PROPORTIONS. 449 (" Les Substances Toxiques," 1857, p. 135.) In this case the pro- portion was less than 10 per cent., while the proportion of oxygen was 7 per cent, more than that existing in the atmosphere. On the other hand, Demarquay says that one part of carbonic acid and three parts of air (25 per cent.) produce in man but slight discom- fort after being breathed for some time. According to this writer, most of the accidents caused by charcoal-vapor, confined air, and gases in fermenting vats are wrongly ascribed to carbonic acid, and should be attributed to carbonic oxide, sulphuretted hydrogen, alcoholic vapors, or other gases not yet understood. (" Chem. News," Aug. 4, 1865.) Those who have employed mixtures of car- bonic acid and air for anaesthetic purposes have stated that air con- taining 20 per cent, of carbonic acid may be breathed without any injurious effects. Such a mixture would be composed (in 100 parts) of 20 of carbonic acid, 16 of oxygen, and 64 of nitrogen. In this mixture, if carefully made, oxy-combustion cannot be maintained ; hence, if there was no error in the above proportions, it follows that a man can breathe with safety and live in air in which a candle will not burn. Bernard's carefully performed experiments are adverse to these statements. He found that animals died in atmos- pheres in which the proportion of carbonic acid varied from 12 to 18 per cent., while the amount of oxygen varied from 5 to -30 per cent. (" Les Substances Toxiques," p. 140.) When it is asserted that a person can thus breathe with impunity proportions which are fatal to life, it would be desirable to know how such mixtures' were made, and whether proper care had been taken to prevent respiration of air by the mouth and nostrils, while the supposed poisonous mixture was being inhaled. Such statements, founded on imperfiect experiments, are highly mischievous, for they may lead to death in cases in which the mixture is accurately made, and administered to a person whose mouth and nostrils are closed against the ordinary atmosphere. Symptoms. — The symptoms of poisoning by carbonic acid vary according to the proportion in the air which is breathed. In a concentrated state, there is sudden insensibility, followed by death, unless the person is immediately removed into pure air. When the air is gradually poisoned, and contains its lowest poisonous pro- portion, insensibility comes on more slowly, and as in ordinary narcotic poisoning, is preceded by giddiness, somnolency, and loss of muscular power. When the gas is\n a fatal proportion, the symptoms commonly observed are as follows : A sensation of great weight in the head ; a sense of pressure in the temples ; a ringing in the ears, with a pungent sensation in the nose ; a strong tendency to sleep, accompanied by giddiness ; and so great a loss of muscular power, that, if the person be at the time in an erect posture, he instantly falls to the ground as if struck. The breathing, which is observed to be at first difficult and stertorous, becomes suspended. The action of the heart, which oi} the first accession of the symp- toms is very violent, soon ceases ; sensibility is lost, and the person now falls into a profound coma, or state of apparent death. The 2y 450 POST-MORTEM APPEARANCES — ANALYSIS. warmth of the body still continues ; the limbs are relaxed and ■flexible, but they have been observed in some instances to become rigid, or even occasionally convulsed. The countenance is livid, or of a leaden color, especially about the eyelids and lips, but on some occasions it has been pale and placid. The access of these symptoms is stated to have been sometimes accompanied by a pleasing sensation of delirium, while at others, the most acute pains have been suffered. In some instances, there appears to have been irritability of the stomach, for the affected person has vomited tlie contents of his stomach in a semi-digested state. Those who have been resuscitated have felt pain in the head, or pain and soreness over the body for several days ; while, in a few severe cases, paraly- sis of the muscles of the face has supervened on recovery. Post-mortem afpearances. — In some instances, the face has been found livid and swollen and the features distorted, but more gene- rally, it has been pale and placid, as if the person had died without a struggle in the position in which his body was found. The skin is sometimes livid, or presents patches of lividity, and the limbs are quite flaccid. The pupils have been found dilated. Internally, the venous system is filled with liquid blood of a dark color. In death from carbonic acid as a result of combustion, the blood has sometimes had a light-red color. The vessels of the lungs and brain are observed to be especially in a state of congestion. The tongue appears swollen, and sometimes the mucous membrane of the intestinal canal presents dark ecchymosed patches. The fol- lowing appearances were met with thirty hours after death in the bodies of two adults, male and female, who died from the acci- dental introduction of carbonic acid into their bedroom from burn- ing ashes. Externally, there was nothing unnatural, excepting a few slight discolorations on the back of the man ; internally, there was congestion of the membranes and great vessels of the brain. Each lateral ventricle contained about half an ounce of clear serum ; the lungs were gOrged with dark blood, and the lining mem- brane of the air-tubes (bronchi) was slightly reddened. The left sides of the heart were nearly empty ; the right contained a quantity of dark half-coagulated blood. The stomachs were healthy. The hodies were found on the floor of the bedroom in easy positions. The deceased persons had had the power to get out of bed, but were unable to escape fijom the chamber. It will be perceived from this description that there is nothing very characteristic in the appearances, and thus it is always easy to ascribe death to apo- plexy or some other cause ; but it should be remembered that car- bonic acid itself is a narcotic poison, inducing cerebral congestion and apoplexy. Analysis. — Sometimes a medical jurist may be required to state for the purposes of justice, the nature of the gaseous mixture in which a person may have died. There will be no difficulty in determining whether carbonic &cid is, or is not, the deleterious agent in such a mixture. When it exists in a confined atmosphere its presence may be identified, if previously collected in a proper TESTS FOR CARBONIC ACID. 451 vessel, by the following characters : 1. It extinguishes a taper if the proportion be above 12 or 15 per cent. 2. Lime-water, or a solu- tion of subacetate of lead, is instantly precipitated white when poured into ajar of the gas; and the precipitate thus formed may be collected by filtration, and proved to possess the well-known pro- perties of carbonate of lime, or lead. Air containing only 1 per cent, of carbonic acid aft'ects lime-water : if it amounts to 2 per cent., a few cubic inches will suffice to show its presence by the lime-water test. The proportion in which carbonic acid exists in a mixture may be determined by introducing into a measured quan- tity, in a graduated tube over mercury, a strong solution of potash. Absorption will take place after a certain time, and the degree of absorption will indicate the proportion of carbonic acid present. When this gas exists in a confined spot, as in a well or cellar, it may be got rid of by placing within the stratum a pan containing the hydrate of lime loosely mixed with water; by exciting com- bustion at the mouth of the pit ; or, what is better when available, by a jet of high- pressure steam. Lives are often successively lost on these occasions, in consequence of one person descending after another, in the foolish expectation of at least being able to attach a rope to the body of his companion. The moment that the mouth comes within the level of the invisible stratum of gas, muscular power is lost, and the person commonly sinks lifeless. Carbonic acid may be collected for the purpose of testing, by lowering a bottle filled with fine sand, by means of a string attached to the neck, and guiding the bottle by another string attached to its base. When the bottle is within the stratum, it should be turned with its mouth downwards ; and when the sand has fallen out, it may be rapidly raised, with its mouth upwards, by pulling the string attached to the neck. Combustion in mixtures containing carbonic acid. — In reference to suffocation by carbonic acid, there is one circumstance which re- quires attention. It is a matter of popular belief — and, in fact, it is generally asserted by writers on asphyxia — that the burning of a candle in a suspected mixture of carbonic acid and air, is a satis- factory proof that it may be respired with safety. The results of some experiments on this subject have led me to the conclusion that a candle will burn in air which is combined with even 10 or 12 per cent, of its volume of carbonic acid gas ; and although such mixtures might not prove immediately fatal to man, yet they would soon give rise to giddiness, insensibility, and ultimately death, in those who, after having been once immersed in them, did not hasten to quit the spot. In air containing a smaller proportion than this (5 or 6 per cent.), a candle will readily burn, but it is probable that such a mixture could not be long respired without causing serious symptoms ; hence the burning of a candle can be no criterion of safety against the effects of carbonic acid. It is true that in gaseous mixtures, where a candle is extinguished, it would not be safe to venture ; but the converse of this proposition is not true — namely, that a mixture in which a candle burns may be 452 CHARCOAL-VAPOR. always respired with safety. It has been observed on several occa- sions, that the combustion of charcoal has been maintained in a room in which persons have been found in a state of insensit)ility from breathing the vapors. Charcoal-vapor. Carbonic Oxide. Gases op Blast Furnaces. The vapor extricated durinsj the combustion of charcoal is not pure carbonic acid, but a mixture of gases. It operates fatally when respired, partly in consequence of the carbonic acid contained in it, and partly from the presence of a variable proportion of car- bonic oxide. The proportion of these gases, however, is subject to variation, according to whether the combustion is vivid or not. When the charcoal burns vividly, the quantity of carbonic oxide was found by Orfila to be less than when it is either nearly extin- guished, or beginning to burn. In the former case, the carbonic oxide was in the proportion of about 11 per cent, by volume — in the latter, the proportion amounted to about 14 per cent. Leblanc found that charcoal burning in the open air produced about J per cent, of carbonic oxide. There is no doubt that a low or imper- fect combustion is more favorable to the production of this gas, and it is considered to operate more powerfully on the body than carbonic acid. According to Leblanc, a bird was killed instantly by breathing an air containing 4 or 5 per cent, of carbonic oxide; only 1 per cent. suiBced to cause death in two minutes. (" Ann. d'llyg." 1843, vol. 2, p. 54.) Charcoal-vapor may be regarded as a mixture of carbonic acid, carbonic oxide, aqueous vapor, and air partially deoxidized. There is also associated with it, at a low temperature, a small quantity of carburetted hydrogen. This does not appear to take any part in the fatal effects produced by the vapor ; these are owing to the action of carbonic acid and carbonic oxide, and according to Bernard a mixture of the two is more de- structive than either gas separately. (" Les Substances Toxiques," p. 212.) M. Leblanc endeavors to determine the proportion of the gases in charcoal-vapor, when this was in such a condition as to prove fatal to animal life. The vapor was conducted from some fully ignited fuel, into an inclosed space in which there was a middle-sized dog whose condition could be watched. In ten minutes the animal fell exhausted, and in twenty minutes it died, after some hard breathing. A candle burnt with its usual bright- ness in the closed room, and it was only ten minutes after the death of the dog that the flame of the candle, from becoming paler and paler was extinguished. The air of the chamber was at this time collected and analyzed ; it contained, in 100 parts — carbonic acid, 4.61; carbonic oxide, 0.54; carburetted hydrogen, 0.04; oxygen, 19.19 ; and nitrogen, 75.62. It would thus appear that less than 5 per cent, of carbonic acid is fatal to life when so little as J per cent, of carbonic oxide is mixed with it. (Bernard, op. eit. p. 159.) The burning of a candle under the circumstances will also show that oxy-combustioii may be maintained in a mixture by which SYMPTOMS AND APPEARANCES. 453 an animal is killed, and therefore that combustion can furnish no criterion of safety in apartments in which charcoal has been burnt. Symptoms and appearances after death. — The following case, illus- trating the effects of charcoal- vapor, occurred to Mr. Collambell. (" Med. Gaz." vol. 27, p. 693.) In January, 1841, a man was en- gaged to clean the windows of three small rooms on the basement- floor of a house. The first room had a door opening into a court- yard ; the others merely communicated with each other by a central door, and there was no fireplace in any one of them. A brazier of burning charcoal had been placed in the'outer room for the purpose of drying it, but it appeared that the deceased had shut the outer door, and had removed the brazier into the inner room of the three, leaving the communicating doors open. In two hours the man was found quite dead, lying on the floor of the middle room. The countenance was pale, as well as the whole of the skin ; the eyes were bright and starina;, the pupils widely dilated, the lips blood- less, the jaws firmly fixed, the tongue protruding, and the face and the limbs were cold. Some frothy mucus had escaped from the mouth. The person who discovered the deceased found the ashes in the brazier still burning, and he experienced great oppression in breathing. An inquest was held, but without an inspection of the body, and a verdict of " accidental death " returned. The body was afterwards privately inspected by Dr. Collambell. On opening the head, the vessels on the surface of the brain were found much distended with dark liquid blood ; the pia mater was bedewed with serum. The brain was of unusually firm consistency, and numer- ous bloody points appeared on making a section of it. The lateral ventricles were distended with about an ounce and a half of pale serurp, and the vessels of the plexus choroides were much congested. The cerebellum was firm, and presented on section numerous bloody points.. About two ounces of serum, tinged with blood, were col- lected from the base of the skull. The lungs had a slate color. On the left side of the chest there were eight ounces of serum tinged with blood, and nearly an equal quantity on the right side. On cutting into the organs, a large quantity of serous fiuid, mixed with blood, escaped. The bronchial tubes were filled with a frothy fiuid tinged with blood. The pericardium contained an ounce of pale serum ; the heart was enlarged, its cavities contained no blood ; the liver and kidneys were, however, much gorged. There was no doubt that the cause of death was the inhalation of charcoal-vapor; and it is probable that the man died from respiring but a compara- tively small proportion. The capacity of the chambers must have nearly reached two thousand cubic feet ; the deceased had been there only two hours, and when the persen who discovered him entered the rooms, the air was not so vitiated but that he could breathe, although with some oppression. The fuel was then in a state of combustion. In a case of death from charcoal-vapor, which was referred to me for examination in 1851, there was a considerable effusion of blood in the submucous tissue of the stomach. This appearance led to a strong suspicion of irritant poisoning. A full 454 CHAECOAL-VAPOR. investigation of the circumstances, however, showed that the sus- picion was unfounded. The vapor had descended through a flue communicating with the hedroom in which deceased slept with her husband : it destroyed the wife, and nearly killed the husband. A stove with burning charcoal had been placed in the room above that in which the couple slept, and an iron pipe conveyed the pro- ducts of combustion into a flue, whence they descended into the bedroom and caused the fatal accident. In one fatal case there was copious bleeding from the nose. (" Med. Gaz." vol. 47, p. 412.) In a case which occurred to M. Gu^rard, the liver and spleen were found gorged with a dark liquid blood ; the heart was collapsed and its cavities were empty, but liquid and dark-colored blood flowed from the large vessels. The windpipe and bronchi had a red color, and were filled with frothy mucus. The membranes of the brain were congested, and the sinuses gorged with fluid blood. The face was pale, the eyelids were closed, and the pupils natural. There were livid patches over the body. ("Ann. d' Hyg." 1843, vol. 2, p. 57.) It often excites surprise on these occasions that no exertion 'is made to escape, when it would apparently require but slight eflbrts on the part of the person aft'ected. The action of this vapor is very insidious ; one of its first effects is to create an utter prostration of strength, so that even on a person awake and active, the gas may speedily produce a perfect inability to move or to call for assistance. For a case illustrative of the dangerous eflect of the diluted vapor, see " Ed. Med. and Surg. Journ." vol. 1, p. 541. In this instance, a charcoal brazier was left, only for a short time, in the cell of a prison. It was removed, and the prisoners went to sleep. They ex- perienced no particular efi^ects at first, but after some hours two were found dead. Thus, then, an atmosphei-e which can be breathed for a short time with impunity, may ultimately destroy life. M. Devergie has shown that the smothered combustion of wood may lead to the evolution of a noxious vapor (carbonic oxide), and give rise to dangerous consequences. ("Ann. d'Hyg.," 1835, vol. 1, p. 442.) His remarks have been recently confirmed by two cases published by MM. Bayard and Tardieu. A man and his wife were found dead in bed. There was a smoky vapor in the apartment, but no fire had been lighted in the grate, and the chimney was blocked up. The planks of the floor were widely separated, and there was a large hole in the boards at the foot of the bed commu- nicating with the apartment below. It was found, on examination, that some joists connected with the flue of an iron plate, which had been heated for making confectionery the previous day, were in a smouldering state ; that the vapor had entered the bedroom of the deceased through the crevices in the floor, and, not finding a vent by the chimney, had led to these fatal results. It is remark- able that the source of combustion was nearly nine yards distant, and one person, who slept nearer to the flue of the iron plate, en- tirely escaped. In the body of the husband, the skin was of a red- dish tint, the blood liquid, the cavities of the heart, empty, the EFFECTS OF CARBONIC OXIDE. 455 lungs gorged, and there were no subpleural ccchymoses. In the body of the wife, there was less redness of the skiu ; the blood was coagulated in the cavities of the heart, principally on the right side extending to the vessels ; less engorgement of the lungs, and a great number of subpleural ecchymoses, indicating that strong efforts had been made to respire. There was at first a rumor of poisoning, which was only removed by a close examination of the locality. ("Ann. d'Hyg.," Oct. 1845, p. 369.) It may be observed in reference to this vapor, that when pro- duced from burning charcoal or wood — in spite of the great density of carbonic acid, the noxious gas is diffused rapidly throughout the whole of an apartment. This is owing partly to the effect of the heated current of air, and partly to the law of the diffusion of gases, whereby heavy and light gases are soon uniformly intermixed. Carbonic oxide. — The noxious effects of the vapor of burning charcoal are considered to be partly due to the presence of carbonic oxide. The action of this gas upon animal life has been made a subject of experiment by Bernard (" Le9ons sur les Substances Tox- iques," p. 164.) An atmosphere containing from 5 to 6 per cent, of it will destroy life. The blood is brightened in color by this gas, while it is darkened by carbonic acid. Bernard has observed that this bright color has been retained for three weeks ; and he consid- ers the mode of action of this gaseous poison to be, that it prevents the arterial blood of the body from becoming venous, while car- bonic acid operates by preventing the venous blood from becoming arterial. (Op. cit., pp. 182, 195.) This condition of the blood as a result of the action of carbonic oxide may occasion some doubt of the cause of death, in cases of suffocation by fire. In April, 1858, an inquiry took place into the cause of death of fourteen persons, owing to a fire in a house in Bloomsbury. The medical witness, on examining the bodies, found 'a redness of the muscles and a redness of the blood. He therefore thought that death was not caused by suffocation, but from the in- halation of arsenical vapors, owing to some minerals containing arsenic having been partially consumed during the fire. But there was a total want of evidence to show that the vapors of arsenic, when breathed, would cause death so speedily as the noxious gases evolved by fire, or that they would redden the blood or muscles. On the other hand, the respiration of carbonic oxide would ex- plain these facts. It is worthy of remark that in many of the ob- served cases of death from charcoal-vapor, the blood has -had a darker color than natural: the greater solubility or carbonic acid, and the larger proportion in which it is produced, may account for this effect. The action of carbonic oxide on the body is that of a pure nar- cotic poison. M. Tourdes has ascertained that rabbits died in twenty-three minutes, when kept in an atmosphere containing ■ l-15th of its volume of pure carbonic oxide ; when the proportion was l-30th they died in thirty-seven minutes, and when l-8th in seven minutes. Dr. Letheby states that in.his experiments a mix- 456 VAPOKS OF COAL AND COKE. ture of J per cent, killed small birds in three minutes, and of 1 per cent, in about half this time. The animals showed no sign of pain: they fell in a state of insensibility, and either died at once, without convulsions, or they gradually passed into a state of profound coma. He found, on inspection, that the blood was redder than usual, that the muscles of the heart were somewhat gorged, and that the brain was congested. ("Lancet," March 1, 1862, p. 219.) Dr. Hoppe- Seyler states that animals which had been made to breathe car- bonic oxide were restored by continuing for some time artificial respiration, and under these circumstances, the gas was expired as carbonic acid, having undergone further oxidation in the blood. This writer has suggested a method for detecting the presence of carbonic oxide in the blood by spectral analysis. (" Chem. ISTews," Aug. 4, 1865, p. 58.) Among the appearances observed in animals destroyed by this gas, Ssabinski has pointed out an ancemic condition of the spleen. This organ had a rose-red color, but when a section of it was made, scarcely any blood flowed from it. (Horn's "Vierteljahrsschrift," 1867, 2, 171.) Coal and Coke Yapoks. Sulphurous Acid. Products from burning coal and coke. — The gases extricated in the ' smothered combustion of coal or coke are of a compound nature. In addition to carbonic acid and carbonic oxide, we may expect to find in the atmosphere of a close room in which such a combustion has been going on, sulphurous acid gas ; and from coal, in addition to this, the sulphuretted and carburetted hydrogen gases. These emanations are equally fatal to life ; but in consequence of their very irritating properties, they give warning of their presence, and are, therefore, less liable to occasion fatal accidents. From an acci-, dent which occurred at Colchester a few years since, in which two children lost their lives, it would appear that some persons are so ignorant as to believe that the vapor of coke is less fatal than the vapor of charcoal. The sulphurous acid gas, when existing in a small proportion in air, has the eflect of irritating the air-passages so violently that, if accidentally respired, it would commonly com- pel the person to leave the spot before the vapors had become suffi- ciently concentrated to destroy life. ISTevertheless, accidents from the combustion of coal and coke sometimes occur. SynSptoms and appearances. — The following cases will convey a knowledge of the symptoms and appearances which may be met with on these occasions. Some years since four persons, in a state of asphyxia, were brought into Gruy's Hospital. It appeared that on the previous evening they had shut themselves up in the forecastle of a coal-brig, and had made a fire. About six or seven o'clock on the same evening, some of the crew accidentally placed a covering over the flue on the outside, and thus stopped the escape of smoke from the fire, which was made of a kind of coal containing much sulphur. Early in the morning one of the crew, on opening the VAPOES OF LIME AND BRICK-KILNS. 457 hatches, ohserved three of the inmates Ijang on the floor senseless and frothing at the mouth, and the fourth in his crib in a similar condition. The air in the place was most ofli'ensive. After the men were brought on deck one of them, aged 21, began to recover, and when brought to the hospital he seemed only giddy, as if in- toxicated ; he soon completely recovered. Another, aged 40, after breathing oxygen-gas, and having brandy and ammonia adminis- tered to him, showed no symptoms of recovery, but died in a few hours. A third, aged 17, soon began to rally, and in a short time he was able to answer questions ; he declared that at the time of the accident he felt no pain, sense of oppression, or weight, either in his head or chest. The fourth, aged 15, died the following day, having shown no symptoms of i-allying. Stimulants were admin- istered, and warm fomentations were used, but all efforts to produce reaction failed. The appearances presented by these persons when brought in, were as follows : The lips were purple, the countenance was livid, and the surface of the body cold ; the hands and nails were purple ; the breathing was quick and short — the pulse small, quick, and feeble ; the pupils were fixed, and there was total in- sensibility. The body of the man aged 40 was inspected four hours after death. Tlie membranes of the brain were congested, and there was a large quantity of fluid under the arachnoid or middle mem- brane ; the sinuses were gorged with blood ; the lungs were in a state of great congestion, as were also the right cavities of the heart. It was remarked that, in its congested condition, this corpse was similar in appearance to that of an executed culprit. The body of the lad aged 15 was inspected about thirty-three hours after death. Under the pia mater, or itmer membrane of the brain, was ob- served one small ecchymosed spot ; in the substance of the brain there were more bloody points than usual ; a small quantity of fluid was found under the arachnoid membrane, and the sinuses were full of coagulated blood. The lungs showed no congestion, but the right cavities of the heart were much distended with blood. (For a report of cases of recovery from the efteets of coal-vapor, see " Med. Gaz." vol. 9, p. 935 ; also " Dub. Med. Press," Jan. 31, 1849, p. 69, and " Med. Gaz." vol. 43, p. 937.) Analysis. — Sulphurous acid is immediately known by its powerful and suffocating odor, which resembles that of burning sulphur. The best test for its presence is a mixture of iodic acid and starch, which speedily acquires a hlue color when exposed to the vapor. The products of the combustion of impure coal-gas are equally destructive to life ; they consist of carbonic acid and sulphurous and nitric acids. Vapoes of Limb, Brick and Cement-Kilns. Gaseous products from lime-burning. — In the burning of lime, car- bonic acid is given out abundantly, but, owing to the nature of the fuel used, carbonic oxide and sulphurous acid are mixed with it. Persons who have incautiously slept in the neighborhood of a 458 EFFECTS OF CONFINED AIR, burning lime-kiln during a winter's night, have been destroyed by the respiration of these vapors. The discovery of a dead body in such a situation would commonly suffice to indicate the real cause of death ; but a practitioner ought not to be the less prepared to show that there existed no other apparent cause of death about the person. It is obvious that a person might be murdered, and the body placed subsequently near a kiln by the murderer in order to avert suspicion. If there are no marks of external violence, the stomach should be carefully examined for poison ; in the absence of all external and internal injuries, medical evidence will avail but little ; for a person might be criminally suffocated, and his body, if found under the circumstances above stated, would present scarcely any appearances upon which a medical opinion could be securely based. The vapors of brick-kilns are equally deleterious, the prin- cipal agent being carbonic acid mixed with carbonic oxide ; although I have found that, according to the stage of combustion of the fuel, ammonia, hydrochloric acid, sulphuretted hydrogen, and sulphurous acid may be evolved. In September, 1842, two boys were found dead on a brick-kiln near London, whither they had gone for the purpose of roasting potatoes. Although the cause of death in both cases was clearly suffocation, in one instance the body was extremely livid while in the other there was no lividity whatever! Such accidents are frequent ; in November, 1844, an inquest was held at Manchester on the body of a man who had died under similar cir- cumstances. The vapors of cement-kilns are quite as noxious as those of brick-kilns ; carbonic and sulphurous acids predominate in them. Confined Air. Symptoms and effects. — An animal confined within a certain quan- tity of air, which it is compelled to breathe, will soon fall into a state of lifelessness. A human being in the same way may be suffocated, if confined in a close apartment where the air is not sub- ject to change or renewal, while the products of respiration are accumulated ; and the effects are hastened when a number of per- sons are crowded together in a small space. The change which air, thus contaminated by breathing, undergoes maybe very simply stated. The quantity of nitrogen in 100 parts will remain neai-ly the same ; the quantity of oxygen will probably vary from 8 to 12 per cent., while the remainder will be made up chiefly of carbonic acid. If many persons are crowded together, the air will acquire a high temperature, and will be saturated with aqueous vapor which contains decomposing animal matter derived from the lungs and skin. Prom this statement, it is evident that air which has been contaminated by continued respiration will operate fatally on the human body, partly in consequence of its being deficient in oxygen, and partly from the noxious effects of the carbonic acid contained in it. The proportion in which cai-bonic acid exists in respired air is subject to variation ; according to the experiments of Allen and COAL-GAS — CAEBURETTED HYDROGEN. 459 Pepj's, it never exceeds 10 per cent, by volume of the mixture, how frequently soever it may have been received into and expelled from the lungs. The influence of respiration on air may be thus stated : An adult consumes from one to two gallons of air per minute, and the air expired contains from 4 to 5 per cent, of carbonic acid ; but it is a remarkable fact that, when a person continues to breathe the same air, the proportion of carbonic acid expelled is reduced at each successive respiration. "When the amount in air has reached 10 or 12 per cent, no more is thrown oft" by the lungs, and the blood is no longer depurated. For healthy existence, a human being re- quires 20 cubic feet or 125 gallons of air per hour. A common candle will consume as much as two gallons of air per minute, or render that quantity of air unfit for respiration. Dalton found that the air in crowded rooms contained about 1 per cent, of car- bonic acid, the atmospheric proportion being therefore increased nearly twenty-fold. It is certain that insensibility and death would ensue in a human adult before the whole of the oxygen of the con- fined air had disappeared ; but the opportunity can rarely present itself for analyzing such a contaminated mixture, and hence it is impossible to specify the exact proportion in which carbonic acid would exist when the confined air proved fatal to persons who had respired it. M. Lassaigne has shown, by direct experiment, that the carbonic acid in the air of close rooms is not collected on the floor, but equally diffused throughout. The whole mass of air is, in fact, vitiated, and requires renewal. (" Med. Gaz." vol. 38, p. 351; see also "Eeport on Mines,"* 1864, App. B, p. 196, and « Chemical ISTews," Feb. 17, 1865, p. 79.) Coal-Gas. Caeburettbd Hydrogen. Coal-gas is a compound which, when respired, acts directly as a poison. Many fatal accidents have occurred from the respiration of air contaminated with it. Its composition is subject to much variation, according to circumstances. Mitscherlich found that it was principally composed of light carburetted hydrogen, hydrogen, and carbonic oxide, in the proportions of 66 per cent, of the first, 21.3 of the second, and 11 of the third. M. Tourdes found that the proportions of light carburetted hydrogen and carbonic oxide were nearly equal, i. e., about 22 per cent. An analysis of coal-gas as supplied to London shows that in 1000 parts it contains — of hydrogen, 464.3 ; of light carburetted hydrogen, 389.3 ; carbonic oxide, 56.2; olefiant gas, 38.6; watery vapor, 24.8; nitrogen, 22.2; carbonic acid, 4.6. The difference in composition depends on the heat to which the gas has been submitted. Some consider that car- bonic oxide is the poisonous principle ; but there is no doubt that the hydrocarbons also have a specially noxious influence, although the use of the safety-lamp in mines proves that a mixture of light carburetted hydrogen with air in an explosive proportion, may be respired without producing serious effects. 460 EFFECTS OF COAL-GAS. Symptoms and appearances after death. — The symptoms produced by coal-gas, when mixed in a large proportion with air, are — giddi- ness, headache, nausea with vomiting, confusion of intellect, loss of consciousness, general weakness and depression, partial paralysis, convulsions, and the usual phenomena of asphyxia. The appear- ances after death will be understood from the following cases. In January, 1841, a family residing at Strasburg respired for forty hours an atmosphere contaminated with coal-gas, which had escaped from a pipe passing near the cellar of the house in which they lodged. On the discovery of the accident four of the family were found dead. The father and mother still breathed, but in spite of treatment, the father died in twenty-four hours ; the mother re- covered. When the five bodies were inspected there was a great difference in the appearances ; but the principal changes observed were, congestion of the brain ard its membranes — the pia mater (inner membrane) being gorged with blood, and the whole sur- face of the brain intensely red. In three of the cases, there was an effusion of blood (coagulated) on the dura mater and in the spinal canal. The lining membrane of the air-passages was strongly injected, and there was spread over it a thick viscid froth tinged with blood ; the substance of the lungs was of a bright-red color, and the blood in the vessels was coagulated. ("Ann. d'Hyg." Jan. 1842.) In two cases communicated by Mr. Teale to the " Gruy's Hospital Reports" (No. 8), there was found congestion of the brain and its membranes, with injection of the lining membrane of the air-passages ; the blood was remarkably liquid. An aged female and her granddaughter, who had been annoyed by the escape of gas during the day, retired to bed, and they were found dead about twelve hours afterwards. Mr. Bloxam has published a case of poisoning by coal-gas, which shows how easil}' life maybe destroyed by it. In November, 1861, he saw the deceased, who was a gas-fitter ; he was supported in a sitting posture on the floor. The man had accide'ntally respired coal-gas while connecting a tube with a meter. The skin was cold, the cornea glazed, and the face pale and placid ; there was some froth about the mouth, the pupils were rather dilated, and the limbs supple. There was a strong smell of gas in the place. He was working in a closet, and he was found insensible on the top of a pair of steps in a sitting posture — his head on one side, his arms hanging down, and his back leaning against the wall, in the atti- tude in which he was engaged at his work. He had evidently died quietly and placidly on his seat, and had made no attempt to decend the steps. He was last seen alive an hour before he was found dead, and he no doubt died rapidly from the inhalation of the gas. An inspection of the body was made twenty-four hours after death. Externally., the skin of the face and upper part of the body was pale — rigidity was well-marked, and there was gene- ral lividity of the back of the body as well as of the limbs. The blood was everywhere fluid. The brain and its membranes were not congested, but were rather pale than otherwise ; the ventricles EFFECTS OF COAL-GAS. 461 contained a pale serum. The brain and cerebellum were apparently healthy. There was a strong odor of coal-gas on exposing the brain. The lungs were of a dark-red color, and did not collapse on raising the chest-bone ; they were dark at the back of the lobes from gra- vitation of blood ; their structure was healthy. The windpipe and bronchi contained frothy mucus in some quantity. A powerful odor of gas was perceived on compressing the lungs. The heart was healthy; the right cavities were distended with blood — the left were nearly empty ; the hood was everywhere black. There was congestion of the abnormal viscera, but no other unusual appear- ance. (" Med.-Chir. Trans." 1862, vol. 45, p. 103.) In the cases above related, the efiects produced by coal-gas were owing to the long-continued respiration of it in a diluted state. The quantity contained in the air of the rooms must have been very small : in M. Tourdes' case it was probably not more than 8 or 9 per cent., because at a little above this proportion the mixture with air becomes explosive ; and there had been no explosion in this case,, although in the apartment in which the person was found dead, a stove had been for a long time in active combustion, and a candle had been completely burnt out. In Mr. Teale's cases, those who entered the house perceived a strong' smell of coal-gas, but still the air could be breathed. Coal-gas, therefore, like other aerial poisons, may destroy life if long respired, although so diluted as not to produce any serious eii'ects in the first instance. Insensi- bility may, however, be an early symptom in a very diluted atmos- phere, and unless the person is speedily removed into fresh air he will die. In a case which occurred to Mr. Jessop, a man entered a large open pipe four feet in diameter, which had been used for gas, to look for a leak. He thought all the gas had been let off. On entering the pipe, he perceived a sti'ong smell, and remembered nothing further. He was taken to the infirmary in an unconscious state, suffering from violent muscular contractions. He recovered in two days. (" Lancet," 1870, 2, 816.) The respiration of this gas renders a man entirely powerless to give any alarm or make any eftbrt to save himself. Stupefaction, and with this, loss of all muscular power, speedily follow the inhalation of diluted coal-gas. ("Ann. d'Hyg." 1870, 1,60.) Coal-gas owes its peculiar odor chiefly to the vapor of naphtha : its presence is thus indicated: The odor begins to be perceptible in air when the gas forms only the 1000th part ; it is easily per- ceived when forming the 700th part ; but the odor is strongly marked when it forms the 150th part (Tourdes). In most houses in which gas is burnt, the odor, owing to leakage, is plainly per- ceived ; and it is a serious question whether health and life may not often be affected by the long-continued respiration of an atmos- phere containing but a small proportion. The odor will always convey a sufficient warning against its poisonous effects. It should be known that this gas will penetrate into dwellings in an insidious manner. In Mr. Teale's cases, the pipe from which the gas had escaped was situated about ten feet from the wall of the bedroom 462 NITROUS OXIDE. where the women slept ; the gas had permeated through the loose earth and rubbish, and had entered the apartment through the floor. I have notes of several other cases in which coal-gas has thus destroyed life by leakage into bedrooms. (See " Lancet," 1872, 1, 32.) It is impossible to determine exactly what proportion of this gas in air will destroy life. An atmosphere containing from 7 to 12 per cent, has been found to destroy dogs and rabbits in a few minutes ; when the proportion was from 1^ to 2 per cent, it had little or no effect. With respect to man, it may destroy life if long breathed when forming about 9 per cent., i. e., when it is in less than an explosive proportion. (See " British and Foreign Med. Rev.," vol. 20, p. 253 ; also, " Ann. d'Hyg." 1830, 1, 457 ; also 1870, 1, 63.) The late Dr. Aldis observed in his experiments, that in ordinary coal-gas mixed with air, rats were rendered insensible in half a minute, and died in a minute and a half to two minutes. There was before death spasmodic action of the diaphragm. The gas was allowed to enter slowly into a bell-jar of air in which the animals were placed. ("Med. and Chir. Trans." 1862, 45, 100.) Analysis. — The circumstances under which the accident occurs will generally suffice to establish the nature of the noxious agent. Coal-gas burns with a bright white light, producing carbonic acid and water. A taper should be cautiously applied to a small quantity ; since, when the gas is mixed with the air in the proportion of from 11 to 14 per cent., it is dangerously explosive. For this reason no lighted candle should be taken into an apartment where an acci- dent has occurred, until all the doors and windows have been for some time kept open, and the smell of gas has entirely disappeared. (See " Med. Gaz." vol. 42, p. 343.) The combustion of the gas, or its explosion with air, is a sufficient test of its nature ; the peculiar odor and the want of action on a salt of lead, if the gas is pure, will distinguish it from sulphuretted hydrogen. ISTiTKOus Oxide. Eecent cases of death from the inhalation of this gas render a short notice of it necessary. Sir Humphry Davy was the first to show by experiments on himself that, under certain precautions, it might be breathed without danger to life, and that it had the effect of producing an agreeable species of intoxication. Sir Humphry in one experiment breathed three quarts, in another nine quarts, and in a third twenty quarts of unmingled nitrous oxide. (Brew- ster's " Natural Magic," p. 345.) He suffered no injury from in- haling these quantities, either at the time, or subsequently. I have seen it taken in quantities of about two to three quarts in more than five hundred cases, without any ill effects following. In three cases, the first symptoms were pallor of the countenance, lividity of the lips, a staggering gait, followed by violent muscular exer- tions. These ett'ecls passed off in from three to five minutes. In a few cases, a feeling of exhaustion, with headache and pain in the NITROUS OXIDE. 463 chest, followed the inhalation. Sir Daniel Brewster describes, on the authority of Professor Silliman, two cases in which some remarkable after-effects were produced. A young man who took nitrous oxide for the sake of experiment was seized with a fit of delirium, and after making some violent exertions, fell exhausted on the ground ; convulsions followed and he uttered the most piercing shrieks and cries. These symptoms continued for two hours ; he was perfectly unconscious of what he was doing, and was in every respect like a maniac. On recovery he stated that his feelings vibrated between the most perfect happiness and the most consummate misery. He recovered in three or four days, suffering only from a feeling of fatigue and exhaustion. The other case was that of a man of mature age and of a grave and respectable character. He had been suffering from bodily and mental debility just before taking the gas, of which he inhaled three quarts. The consequences were an astonishing invigoration of his whole system, with a great increase of muscular power. These effects were felt for at least thirty hours, and in a greater or less degree for more than a week. (Brewster's " ITatural Magic,' p. 349.) Passing from these exceptional cases, no instance of the gas proving fatal has been recorded until recently. Nitrous oxide has been employed extensively by oculists and dentists as a substitute for chloroform and ether, and, so far as it is known, with greater safety than these two anaesthetics, the effects passing oft more rapidly and leaving no unpleasant after-consequences. In these cases, too, it has been administered in doses, not of quarts, as in the early experiments of Davy, but of gallons. At the same time, nitrous oxide cannot be substituted for atmospheric air, without danger to life. It cannot produce in the blood those oxidative changes on which life depends, which are produced by the uncom- bined oxygen of the air. It is absorbed into the blood and changes its color to a deep purple, as indicated by the change of color in the lips. An animal soon dies in this gas when air is not supplied ; and from the symptoms preceding death, namely, convulsions and insensibility, it must be regarded as a neurotic poison, but not of a dangerous kind. In January 1873 it was administered by a dentist at Exeter to a lady, set. 38, at her own desire, in order to annul pain during the extraction of a molar tooth. A physician carefully examined her before the operation, and found that there was nothing to preclude the use of the gas. The nitrous oxide was pure ; it had been safely used for other patients from the same condenser, and an apparatus was employed so as to secure the removal of the expired air. The total quantity administered was about six gallons. This could not be regarded as an ov-erdose. Sir H. Davy himself breathed with safety five gallons in one of his experiments. Soon after the com- mencement of the inhalation, it was observed that the pulse became rapid and less full, indicating an action on the heart ; the patient was then sensible, and the apparatus was removed. The operation 46-i NITROUS OXIDE. was -commenced, but the lady insisted on having the gas again. She took it ; insensibility came on, and the operation was completed. Immediately afterwards, the face became livid, the features began to swell, and the tongue protruded. In spite of every eftbrt to re- store her, she did not recover from the state of insensibility ; she breathed two or three times, and the pulse then ceased. JSTo inspec- tion of the body was made. The above-mentioned facts were given in evidence at the coroner's inquest, and the medical opinion was that death had been caused by the gas in producing paralysis of respiration, and that in this case no forethought could have pre- vented the result. The jury returned a verdict of homicide by mis- adventure. (" Lancet," 1, 178.) It has been suggested that death may have taken place from suf- focation, by blood entering the air-passages ; but while there were no symptoms indicative of this, the facts conclusively prove that the gas operated as a blood-poison to destroy life. Nitrous oxide as an anaesthetic. — Some observations on the com- parative effects of nitrous oxide, bichloride of methylene, and cholo- form as ansesthetics, have been published by Mr. R. Rendle, Surgical Registrar of Guy's Hospital. (-' Brit. Med. Journ." Oct. 16, 1869.) He gave the nitrous oxide in twenty-four cases, the gas being re- breathed and the carbonic acid of the expired air removed by slaked lime. The. persons to whom it was given varied from 3 to 73 years of age. It was given chiefly ibr short operations on the eyes and teeth. The shortest pei'iod in which anaesthesia was produced was sixty seconds ; the longest, 150 ; the average was about a minute and a half. Anaesthesia was maintained thirteen minutes in one case, six minutes in five cases, four minutes in five, two minutes in twelve, and one minute in one case. Intervals of breathing air were allowed in all but one. The period during which air was admitted varied very much, and herein lies probably the secret of preventing fatal accidents. When the quantity of air admitted was small, anaesthesia was still produced, though less rapidly, and the blueness of the lips and skin was less marked. A woman, set. 48, was under the influence of the gas in one minute. It was continued for five minutes longer, without any admission of air. At the end of this time she was unusually blue, and the breathing and pulse were very slow and failing. The gas was removed, and the woman turned over on her left side, — the plan of restoration employed at Guy's Hospital when unpleasant symp- toms occur. This woman must have been very near death, and probably would have died had she been in the sitting posture. She gradually recovered, and walked away in five minutes more. One man who began to imbibe the gas for the extraction of a tooth, pushed away the inhaler, and refused to continue breathing the gas. He complained of very unpleasant symptoms in his head for some hours after, but these passed off. One woman complained of head- ache. In one case, that of a child set. 4, vomiting followed. In a child set. 3, where anaesthesia was maintained for a minute and a half, two intervals of breathing air having been allowed, the respi- NITROUS OXIDE. 465 ration ceased and the pulse sank so as to be scarcely perceptible for several seconds. The gas was removed, and the child was turned slowly over on his left side. He gave a deep sigh ; the pulse and respiration gradually returned, and he completely recovered in five minutes. According to Mr. Rendle, the advantages of nitrous oxide are the rapid production of, and recovery from, anfesthesia, the absence of sickness, and the agreeable taste. He considers it safe for all opera- tions, short or long, even to a duration of twenty minutes, provided there be a due admission of air at proper intervals. But that great care is required in its use is shown hy the alarming symptoms which occurred in some of the cases. Among its disadvantages are these : it is apt to produce rigidity of the muscles, with muscular twitch- ing and congestion. Mr. Tomes met with cases in which recovery was slow ; there was feeble pulse, irregular breathing, loss of appe- tite, and a necessity for stimulants. In one instance, coma was produced ; and other cases are reported of sudden supervention of dangerous symptoms — sickness and apparent death. It would appear, therefore, that the danger from nitrous oxide arises chiefly from the continuous administration of the gas, with- out allowing proper intervals for the breathing of air. In one case, supra, Mr. Rendle gave the pure gas for six minutes without the admission of air. Death did not result, although the sym2> toms were very alarming for a few minutes. (" Brit. Journal of Dental Science," May, 1871.) The fatal case above related has given rise to some difference of opinion. As the body was not inspected, the cause of death can only be a matter of inference, but all the facts known point to this conclusion — the only practical one which concerns the public — that but for the administration of the nitrous oxide, this lady would not have died. "Whether the proximate cause was asphyxia from paralysis of the muscles of respiration, or from the entrance of blood into the air-passages, is not very important. According to the report of a committee appointed to investigate the effects of nitrous oxide as an anaesthetic, the gas operated b^"^ preventing oxi- dation-changes in the blood, and, as in death from asphyxia, the respiration was arrested before the heart ceased to beat. (" Lancet," 1872, 2, 687.) See also a reference to asphyxia, vol. 1, p. 163. For some additional remarks on this case see "Lancet," 1873, 1, 245. At page 254 of the same volume will be found a report of the case by Mr. Browne Mason. [See an excellent paper by Dr. F. D. Weisse, read before the IST. Y. Med.-Leg. Society, in " N. Y. Daily Eegister," Feb. 17, 1873.— R.] It is evident that much is still to be learned respecting the ope- ration of nitrous oxide on the human body. One experienced administrator contends that air must be occasionally admitted in order to prevent fatal effects, while another states that, according to his experience, the giving of air pi-events complete insensibility, and therefore does not fulfil the purpose for which the gas is administered. (" Lancet," 1872, 2, 762.) The nitrous oxide has 30 466 SULPHURETTED HYUROGEK GAS. beyond doubt caused fewer accidents than ether and chloroform ; but there is a very narrow line between life and death in the action' of this, as well as all ansesthetics ; and it should therefore only be given by a skilled administrator. CHAPTER XLL SULPHURETTED HYDROGEN GAS. — ITS POISONOUS PROPERTIES. — SYMPTOMS. POST-MORTEM APPEARANCES.— EFFLUVIA OF DRAINS AND SEWERS. — ANALYSIS. — MEPHITIC VAPORS. — EXHALATIONS FROM THE DEAD. Sulphuretted Hydrogen has a more powerful action on the body than either carbonic acid or charcoal vapor. Persons are some- times accidentally killed by it ; but the very offensive odor which a small portion of it communicates to a large quantity of air is sufficient to announce its presence, and thus, with due caution, to prevent any dangerous consequences. Sulphurretted hydrogen gas when respired in its pure state, is instantaneously fatal. It exerts equally deleterious effects upon all orders of animals, and upon all the textures of the body. It has been found to destroy life even when it is allowed to remain in contact with the skin. When introduced into the lungs of animals, even in a diluted state, it has given rise to fatal consequences. Thus Th^nard found that air which contained gits^h of its volume of this gas would destroy a dog, and that when the gas existed in the proportion of 255th it sufficed to kill a horse. The latter researches of M. Parent Ducliatelet have, however, shown that the poisonous effects of the gas have been somewhat exaggerated, at least in the application of these results to man. He observed that workmen breathed with impunity an atmosphere containing 1 per cent, of sulphuretted hydrogen ; and he states that he himself respired, without serious symptoms ensuing, air which contained three per cent. In most drains and sewers rats and other vermin are found to live in large numbers; and, according to Gaultier de Claubry, the air in those localities contains from 2 to 8 per cent. (" Devergie," vol. 2, jx 520.) One fact, however, is worthy the attention of medical jurists — namely, that the breathing of an atmosphere only slightly im- pregnated with the gas may, if long continued, seriously affect a person, destroy health, and even cause death. M. d'Arcet was required to examine a lodging in Paris, in which three young and healthy men had died successively, in the course of a few years, under similar symptoms. The lodging consisted of a bedroom with a chimney, and an ill-ventilated ante-room. The pipe of the privy passed down one angle of the room by the head of the bed, and the wall in this part was damp from infiltration. At the time of the examination, there was no -perceptible smell iu the room, SULPHUEBTTKU HYDROGEN — SYMPTOMS. 4f)7 • although it was small and low. M. d'Arcet attributed the mor- tality in the lodging to the slow and long-continued action pf the emanations from the pipe ; and it is highly probable that this was the real cause. (" Ann. d'liyg.," Juliet, 1836.) The men who were engaged in working at the Thames tunnel suffered severely during the excavation, from the presence of this gas in the atmosphere in which they were obliged to work. As a result of breathing this atmosphere, the strongest and most robust men were, in the course of a few months, reduced to an extreme state of exhaustion, and several died. The symptoms with which they were first affected were giddiness, sickness, and general debility ; they became emaci- ated, and fell into a state of low fever, accompanied by delirium. In one case which I saw, the face of the man was pale, the lips of a violet hue, the eyes sunk with dark areolae around them, and the whole muscular system was flabby and emaciated. Symptoms. — The symptoms produced by sulphuretted hydrogen on the human body vary according to the degree of concentration in which it is respired. When breathed in a moderately diluted state, the person speedily falls inanimate. An immediate removal to pure air, and the application of stimulants, with cold affusion, may, however, suffice to restore life. According to the account given by those who have recovered, this state of inanimation is preceded by a sense of weight in the stomach and in the temples ; also by giddiness, nausea, sudden weakness, and loss of motion and sensation. If the gas in a still less concentrated state be respired for some time, coma, insensibility, or tetanus with delirium super- venes, preceded by convulsions, or pain and weakness over the whole body. The skin in such cases is commonly cold, the pulse irregular, and the breathing laborious. When the air is but slightly contaminated with the gas, it may be breathed for a long time with- out producing any serious symptoms ; sometimes there is a feeling of na!usea or sickness, accompanied by pain in the head, or dif- fused pains in the abdomen. The symptoms are often observed to affect those who are engaged in chemical manipulations with this gas. Sulphuretted hydrogen appears to act like a narcotic poison when highly concentrated, but like a narcotic irritant when much diluted with air. It is absorbed into the blood, to which it gives a brownish-black color, and it is in this state circulated throughout the body. In all cases, a noxious atmosphere containing this gas is indicated by an offensive smell, producing nausea and sickness. For a case of poisoning by this gas, in which the person recovered, see " Medical Gazette,^' vol. 43, p. 871. Appearances after death. — On examining the bodies of persons who have died from the effects of sulphuretted hydrogen, when respired in a concentrated form, and the inspection is recent,, the following appearances have been observed : The mucous membrane of the nose and throat is commonly covered by a brownish viscid fluid. An ofl'ensive odor is exhaled from all the cavities and soft parts of the body. These exhalations, if received into the lungs of those engaged in making the inspection, sometimes give rise to nausea 468 FATAL EFFECTS OF SULPHURETTED HYDROGEN. and other unpleasant symptoms, and may even cause syncope or asphyxia. The muscles of the hody are of a dark color, and are not susceptible of the galvanic stimulus. The lungs, liver, and the soft organs generally, are distended with black liquid blood. There is also great congestion about the right side of the heart, and the blood has been found everywhere liquid and dark-colored ; the body rapidly undergoes' the putrefactive process. When death has oc- curred from the respiration of this gas in a more diluted form, the appearances are less marked. There is then general congestion of the internal organs, with a dark and liquid state of the blood. In fact, in such cases the appearances can scarcely be distinguished from those produced by carbonic acid. Four men lost their lives in the Pleet Lane Sewer in February, 1861 ; they were found dead, and there was no doubt that sulphuretted hydrogen was the cause of death. An account of the appearances presented by the bodies is given in the " Lancet," by Mr. Holden and Dr. Letheby (February 23, 1861, p. 187). The eyes and mouth were open, the lips and tongue livid, the pupils widely dilated, the blood black and fluid, the lungs congested, the heart full of black fluid blood, the right side gorged, and there was a bloody froth in the windpipe. In the brain, the large vessels of the dura mater were full of black fluid blood. In June, 1857, six persons lost their lives, at Cleator Moor, near Whitehaven, by the respiration of sulphuretted hji'drogen in a di- luted form, by reason of their having slept in small, close non-ven- tilated rooms, into which the gas had penetrated. Three of the deceased persons — a husband, wife, and child, of one family [Arm- strong) — had retired to rest, in their usual health, on the night of the 9th of June. Two of them were found the next morning dead in bed, and a third (the child) was found in a state of insensibility, and lingered until the afternoon of the same day, when she died. The fourth, a healthy adult, retired to sleep in his bed, with his door closed, and he was found dead in an hour. The flfth, a child, was taken ill on the morning of the 11th, and died the same day. The sixth was taken ill on the morning of the 10th, and died on the 12th of June. The symptoms complained of by some who recovered were nausea, sickness, giddiness, and insensibility. On inspection of the body of one child, the pupils were found dilated — viscid mucus escaped from the nostrils — there was congestion of the lungs and kidneys, as well as of the membranes of the brain. In the adult who died in an hour, the pupils were natural, the jaws firmly clenched, the fingers contracted, and the nails blue; there was great cadaveric lividity, and a quantity of fluid with frothy mucus issued from the nostrils and mouth. The lungs were much congested, and serum was effused in the cavity of the chest. The heart contained a little fluid blood, and was somewhat flaccid. The membrane of the windpipe and gullet was redder than natural. In the windpipe there was frothy mucus. The stomach, as well as the large and small intestines, were highly congested, but otherwise healthy. GASES OF SEWERS AND DRAINS. 469 The brain and its membranes were greatly engorged with blood, which, as in the body generally, was very dark and fluid. Mr. J. B. Wilson, who examined the body of the child, drew the conclu- sion, which was confirmed by the subsequent inquiry, that death had been caused by sulphuretted hydrogen. Dr. Thompson, who examined the body of the man, also inferred that some noxious gas or gases had destroyed life. Ilaving been required by the Home Office to investigate the cause of death in these cases, I visited Cleator on the 22d of June, and found that the cottages in which the accidents had occurred were built upon a heap of iron-slag, which also abutted on the premises behind. This slag contained, among other matters, sulphide of iron and sulphide of calcium. A foul smell, compared to that of cinders extinguished by water, had tor some time been perceived about the rooms, chiefly at night, when the doors and windows were closed ; and the day before" the occurrence a heavy storm of rain had washed through the slag- heap, and aggravated the efteets. The heap of slag was burning in certain parts, and sulphuretted hydrogen was evolved in large quantities at a depth of a few feet below. At the time of my visit, *. e., a fortnight after the deaths, on removing the flags in the lower rooms, the slag below was found damp, and sulphuretted hydrogen was still issuing from it. The white-lead paint in the closets was partly converted into black sulphuret, and this chemical change was found in patches on the chamber door of one small room in which two persons had died. It is highly probable that the sulphuretted hydrogen was mixed with other gases and vapors, as it is never found pure except in a chemical laboratory ; but the circumstances left no doubt that it was the principal agent of death. This seems to have been clearly established by the fact, that after a channel had been cut through the slag-heap, and the slag removed, no further accidents occurred. Sewer gases. Effluvia of drains and sewers. — -The most common form of accidental poisoning by sulphuretted hydrogen (for it is rare that a case occurs which is not purelj'' accidental) is witnessed among nightmen and others who are engaged in cleaning out drains and sewers, or in the removal of nightsoil. These accidents are much more frequent in France than in England, the soil being often allowed to collect in such quantities in Paris and other large con- tinental cities, as to render its removal a highly dangerous occupa- tion for the workmen. According to the results of Th^nard's observations, there are two specie's of compound gases, or mechanical mixtures of gases, which are commonly met with in the exhalations of privies. The first compound consists of a large proportion of atmospheric air holding diffused through it, in the form of vapor, the sulphide of ammonium. The sulphide is contained abundantly in the water of the soil, and is constantly rising from it in vapor, and diftusing itself in the surrounding atmosphere. It is this vapor which gives the unpleasant and pungent odor to the effluvia, and causes an increased secretion of tears in those who unguardedly expose themselves to such exhalations. The symptoms produced by 470 GASES OF CESSPOOLS. the breathing of this gaseous mixture, when in a concentrated state, bear a close resemblance to those which result from the action of sulphuretted hydrogen gas. If a person is but slightly affected, he will probably complain of nausea and sickness ; his skin will be cold, his respiration free but irregular; the pulse is commonly fre- quent, and the voluntary muscles, especially those of the chest, are affected by spasmodic twitchings. If more strongly affected, he loses all power of sense and motion ; the skin becomes cold, the lips and face assume a violet hue, the mouth is covered by a bloody and frothy mucus ; the pulse is small, frequent, and irregular, the respi- ration hurried, laborious, and convulsive ; and the limbs and trunk are in a state of general relaxation. If still more severely affected, death may take place immediately ; or should the person survive a few hours, in addition to the above symptoms there will be short but violent spasmodic twitchings of the muscles, sometimes even accompanied by tetanic spasms. (See " Ann. d'Hyg." 1829, 2, 70.) If the person is sensible, he will commonly suffer the most severe pain, and the pulse may become so quick and irregular that it can- not be counted. When the symptoms are of such a formidable nature, it is rare that a recovery takes place. The appearances met with on making an examination of the body are similar to those observed in death from sulphuretted hydrogen. The inspection should be made with caution, for a too-frequent respiration of the poisonous exhalations may seriously affect those who undertake it. The fluid matter of cesspools is generally saturated with this gas, and contains much sulphide of ammonium, which is always escap- ing from it in vapor. This fluid is noxious, and if swallowed in quantity may cause death. The following case, which has some relation to this subject, occurred in London in 1831 : Twenty-two boys, living at a board- ing-school at Clapham, were seized in the course of three or four hours with alarn)ing symptoms of irritation in the stomach and bowels, spasms of the muscles of the arms, and excessive prostration of strength. One child, that had been similarly attacked three days before, died in twenty-five hours, and one among the last attacked died in twenty-three hours. Both of the bodies were ex- amined after death : in the first the mucous glands of the intestines were found enlarged and, as it were, tuberculated ; in the second the mucous coat of the small intestines was found ulcerated, and that of the colon softened. At first, it was suspected that the boys had been poisoned, but an analysis' of the food did not lead to the discovery of any noxious substance. The only circumstance which was considered sufiicient to explain the accident was, that two days before the first child was seized, a foul cesspool had been opened, and the materials diffused over a garden adjoining the children's play ground. This was the source of the noxious eflBuvia, accord- ing to the opinion expressed by six medical practitioners. (" Ghris- tison on Poisons," p. 810.) [The epidemic which affected so many of the visitors of the National Hotel in Washington, D. C, during the winter and TESTS FOR SULPHURETTED HYDROGEN. 471 spring of IS^T, and well known in the United States as the " 'Nn- tional Hotel Disease," affords a remarkable illustration of this form of atmospheric poisoning, in a which a large number of persons of both sexes were attacked with violent irritation of the alimentary canal, generally of the large intestines ; many having died, after variable periods of illness, and in some instances, after repeated relapses. The symptoms of irritation of the stomach and bowels presented so generally by the guests of this hotel, at a time of high political excitement, gave rise to a suspicion of metallic poisoning, which for a while became the popular belief. The evidence pre- sented at the inquest of the local Board of Health, however, en- tirely contradicted this theory, and showed not only that no irri- tant poison could have been used in the food, and that the symp- toms were not those of metallic irritation, but that they were those of poisoning by sewer emanations ; and that such emana- tions had been present to a dangerous extent in the most fre- quented parts of the house, during the whole of the three months of the epidemic visitation. The officers of the Board of Health discovered a stream of sewer gas which was flowing through a defective inlet, from a badly working culvert directly into the cel- lar of the hotel, with force enough to extinguish a lighted candle. Abundant evidences from other sources, equally indisputable, might be presented in corroboration. Repeated instances occurred of in- dividuals being taken ill after a visit to the hotel, who had neither eaten or drunk anything while in the house ; and the oftensive smell observed about the building, especially in the lower rooms, had been very generally observed. This fetor was aggravated dur- ing the prevalanee of cold weather, at which time the windows and doors were closed, and the disease increased in violence. The pathological condition was ascertained to be that of ulcerative diarrhoea, " a superficial erythematous or catarrhal inflammation of the mucous membrane of the colon." We have witnessed this peculiar effect of cesspool exhalations in various degrees, so fre- quently among prison convicts, that we were satisfied as to its true origin, before the investigations had been undertaken to contradict the erroneous hypothesis of poisoned food or drink. An epidemic of diarrhoea and general intestinal irritation, the exact counter- part of the ]!fational Hotel disease, might at any time be developed among the inmates of our prisons by a neglect of the usual cleans- ing of the privy pans and pipes. See on this subject, " Am. Journ. of Med. Sci.," Jan. 1858, p. 97 ; " Boston Med. and Surg. Journ.," vol. Ivi., 1857, pp. 305, 371, 422 ; " 'New York Journ. of Med.," July, 1857, p. 90 ; " Virg. Med. and Surg. Journ.," vol. viii. 1857, pp. 478, 514 ; "Trans. Coll. of Phys. of Philad.," New Series, vol. iii. No. 3, 1857, p. 128.— H.] Analysis. — The recognition of these gases and vapors is a simple operation. The odor which they possess is sufficient to determine tlieir presence, even when they are diluted with a large quantity of atmospheric air. The sutphureMed hydrogen gas is at once iden- tified by its action on paper previously dipped in a solution of a sa!t 472 TESTS FOR SULPHURETTED HYDROGEN. of lead ; if present, even in very small proportion (T^j'^^Tith part), the moistened paper speedily acquires a brownish-black stain from the production of a sulphuret of lead. It must not be supposed that sulphuretted hydrogen, when it has proved fatal in a diluted form, can be detected in the lungs, stomach, or blood of a dead body. When the body is recently removed from a drain or sewer, the gas may be found pervading the whole of the tissues ; but in other cases it will be as useless to look for it as for carbonic acid in poisoning by this gas. Noxious gases are not long retained by the tissues ; a short exposure will suffice to remove all traces of them. The examination of the locality can alone throw a light upon the cause of death. The proportion of the gas found in an apartment will, however, rarely be a criterion of the quantity which has de- stroyed life. A person going into a room where the deceased bodies are lying may notice only a disagreeable or a stifling smell, but he may be able to breathe for a longer or shorter period with the door or window open. It is not the respiration of a few minutes, but the breathing of the diluted noxious atmosphere for many hours, that really destroys life. The best method of detect- ing sulphuretted hydrogen when present in a dead body (not putre- fied) is to place a piece of card, glazed with lead, in the muscles or soft organs ; it will sooner or later be tarnished, and acquire a brown color, if the gas is present. Sulphuretted hydrogen may be proved to exist by the lead test in the vapor of sulphide of ammonium when mixed with air, and the presence of ammonia is indicated in the compound by its vola- tile alkaline reaction on test-paper ; also by holding, in a vessel containing the paper recently collected, a rod dipped in strong hy- drochloric acid, — the production of dense white fumes announces the formation of hydrochlorate of ammonia. The presence of this vapor in any mixture is at once indicated by introducing paper wetted with a solution of nitroprusside of sodium : the sulphide produces with it a rich crimson color. If sulphuretted hydrogen alone is present, the nitroprusside paper undergoes no change. It is a fact, which cannot be too universally known, that a candle will readily burn in a mixture of either of these gases with air which, if respired, would suffice to destroy life. (" Ann. d'Hyg.," 1829, 2, 69.) The candle-test should be applied with caution in places where these effluvia are collected and confined in sewers or close cesspools. "When sulphuretted hydrogen is diffused in a proportion of about 7 per cent, with air, it forms a dangerously explosive mix- ture. Dr. Perrin has lately investigated this subject, " Mephitisme des Fosses d'aisances." (Ann. d'Hyg.," 1872, 2, 73.) It is worthy of remark that the air of a cesspool may be often respired with safety until the workmen commence removing the soil, when a large quantity of mephitic vapor may suddenly escape, which will lead to the immediate suffocation of all present. Several persons have been killed by trusting to the previous burning of a candle, in ignorance of this fact. In descending in order to render assistance to persons who are lifeless, the person should on these occasions, whether sulphuretted hydrogen or carbonic acid be the EXHALATIONS FROM THE DEAD. 473 cause, make a moderate inspiration of pni'.e air and hold his breath while in the noxious mixture. In an accident which occurred in Whitechapel, in August, 1857, three men died speedily from breathing the vapor of an old sewer, and two others nearly lost their lives in attempting to assist them. The best plan for getting rid of the gas is by a free exposure of the locality, or by exciting active combustion in it. According to Parent Duchatelet, men can work in an atmosphere containing from 2 to 3 per cent, of sulphu- retted hydrogen. The air of one of the principal sewers of Paris gave the following results, on. analysis, in 100 parts: Oxygen, 13.79 ; nitrogen, 81.21 ; carbonic acid, 2.01 ; sulphuretted hydrogen, 2.99. Another gaseoxis mixture in the form of deoxidized air was found by Th^nard in the sewers of Paris ; it was composed, in 100 parts, of nitrogen 94, of oxygen 2, and of carbonic acid 4. Some- times the carbonic acid is combined with ammonia, and then it may be regarded chiefly as a mixture of nitrogen holding dift'ased through it the vapor of carbonate of ammonia, which is sufficient to render it highly irritating to the mucous membrane of the eyes and nose. Its action on the human body when breathed will be readily understood from its chemical composition. In its opera- tion it is essentially negative, and destroys life by cutting off the access of oxygen. The small proportion of carbonic acid or of car- bonate of ammonia existing in it cannot give rise to the asphyxia which so rapidly follows its inhalation. The chances of recovery are much greater in persons who become asphyxiated from the breathing of this compound, than in those who are exposed to the influence of the preceding. Commonly, the immediate removal to a current of pure air is sufficient to bring about a recovery. Should death take place, it will be found on inspection that the in- ternal appearances are the same as those which are met with in death from suflbcation. Analysis. — This compound has no offensive smell; it extin- guishes a taper; the carbonic acid contained in it may be removed by caustic potash, and then it will be seen that the great bulk of the mixture is formed of nitrogen — a gas which, by its negative properties, cannot be easily confounded with any other. In a mixed atmosphere of carbonic acid and sulphuretted hydrogen, the two gases may be separated by agitating the mixture with a solu- tion of acetate of lead, and treating the precipitate with acetic acid, which dissolves the cai-bonate and leaves sulphide of lead. EXHALATIONS FROM THE DEAD. It may be proper in this place to make a few remarks on the alleged danger of the exhalations given off by dead bodies in a state of putrescence. Formerly, there existed a groundless fear relative to the examination of a putrefied dead body ; and during the last century, on several important occasions, medical witnesses refused to examine the bodies of deceased persons, who were pre- sumed to have been murdered, alleging that it was an occupation 474 EXHALATIONS FBOM THE DEAD. whiet might be attended with serious consequences to themselves. Oriila has collected many accounts of the fatal effects which are re- corded to have followed the removal of the dead some time after interment. (" Traits des Exhumations," vol. 1, pp. 2 et seq.) He allows, however, that the details of most of these cases are exasj- gerated, and attributes to other causes the effects which followed. Indeed, the observations of Thouret and Fourcroy pi'ove that these dangers are restricted within a narrow compass, and that in general, with common precautions, dead bodies may^ be disinterred, and transported from one locality to another, without any risk to those engaged in carrying on the exhumations. About the latter part of the last century, from fifteen to twenty thousand bodies, in al- most every stage of putrefaction, were removed from the Cimeti&re des Innoeens in Paris ; and the accidents that occurred during the operations, which lasted ten months, were, comparatively speaking, few. The workmen acknowledged to Fourcroy that it was only in removing the recently interred corpses, and those which were not far advanced in decomposition, that they incurred any danger. In these cases, the abdomen appeared to be much distended with gase- ous matter ; if ruptui-ed, the rupture commonly took place about the navel, and there issued a bloody fetid liquid, accompanied by the evolution of a mephitie vapor — probably a mixture of carbonic acid and sulphuretted hydrogen. Those who breathed this vapor, as it escaped from the body, fell instantly into a state of asphyxia and died ; while others who- were at a distance, and who conse- quently breathed it in a diluted state, were affected with nausea, giddiness, or fainting, lasting some hours, and followed by weakness and trembling of the limbs. Some years since, when it was the practice to bury the dead in the crowded churchyards of London, lives were frequently lost by reason of the noxious gases and efflu- via which at once filled every grave as it was made. These gases were chiefly carbonic acid and sulphuretted hydrogen; they have, been already fully described. A grave twenty feet deep was usually dug between strata of exposed coffins, and this grave was kept open until it was filled with bodies. In September, 1838, two persons were killed by the effluvia which had collected in one of these deep graves kept open in Aldgate Churchyard. (See, in refer- ence to this subject, Henke's " Zeitschrift," 1840, vol. 2, p. 446 ; "Ann. d'Hyg.," 1832, p. 216; 1840, p. 131; 1840, pp. 28, 32.) With ordinary precautions, and the care of well-known deodorizers, the remains of the dead may be removed and transported to other localities without injury to the living. "Within a few years, many bodies have been thus removed, without ill effects, from London cemeteries, as that of St. Andrew's, Holborn, and Old St. Pancras. Some remarks on this subject by M. Devergie will be found in the " Ann. d'Hyg.," 1869, 2, 78. In addition to these exhalations from the dead, there are other gases and vapors of a poisonous nature, which are for the most part artificial products. It is seldom that individuals are exposed to respire them in such quantity as to cause serious symptoms or to eudanijer life. DEATH FROM LIGHTNING. 475 LIGHTNING. COLD. HEAT. STARVATION. CHAPTER XLII. lightning. — effects of the electric fluid. — cause op death. — ■ post-mortem appearances. — cases. — legal relations. — cold an occasional cause of death. symptoms. circumstances which accelerate death. post-mortem appearances.— case of murder by cold. effect of heat. — starvation a rare cause of death. symptoms. appearances after death. legal relations. Lightning. Effects of the, electric fluid. — Death bj' lightning is sufficiently common to require that a medical jurist should be prepared to understand the phenomena which accompany it ; but there is a more important reason why he should devote some attention to this subject — that is, that the appearances left by the electric fluid on the human body sometimes closely resemble those produced by great mechanical violence. Thus, a person may be found dead in an open field, or on the highway ; his body may present the marks of con- tusion, laceration, or fracture ; and to one unacquainted with the fact that such violence occasionall}'^ results from the effect of this subtle force, it might appear that the deceased had been maltreated, and probably murdered. In fourteen years (1853-65) 242 deaths from lightning were registered in England and Wales, of which 199 were males and 43 were females. The numbers in each year fluctuate considerably. Nearly all the deaths took place among persons engaged in work out of doors, i. e., field-laborers and others. We do not often hear of persons being killed by lightning in dwellings. In 1870 there were nineteen deaths registered from lightning. Cause of death. — The electric fluid appears to act fatally by pro- ducing a violent shock to the brain and nervous system. In general there is no sense of pain ; the person falls at once into a state of unconsciousness. In a case which did not prove fatal, the person, who was seen soon after the accident, was found laboring under the following symptoms: Insensibility; deep, slow, and uninterrupted respiration; entire relaxation of the muscular system; the pulse soft and slow ; the pupils dilated, but sensible to light. (" Med. Gaz.," vol. 14, p. 654.) It will be seen that these are the usual symptoms of concussion of the braiu. The efi:ect of a slight shock 476 APPEARANCES AFTER DEATH. is that of producing stunning ; and when persons who have been severely struck recover, they sufter fi-om noises in the ears, paralysis, and other symptoms of nervous disorder. ("Med. Times," July 15, 1848.) Insanity has even been known to follow a stroke of light- ning. (Conolly's "Eeport of Hanwell," 1839.) In one case the person remained delirious for three days, and when he recovered, he had completely lost his memory. ("Lancet," August 3, 1839, p. 582.) A boy, at. 4, received a severe shock on the 11th May, was seized with tetanus on the 13th, and died in four hours. ("Med. Times and Gaz.," May 26, 1855.) In another instance, an old man who took shelter under a tree, felt as if a vivid flash had struck him in the face; he did not fall, but he became almost blind. He suffered for some days from frontal headache, and loss of sight supervened. (" Med. Times and Gaz.," July 24, 1858.) It may be observed of the effects of lightning, generally, that death is either immediate, or the individual recovers. A person may however linger, and die from the effects of severe lacerations or burns indirectly produced. A case occurred in this city, in July, 1888, where death was thus caused indirectly by the effects of electricity. The following case of recovery illustrates further the action of the electric fluid: Three persons were struck by lightning at the same time. In one, a healthy man, set. 26, the symptoms were severe. An hour and a half after the stroke he lay completely unconscious, as if in a fit of apoplexy ; his pulse was below 60, full and hard; his respiration snoring, his pupils dilated and insensible. There were frequent twitchings of the arms and hands; the thumbs were fixed and immovable, and the jaws firmly clenched. Severe spasms then came on, so that four men could scarcely hold the patient in his bed; and his body was drawn to the left side. When these symptoms had abated, he was copiously bled; cold was applied to the head, a blister to the nape of the neck, and mustard-poultices to the legs ; stimulating injections and opium were also adminis- tered. In the course of twenty-four hours consciousness slowly returned, and the man soon completely recovered. The only external injury discoverable was a red streak, as broad as a finger, which extended from the left temple over the neck and chest ; this disappeared completely in a few days. (" Brit, and Eor. Med. Rev.," Oct. 1842.) These red streaks or marks sometimes assume a remarkable disposition over the skin. (See case by Dr. Horst- mann, Casper's " Vierteljahrsch." April 1863, p. 308.) Appearances after death. — The suddenness of death is such that the body sometimes preserves the attitude in which it was struck. (" Med. Times and Gaz.," Feb. 18, 1860, p. 167.) Generally speak- ing, there are, externally, marks of contusion and laceration about the spot where the electric current has entered or passed out : — ■ sometimes a severe lacerated wound has existed: on other occa- sions there has been no wound or laceration, but an extensive ecchymosis, which, according to Meyer, is most commonly found on the skin of the back. In one instance, which occurred in Lon- don in May, 1839, there were no marks of external violence ; and FATAL EFFECTS PRODUCED BY LIGHTNIXG. 477 several similar cases are quoted from American journals in the " Medical Times" (May 3, 1845, p. 82). The clothes are in almost all cases rent and torn, and partially singed, giving rise to a pecu- liar odor — sometimes even rolled up in shreds, and carried to a dis- tance. They are occasionally found partially burnt, but this is not a frequent occurrence. Metallic substances about the person pre- sent traces of fusion, and articles of steel have been observed to acquire magnetic polarity. Dr. West has informed me, that in a case to which he was called, in which a boy, set. 18, had been in- stantly struck dead by lightning, he observed that a knife in the pocket of the deceased had acquired strong magnetic polarity. This case further shows that which has frequently been noticed — namely, that while much violence has been done to the dress, the parts of the body covered by it had escaped injury. The deceased wore at the time of the accident a pair of strong leather boots ; these were torn to shreds, probably owing to the presence of iron nails in the soles, but the feet of the deceased presented no mark of injury! An accident by lightning occurred in the presence of a friend of mine, by which a healthy man was instantaneously killed. A cap which the man wore had a hole through it ; his hair was singed, his shoes Avere burst open, and his trousers torn. The woodwork of the building down which the electric fluid passed was merely split, and there was no mark of burning. I have examined, in sevei'al in- stances, the wood of trees -vyhich have been struck by the electric fluid ; in each case it has presented only the appearance of rending by mechanical force. Wounds and kirns are sometimes met with on the body. The wounds have commonly been lacerated punctures, like stabs pro- duced by a blunt dagger. In the case of a person who was struck but not killed, a deep wound was produced in one thigh, almost laying bare the femoral artery. This person was struck, as many others have been, while in the act of opening an umbrella during a storm. Fractures of the bones have not been commonly observed : in a case mentioned by Pouillet, the skull was severely fractured, and the bones were depressed. (" Trait6 de Physique, Elect. At- mosph.") In May, 1864, Dr. Mackintosh, of Littleport, was called to see three persons who had been struck with lightning about twenty min- utes previously. They had taken shelter under a haystack, which had been set on fire by the same flash. 1. A boy, aged 10, was then able to walk, although unable to move his legs immediately after the occurrence. All that he remembered was — he saw the stack on fire, and called to his father ; he felt dizzy all over, and unable to move. His hair and clothes were not singed, and the metallic buttons on his dress showed no signs of fusion. On re- moving his clothes a slight odor of singing was perceptible. He complained of pain at the lower part of the abdomen. There were several red streaks, of about a finger's breadth, running obliquely downwards and inwards on either side of the chest to the middle line in front of the abdomen ; they then descended over the pubes. 478 FATAL EFFECTS PRODUCED BY LIGHTNING. and were lost in the perineum. It does not appear that there was any abrasion of the skin. This boy perfectly recovered ; the red streaks disappeared gradually, and could hardly be traced four days after the injury. 2. Another boy, aged 11, lay prostrate and unconscious, with an expression of grim terror and suffering; he frothed at the mouth, moaned piteously, and flung his legs and arms about in all directions. The breathing was deep, slow, and laborious; the heart palpitating, pulse weak and very irregular ; the pupils were dilated, and insensible to light. There were in this case several red streaks converging from the neck and shoulders to the middle of the chest-bone, and passing over the abdomen until they were lost on the pubes. There were similar streaks radiating for a few inches from the tuber ischii on each hip, in different di- rections, until they were lost in the skin. It appears that this boy was in a sitting posture when struck. The hair on the back of his head and neck was singed, and the peculiar odor of singing was perceived, although his clothes showed no traces of burning, nor the metallic buttons of fusion. The boy became conscious in five hours, and rapidly recovered. The red streaks gradually disap- peared, leaving streaks of a scaly glistening white appearance, which ultimately left no trace of their existence. 3. A man, aged 46. Like the two others, he was in a sitting posture, and he appeared to have been killed on the spot ; he had not moved hand or foot. The countenance was placid, and the pupils were widely dilated. The electric fluid had produced a large lacerated wound of the scalp, at the junction of the occipital with the parietal bones, but without producing any fracture. The electric fluid appeared to have passed down each side of the head, between the soft parts and the cranium. On the left side it had passed downwards in front to the left ear, and terminated on the side of the neck, rupturing bloodvessels and muscles, and causing swelling of the parts with effusion of blood. It presented the appearance of an extensive bruise caused by me- chanical violence. On the right side, the current had passed down to the space above the collar-bone, causing lividity and swelling of the right ear as well as of the adjacent skin ; and it terminated in a dark-blue mangled patch of skin, in which there were several free communications with the surface. The hair on the back of the head was slightly singed, and that in front of the chest was singed quite close to the skin, but the hair which covered the wound in the scalp, where the current had entered, was uninjured. The clothes were neither torn nor burnt, and the metallic buttons were not fused. The clothes of all three were very wet. The hat was not examined. The left side-pocket of the ti-ousers contained several lucifer-matches and a tin tobacco-box, which were unaf- fected by the electric discharge. The right pocket contained a knife, which had acquired strong magnetic polarity. The body was placed in a warm room, and it is worthy of remark that cadaveric rigidity came on in fourteen hours after death. (" Lancet," July 30, 1864, p. 118.) It is to be regretted that no post-mortem exami- nation was allowed. It is probable that the brain sustained severe FATAL ACCIDEXTS FROM LIGHTNING. 479 injury, causing immediate death. These cases singularly present the etteets of lightning in three degrees — the eltect of a slight shock in No. 1, of a severe shock in JSTo. 2, and of a fatal shock in No. 3. There was but little bodily injury in either case, and no appearance of burning. The marks on the skin in Nos. 1 and 2 could not have been mistaken for violence, but the wound to the scalp and the in- juries to the neck in 'So. 3 might have been ascribed to the vio- lence of another, had not the circumstances been fully known. The clothes probably escaped burning or tearing by reason of their being wet, and their readily conducting the electric fluid. The burns occasionally found on the bodies of persons who have been struck by lightning have been hitherto ascribed to the igni- tion of the clothes. It appears, however, from the subjoined cases, that burns even of a severe kind may be the result of a direct agency of the electric fluid itself upon the body. The late Dr. Geoghegan, met with the case of a girl who had been struck by lightning ; there was burning of the thigh and buttocks to the first and second degrees, but the clothes did not show any signs of com- bustion. On the 16th of July, 1852, a man, set. 23, while engaged in milking a cow in a wooden shed, during a severe thunder storm, suddenly observed a vivid flash of lightning, which killed the cow instantly, and inflicted serious injuries upon himself. He was seen sixteen hours after the accident, and a severe burn was found upon his person, extending from the right hip to the shoulder, and cov- ering a large portion of the front and side of the body. His mind was then wandering, and there were symptoms of inflammatory fever. The man was confined to his bed for seventeen days, at the end of which time the injuries had not perfectly healed. On ex- amining his dress, the right sleeve of his shirt was found burnt to shreds, but there was no material burning of any other part of the dress. The case is singular, inasmuch as it shows that the dress may be burnt without the surface of the body being simultaneously in- jured; and further, that a burn may be produced on the body, although the clothes covering the part may have escaped combus- tion. Mr. Fleming has described the cases of eight persons who were struck by lightning, and on the bodies of some of these there were marks of severe burns. The dresses were, in parts, much singed. These cases show, in a remarkable manner, the intense heat evolved in the instantaneous passage of the electric fluid through the clothes and body. The persons struck were benumbed or paralyzed in various degrees, hut all ultimately recovered ; but the burns were so severe that some months elapsed before they were entirely healed. (" Glasgow Med. Journal," Oct. 1859, p. 257.) The following complete account of the external and internal ap- pearances found in the body of a healthy middle-aged laborer, who was killed by a stroke of lightning, has been published by Dr. Schaffer : The man was working in the fields with several other laborers, just after a thunder storm had passed over, and had appa- rently subsided. He was endeavoring to kindle a light with a flint and steel, when the lightning struck him. For a moment after the 480 FATAL ACCIDENTS FROM LIGHTNING. shock he stood still, and then his body fell heavily to the ffround. The electric fluid entered at the upper part of his forehead, perfo- rating and tearing his hat at that part ; it seemed then to have become divided into two currents, -which passed down the sides of the body, along the lower limbs, and out at the feet. On the upper part of the forehead was found a soft swelling, of a dark-blue color, and about the size of the palm of a hand ; the hair which covered it was uninjui'ed. From this spot two dark red streaks proceeded in different directions. One of these passed to the left, running over the temple, in front of the left ear, down the neck to the sur- face of the chest, over which it passed between the left nipple and the armpiit ; and so made its way over the body to the left inguinal I'egion, where it formed a large, irregular, scorched-looking (bran- dige) patch on the skin. From this point, a dark-red streak again continued its downward course, passing over the great trochanter, then along the outer surface of the left leg to the back of the foot, where it terminated in several small dark-blue spots. The other streak, which proceeded from the ecchymosed swelling on the forehead, passed directly to the right ear, which was considerably swollen and of a dark-blue color; from the ear it ran downwards and backwards along the neck, crossed the right border of the scapula, and eventually reached the right groin, where a scorched patch of skin similar to that in the left groin was found. From this part, the discolored streak continued down the outer side of the right leg to the termination on the back of the foot, just as on the left side. It is remarkable that, although the hair on the forehead, as well as that which occurred in any part of the track taken by the electric current down to the groin, was not burnt, yet at the groin itself, and at every part hence to the foot over which the electric stream had passed, the hairs were completely burnt. The cause of the skin and hair in the groins being burnt is probably to be referred to the buckles of a belt which the man wore round his abdomen at the time of the accident ; the belt was completely de- stroyed. Nothing further, worthy of notice was observed on the exterior of the body, with the exception of the face being very red. The swelling of the head was found to be due to the presence of a large quantity of extravasated blood. The bone beneath was not injured. Blood was effused in other parts of the scalp correspond- ing to the swollen discolored patches outside ; about four ounces had been effused. The vessels of the cerebral membranes were greatly congested, and the brain itself contained much blood, espe- cially observed in the choroid plexuses. A large quantity of reddish mucus was found in the larynx, windpipe, and air-tubes; the lungs were loaded with dark blood ; there was a great deficiency of blood in the cavities of the heart and in the large vessels ; the blood- vessels of the stomach and intestines were more than usually con- gested ; the right lobe of the liver was of a dark-red color, and loaded with blood, especially the part which corresponded to the burnt patch of skin at the lower part of the abdomen ; the spleen also was large, and filled with blood. Much blood was found accu- PROOFS OF DAMAGE BY LIGHTNING. 481 mulated in the substance of the muscles of the abdomen, at those parts which lay beneath the burnt surfaces outside. (" Oesterreich. Med. Wochenschrift," 6th June, 1846.) It was formerly supposed that the blood was never found coagulated in persons killed by lightning, and that the body did not become rigid after death. Experience has shown, however, that these statements are not correct. JEcchymoses of greater or less extent are sometimes found on the bodies of those who have been killed by lightning. Thus ecchymoses have been occasionally disposed in an arborescent form over the surface of the skin. When persons have been killed while standing under or near trees, and such arborescent ecchymoses are found, they have been described as presenting the picture of a tree. This has even formed the subject for medical evidence at an inquest, in a case of death from lightning. ("Australian Med. Journ.," Sept. 1870, p. 295.) A youth was killed by lightning. There were marks of coiitusion on the left side of the body, and it was noticed that there was extreme rigidity on that side. The hair on the back of the head was burnt off. The pupils of both eyes were much dilated, and blood oozed from the left nostril. The surgeon then stated that he observed on the skin of the chest the perfect impression of a young tree inverted, of g, dark color, as if tattooed on the skin. It resembled the tree which grew near the place of the accident ! The deceased, it seems, when struck had two or three layers of woollen cloth buttoned over his chest. His cap was torn to pieces. The trowsers on the left side were torn from the hip to the stockings, which were torn open, as well as the boot. He had died from injury to the brain. Eanke has endeavored to determine the relative conducting power of living muscle which constitutes so large a portion of the body. The conclusion at which he has arrived is that the conducting power of muscle in reference to electricity is three million times weaker than that of mercury, and fifteen million times below that of copper. (Brown-S^quard, "Proc. E. S.,"E"o. 44.) J^otwithstand- ing these results, the human body is often struck under circum- stances where, according to theory, it should escape. There is also another difficulty. Of three or more persons together, one or two only may be struck, although there is no apparent reason why the electric fluid should select one body more than another. M. Toude met with the following cases in 1869 : Three soldiers were sitting under a tree during a storm. They were struck down by lightning, and two were killed on the spot. There were loftier trees in the neighborhood — a lightning conductor was not far oft", and an iron railway bridge, as well as a river. The electric fluid struck the lower tree, and passed through the bodies of the men in place of being carried oft' by the surrounding conductors. (" Ann. d'Hyg.," 1871, 1, 478.) In June, 1871, a coachman while driving a carriage was killed on the box during a storm, while the footman sitting by his side escaped uninjured. The electric fluid had struck the coach- man on the head, destroyed his hat, and rent his clothes. It passed SI 482 ACTION FOB DAMAGES BY LIGHTNING. through his body, tore a large hole in the cushion on which he was sitting, and except the shattering of the glass, did no injury to the carriage, nor to those who were inside. At about the same time, three men were mowing in a field during the storm. They put down their scythes and sought shelter ; but as they were leaving the field, they were all three struck to the ground by lightning. One only was killed. It was found that he had been struck on the right side, where he wore a steel chain with a watch. This was broken to pieces. In another accident occurring at the same date, a man set. 74 was struck while standing under a fir-tree. He was taken up in an insensible state, and soon died. There was a jagged wound over the right eye, and a great part of the surface of the body was burnt, including the hair, whiskers, eyebrows, and eye- lashes. The boots were burnt oif the feet, and the hat and trousers were torn to pieces. In these cases, no doubt one body received more of the electric fluid than another, and in the fatal cases, there were appearances in the condition of the bodies and the clothes sufiicieut to point to death by lightning, even if the facts had not been known. The external injuries in these cases resemble those caused by violence, but the peculiar form, extent and direction of the ecchy- moses, as well as the presence of marks of burning, either on the clothes or the bod/, were sufficient to distinguish them as injuries produced by the electric fluid. Legal relations. — Rare as the combination of circumstances must be in which a medico-legal question can arise in reference to the action of the electric fluid on the body, a case was tried in France, in October, 1845, in which medical evidence respecting the charac- ters of wounds caused by electricity was of considerable importance. In August of that year, some buildings were destroyed at Malaunay near Rouen, as it was alleged, on the one side by a thunderstorm, on the other by a whirlwind ; and as the parties were insured against lightning, they brought an action for recovering the amount in- sured. The evidence in favor of the accident having been due to electricity consisted — first, in the alleged carbonized appearances of the leaves of some trees and shrubs growing near ; and secondly, in the characters of the wounds on the bodies of several persons who were injured at the time of the occurrence. M. Lesauvage stated at the trial, that there was an appearance of dark stains scattered over the bodies, and that those who .survived sufl'ered from torpor, pains in limbs, and a partial paralysis of motion. He observed, also, that decomposition took place \qvj speedily in the bodies of those who were killed. In one instance, the muscles were torn and lacerated, and some small arteries divided. This witness attributed most of the wounds to the eflects of electricity. M. Eunel deposed, that in some of the dead bodies which he examined, the face and neck were bloated and discolored, as if death had taken place from asphyxia. It does not appear, however, that there were any circumstances decisively proving that the buildings had been destroyed by lightning. M. Pouillet has given an accurate FATAL EFFECTS OF COLD. 483 description of the storm: he believed that although, as deposed to by some of the witnesses at the trial, it may have been attended with thunder and lightning, the buildings with the surrounding trees were overthrown by the mere force of the wind, and not by the electric fluid. The description given bears out this view, but at the same time, it is unusual that trees when struck, unless old or dry and withered, should present any marks of combustion about the leaves or trunk. (See " Comptes Rendus," Sept. 1845 ; also " Med. Gaz.," vol. 36, p. 1133.) The scientific evidence was of the most conflicting kind. The Eoyal Court of Eouen decided that the disaster was occasioned by the atmosphere ; and, without enter- ing into the various theories of storms, condemned the insurance companies to pay the amounts claimed. (" Law Times," Mai'ch 14, 1846, p. 490.) Cold. Cause of death. — The protracted exposure of the human body to a low temperature may destroy life ; and although in this country cases but rarely occur in which cold alone operates fatally, it is not unusual, during a severe winter, to hear of persons in a state of misery and destitution, being found dead in exposed situations. On these occasions, we may reasonably suspect that the want of proper food and nourishment has accelerated death. It is, how- ever, convenient to make a distinction between the eff"ects of cold and of starvation on the system, as the symptoms preceding death and the rapidity with which it takes place, are difl"erent in the two cases. Symptoms. — A moderate degree of cold is well known to have an invigorating effect upon the body; but if the cold be severe, and the exposure to it long-continued, while the calorific function is not maintained by warmth of clothing or exercise, the skin becomes pale, and the muscles become gradually stifi" and contract with diffi- culty, especially those of the face and extremities. Sensibility is- lost, a state of torpor ensues, followed by profound sleep from which the person cannot be readily roused ; in this state of lethargy, the- vital functions gradually cease, and the person finally perishes.- Such are the general effects of intense cold upon the body ; its in- fluence on the nervous system is seen in the numbness, torpor, and sleepiness which have been described as consequences of a long ex- posure to severe cold. Giddiness, dimness of sight, tetanus and paralysis have in some cases preceded the fatal insensibility. It has been found that temperature materially aftects the amount of oxygen taken by the blood. At a low temperature, this fluid takes less oxygen ; hence it becomes less oxygenated, and this state of the blood affects the condition of the brain and nervous system., (Beruard, op. cit. p. 114.) It was observed during the retreat of the French from Moscow, that those who were most severely aftected by cold often reeled about as if in a state, of intoxication ; they also complained of giddiness and indistinctness of vision, and sank under a feeling of lassitude into a state of lethargic stupor, from- which it 484 COLD — ACCELERATION OF DEATH, ■was found impossible to rouse them. Sometimes the nervous system was at once affected ; tetanic convulsions followed by rigiditj' of the whole of the voluntary muscles, seized the individual, and he rapidly fell a victim. Symptoms indicative of a disturbance of the functions of the brain and nervous system have also been experienced by Arctic travellers during their residence within the Polar circle. The late researches of M. Pouchet on the effects of a freezing tem- perature on animals have led him to the conclusion that death is due to a physical change in the blood-globules, and not to anj' effect on the nervous system. The first phenomenon produced by cold is a contraction of the capillary vessels to such an extent that the blood-globules cannot enter them ; these vessels, therefore, remain completely empty. The second phenomenon is an alteration of these globules, amounting to their complete disorganization. Under these circumstances an animal cannot be restored. (" Chemical News," Doc. 1, 1865, p. 268.) A human being may, however, per- ish from a degree of cold not sutBcient to produce congelation. Circumstances which accelerate death. — There are certain condi- tions which may accelerate death from cold. In all cases in which there is exhaustion in the nervous system — as in those who are worn out by disease or fatigue, in the aged or infirm, or, lastly, in persons who are addicted to the use of intoxicating liquors — the fatal effects of cold are more rapidly manifested than in others who are healthy and temperate. It has been uniformly remarked that whenever the nervous energy is impaired, either by intoxica- tion or exhaustion from fatigue, a man dies quickly from cold. The exposure of drunken persons, during a severe winter, may therefore suffice to destroy life, although the cold may not be so intense as to effect others who were temperate. Casualties of this nature sometimes occur during the winter season in this metropo- lis; and a knowledge of the influence of intoxication, in acceler- ating death under such circumstances, may occasionally serve to remove a doubt in the mind of a practitioner respecting the real cause. -Infants, especially when newly born, easily perish from ex- posure to cold. Cold, when accompanied by rain and sleet, appears to have a more powerful depressing influence than when the air is dry — probably from the effects of evaporation. The following case by Dr. Currie shows the fatal eflects of cold winds accompanied by humidity : " Of several persons who clung to a wreck, two sat on the only part that was not submerged ; of the others, all were con- stantly immersed in the sea, and most of them up to the shoulders. Three only perished, two of whom were generally out of the sea, but frequently overwhelmed by the surge, and at other times exposed to heavy showers of sleet and snow, and to a high and piercing wind. Of these two, one died after four hours' exposure : the second died three hours later, although a strong healthy adult, and inured to cold and hardship ; the third that perished was a weakly man. The remaining eleven who had been more or less completely sub- merged, were taken from the wreck the next day, after twenty- three hours' exposure, and they recovered. The person among the COLD — APPEARANCES AFTER DEATH. 485 whole who seemed to have suffered least was a negro; of the other survivors,' several w^ere by no means strong men, and most of them had been inured to the warm climate of Carolina." Appearances after death. — Opportunities rarely occur of examin- ing bodies when death results purely from exposure to cold. The skin is conmionly pallid, and the viscera of the chest and abdomen as well as the brain are congested with blood. Dr. Kellie, of Leith, found in two cases which he examined, a redness of the small in- testines from the congestion of the capillary vessels, and a great effusion in the ventricles of the brain. A sufficient number of cases have not yet been inspected to enable us to determine how far these two last-mentioned appearances are to be regarded as conse- quences of death from cold ; but all observers have found a general congestion of the bloodvessels and viscera. In consequence of the great congestion uniformly met with in the vessels and sinuses of the brain, some pathologists have regarded death from cold as re- sulting from an attack of apoplexy ; but the symptoms which pre- cede death do not bear out this view. Effusions of blood have not yet been observed, and a mere fulness of the cerebral vessels after death is not in itself sufficient to justify this opinion. It will be observed that, on the whole, these appearances are remarkably similar to those which are found in death from severe burns and scalds. Thus then a medical jurist will perceive, that in order to come to a decision whether, on the discovery of a dead body, death has taken place from cold or not, is a task of some difficulty. The season, of the year — ^the place and circumstances under which the body of the deceased is found — -together with the absence of all other possible causes of death (such as from violent injuries or in- ternal disease), form the only basis for a medical opinion. Death from cold is not to be determined except by negative or presump- tive evidence ; for there is no organic change, either externally or internally, sufficiently characteristic of it to enable a medical man to give a positive opinion on the subject. , Under the name of Coldstroke Dr. Hartshorne has described a case showing the fatal effects of a slight exposure to intense cold suddenly applied to the hoAj. A youth set. 14 exposed himself for a few minutes in his night-dress at an open window, during a winter's night, the thermometer having fallen 50° from the day temperature. He felt thoroughly chilled, and the next day he was suffering from headache, drowsiness, and vomiting — the skin hot, the pulse hard and quick. On the second day he became restless and delirious, and on the following morning he died. There was no cause for this fatal attack of illness excepting the few minutes' exposure on removing from a warm bed to the piercing wind of a cold winter's night. Other instances are recorded in which persons have become delirious, and died from the effects of a slight expo- sure to severe cold. (Amer. Jour. Med. Soc, October, 1851, p. 432.) Many of the fatal cases registered during a severe winter are owing to this direct effect of cold. A complete history of the effects of 486 EFFECTS OF HEAT. cold and the phenomena connected with this kind of death is given by Dr. Hdche, of Zeitz, in Horn's " Vierteljahrsschrift " for 1868, 2, 44. Heat. Intense heat. — The effect of an intensely-heated atmosphere in causing death has been but little studied. I have been consulted in one case, in which the captain of a vessel was charged with man- slaughter, for causing a man to be lashed within a short distance of a stoke-hole of a steam furnace in the hold of a vessel. The man died apparently from the eft'eets of this exposure. The engine- rooms of steamers in the tropics have been observed to have a temperature as high as 140° ; and engineers after a time become habituated to this excessive heat, without appearing to suifer materially in health. In certain manufactures, the body appears to acquire a power, by habit, of resisting these high temperatures — still, it has been proved that many suffer severely. In the Turkish bath, higher teniperatures than this have been noted, but there is reason to believe that serious symptoms have been occasionally produced in persons unaccustomed to them, and that in one or two cases death has resulted. In attempting to breathe air heated to temperatures varying from 180° to 200°, there is a sense of suffocation with a feeling of dizziness and other symp- toms indicative of an effect on the brain ; the circulation is enor- mously quickened. In July, 1861, an inquest was held in London on the body of a stoker of an Aberdeen steamship. He had been by trade a grocer, and was not accustomed to excessive heat. While occupied before the engine furnace he was observed to fall suddenly on the floor in a state of insensibility; when carried on deck it was found that he was dead. All that was discovered on a post-mortem examination was an effusion of serum into the ventricles of the brain ; death had been caused by sudden apoplexy. Intense heat appears to operate by inducing congestion of the brain (heat-apoplexy). In some cases a person may sink and die suddenly from exhaustion ; or symptoms of cerebral disturbance may continue for some time, and the case ultimately prove fatal. In 1870, 112 deaths from sunstroke were registered in England. Death from sunstroke, when not immediately fatal, is preceded by some well-marked symptoms, such as weakness, giddiness, head- ache, disturbed vision, flushing of the face, followed by oppression and difliculty of breathing, and in some cases stupor passing into profound coma. The skin is dry and hot, and the heat of the body is much gi-eater than natural. ("Ann. d'Hyg.," 1867, 1, 423.) In one case, observed by Dr. Sieviking, the patient, a boy set. 13, re- mained in a state of semi-consciousness for four days, and then had a cataleptic seizure. (" Lancet," 1870, 2, 184.) Dr. Passauer has fully considered this subject in reference to armies in Horn's "Vier- teljahrsschrift," 1867, 1, 185. The symptoms in cases of sunstroke EFFECTS OF STARVATION. 487 have not been always accurately recorded. In one instance, a med- ical man, who suftered from an attack while on a voyage in the tropics, was unable to note and describe the symptoms from the commencement of the attack up to the eighth day, when he recov- ered. (" Lancet," 1872, 1, 464 ; also 2, 128.) [Dr. H. C. Wood (Boyleston Prize Essay, Phila., 1872), considers that intense heat of skin is characteristic of true sun-stroke ; the temperature reaching, in some instances, to 110°, or even 113° F. In all autopsies made by him, the heart was firmly contracted, espe- cially the left ventricle. He ascribes the flaccidity of the heart noticed by others, to the fact that the examination was not made for many hours after death, during which time putrefaction had set in. Dr. Wood found that congestion of the brain or effusion into the ventricles was not of frequent occurrence; nor did he ob- serve any change in the blood, microscopically. — R.] Starvation. Death from the mere privation of food is a rare event, although, if we wei'C to form an opinion from the verdicts of, coroner's juries, its occurrence would not appear to be uncommon in this and other large cities. In one of the Annual Registration Returns it is stated that 130 persons died from starvation. Such cases must, however,, be received with some distrust, as care is rarely taken to ascertain precisely how far bodily disease may have been concerned in causing death. Still, it cannot be denied that starvation should be classed amonsc the forms of violent death, beina; sometimes the result of criminal neglect or inattention in the treatment of children, or of infirm and decrepit persons, and thus constituting homicide ; or at other times, although rarely, arising from an obstinate determina- tion to commit suicide in those from whom all other means of self- destruction are cut off. Symptoms. — The symptoms which attend on the privation of food, or the supply of improper food, have been variously described. Referring to eases which occurred during the Irish famine of 1847, Dr. Donovan states that the persons who suffered described the pain of hunger as at first very acute, but said that after twenty- four hours had been passed without food, the pain subsided, and was succeeded by a feeling of weakness and sinking, experienced principally in the region of the stomach ; accompanied with insati- able thirst, a strong desire for cold water, and a distressing feeling of coldness over the entire surface of the body. In a short time the face and limbs became frightfully emaciated ; the eyes acquired a peculiar stare ; the skin exhaled an offensive smell, and was cov- ered with a brownish filthy-looking coating, almost as indelible as varnish. This he was at first inclined to regard as incrusted filth, but further experience convinced him that it was a secretion poured out from the exhalants on the surface of the body. The sufferer tottered in walking, like a drunken man; his voice was Aveak, like that of a person affected with cholera ; he whined like a child, and 488 EFFECTS OF STARVATION. burst into tears on the slightest occasion. In respect to the mental faculties, their prostration kept pace with the general wreck of bodily power ; in many there was a state of imbecility, in some almost complete idiocy ; but in no instance was there delirium or mania, which has been described as a symptom of protracted absti- nence among shipwrecked mariners. (" Dub. Med. Press," Feb- ruary, 1848, p. 67.) Among the symptoms, there is severe pain in the region of the stomach, a suppression of the feces, or, if discharged, they are in small quantity, dry, and dark-colored ; the urine is scanty, high- colored, and turbid ; the intellect is dull. The person maybe ex- hausted, and remain without motion in one position, or be seized with a furious delirium, which may drive him to acts of violence. In the last stage, the body is reduced to an extreme state of emacia- tion, and before death it evolves an offensive odor, like that of incipient putrefaction. The excretions have also a putrescent odor. The surface of the skin may be covered with spots (petechife), and the person finally dies, in some cases slightly convulsed. (Op. cit. p. 415.) M. Chassat found, in his experiments on animals, that in some instances, the animal died after having had successive attacks of convulsions. (Beck's " Med. Jurisp.," vol. 2, p. 80.) In a case which fell under the notice of Dr. Sloan, a healthy man, set. 65, was by an accident shut up in a coal-mine for twenty-three days without food. When found, he was conscious, and he recog- nized and named his deliverers. He was so weak that he could scarcely raise his hand to his mouth, and so much emaciated as to excite the surprise of his fellow-workmen by the extreme lightness of his body. Under careful treatment he so far recovered as to give an account of his feelings. For the first two days, hunger was his most urgent symptom. This passed off, and he then began to suffer from severe thirst, which he allayed by drinking some foul water. After ten days he became so weak that he was unable to move from the spot where he had lain down. He slept but little, and not soundly — never entirely losing the consciousness of his situation. His bowels acted only once, but he passed urine freely. The mat- ter brought from his bowels by injections was dark-colored, like meconium, and very fetid. He died on the third day after his re- moval, in spite of every efibrt to save him, and on the day of his death he was in the following state ; his features were sharp and pale, his eyes sunk ; the skin of the abdomen seemed to touch the backbone, which could be distinctly felt through it ; his body pre- sented more emaciation than Dr. Sloan had ever seen produced by disease ; he had altogether a dried appearance, very much like that of natural mummies found in catacombs; his pulse was gone; his voice was in a whisper, like the vox cholerica ; there was uneasiness, increased by pressure, in the region of the stomach ; his intellect was sound, and remained so until death. (" Med. Gaz.," vol. 17, p. 265.) This case confirms the observation of Dr. Donovan, that deli- rium is not a necessary attendant on protracted abstinence ; and it proves incontestably that a person may die from the effects of ab- APPEARANCES AFTEE DEATH. 489 stinence or starvation, in spite of the best-directed efforts for re- covery. Mr. Thornhill reports, in the same journal, the cases of eight men and a boy who were shut up in a coal-mine for eight days without food (" Med. Gaz.," vol. 17, p. 390) ; but the symptoms here noted were rather those of hunger than of long abstinence. They all suffered from excessive thirst ; they were all troubled with ocu- lar illusions, showing cerebral excitement. . The occurrence of ocular spectra, and other symptoms indicative of a depressed state of the nervous system, has also been noticed by Casper. (" Handbueh der Ger. Med.," 1857, vol. 1, p. 374.) According to Dr. Martin, the emaciation in starvation is characteristic ; it is a withering or shriv- elling up of the skin, which has lost its elasticity, giving to youth the aspect of age. Death, when not hastened by disease, is slow and imperceptible, or it is precipitated by syncope from sudden effort, or by exposure to severe cold. Delirium is not, according to him, a symptom of starvation. (" Med. Times and Gaz.," March 30, 1861, p. 344.) The period which it requires for an individual to perish from hunger is subject to variation; it will depend mate- rially upon the fact whether a person has had it in his power or not to take at intervals a portion of liquid, to relieve the overpowering thirst which is commonly experienced. The smallest portion of liquid, thus taken occasionally, is found to be capable of prolonging life. It is probable that in a healthy person, under perfect absti- nence, death would not commonly take place in a shorter period than a week or ten days.' This opinion appears to derive support from the results of those cases in which there has been abstinence owing to disease in the throat and difficulty of swallowing food. Age, sex, state of health, and the effects of exposure to cold, may accelerate or retard a fatal termination. Appearances after death. — There are but few details of the appear- ances presented by the bodies of those who have died from starva- tion, and the cases themselves are too rare to enable us to decide with certainty upon the accuracy of the reports which have hitherto appeared on the subject. The body is shrunk and emaciated, and remarkable for its lightness. The skin is dry, shrivelled, and free from fat. The muscles are soft, deprived of fat, and much reduced in size. The stomach and intestines are usually found collapsed, contracted, and empty- — the mucous membrane being thinned and sometimes ulcerated. The liver, lungs, heart, kidneys, and the great vessels connected with these organs are collapsed and destitute of blood ; the heart and kidneys free from any surrounding fat — the gall-bladder distended with bile — the omentum shrunk and destitute of fat. In Dr. Sloan's case (supra) the body was observed to be extremely emaciated ; the intestines were collapsed, the stomach was distended with air, and slightly reddened at its greater extremity. The omentum had almost disappeared ; it was entirely destitute of fat. The liver was small, and the gall-bladder distended with bile. The other viscera were in their normal state. (" Med. Gaz.," vol. 17, p. 389.) Mr. Tomkins, of Yeovil, inspected the body of a man who died from starvation in February, 1838. The face 490 APPEABANCES AFTER DEATH. was much shrunk and emaciated ; the eyes were open, and presented a fiery red appearance, as intense as in a case of acute ophthahnia during life. This red appearance has been met with by Dr. Donovan in death from exposure to cold (" Dublin Med. Press," Feb. 2, 1848, p. 66.) The skin was tough, and there was scarcely any cellular membrane to be seen. The tongue, lips, and throat were dry and rough. A peculiar odor was exhaled from the body. The lungs were shrunk and contracted ; the investing membrane was slightly inflamed. The" stomach and intestines were empty, but quite healthy ; the gall-bladder was nearly full of bile, and the surround- ing parts were much tinged by this liquid. The urinary bladder was empty and contracted; (" Lancet," March, 1838.) In some cases inspected during the Irish famine, Dr. Donovan states that the appearances which he witnessed were extreme emacia- tion, total absorption of the fatty matter on the surface of the body, total disappearance of the omentum, and a peculiarly thin condi- tion of the small intestines, which in such cases were so transparent, that if the deceased had taken any food immediately before death, the contents could be seen through the coats of the bowel ; on one occasion (at an inquest) he was able to recognize a portion of raw green cabbage in the duodenum of a man who had died from star- vation. This thin condition of the coats of the intestines he looks upon as the strongest proof of this mode of death. The g^ll-bladder was usually full, and the parts in the vicinity of it were much tinged by the cadaveric exudation of bile ; the urinary bladder was gen- erally contracted and empty, and the heart pale, soft, and flabby ; there was no abnormal appearance in the brain or lungs. Dr. Martin assigns as a condition of the intestines diagnostic of starvation, that they are not only contracted but shrunken and diminished in size, shortened in length as well as in calibre, and like a mere cord, as if the canal was obliterated. (" Med. Times and Grazette," March 30,1861.) He met with this state in three cases: once in starva- tion from want of food, and twice from total obstruction to its in- gestion. Mr. Fletcher found the following appearances in the case of two children, named Aspinall, who died from starvation — the elder aged one year and ten months, the younger four months. In the body of the elder there was extreme emaciation, without the slightest trace of disease in any of the viscera. Some dirty creamy fluid and four cherry-stones were found in the small intestines, but no distinctly fecal matter, a few grains of which, however, were found in the large intestines ; scarcely a trace of fat was visible. In the infant the same appearances were presented, although the emaciation had not proceeded to the same extent. The evidence produced on the trial proved that the mother spent in drink the money given to her for household expenses, and that the children's food and clothing were neglected. The prisoners were tried for wilful murder, in accordance with the verdict of the coroner's jury. The judge ruled that the wife in law was the husband's servant, and if it were proved that he had supplied her with sufiicient money, he must be acquitted; if he had not, the wife must be ac- PRETENDED PASTING. 491 quitted. The jury acquitted the man and brought in a verdict of manslaughter against the woman, who was sentenced to twoyeai-s' imprisonment. (" Proceedings of Liverpool Medical Society," 1855- 56.) In some of these alleged deaths by starvation, ulceration of the bowels is met with. This has been considered to arise from want of food ; but Dr. Donovan did not meet with it in those who died of lingering starvation. (" Dublin Med. Press," Feb. 2, 1848, p. 66.) These appearances, in order to throw any light upon the cause of death, should be accompanied by an otherwise healthy state of the body ; since it is well known, they may be produced by many organic diseases, and death may be thus due to disease, and not to the mere privation of food. It will not be always easy to say whether the emaciation depends on disease or want of food, unless we are •put in possession of a complete history of the case. On this account, in all charges of homicidal starvation, the defence generally turns upon the co-existence of disease in the body, and the sufficiency of this to account for death. Delirium may be the i-esult of great bodily weakness, on what- ever cause depending ; it is probably more rare in cases of chronic diarrhoea than in those of protracted abstinence. Too much importance must not be attached to its presence or absence on these occasions, since experience shows that there are few cases of starva- tion accurately observed, in which the symptoms have been strictly accordant ; and it would be going too far to assert that the occur- rence of delirium before death would justify a medical witness in assertipg that death could not have been caused by starvation, when the condition of the body and the whole history of the case allowed of no other reasonable interpretation of the facts. Voluntary starvation. Pretended fasting. — Thei-e are a few cases recorded in which persons have voluntai'ily abstained from food, liquid or solid, for the purpose of self-destruction. Suicide, as a result of perfect abstinence is, however, exceedingly rare ; the per- son cannot resist the intolerable thirst, or the desire for food, when placed within his reach. As it requires a period of about eight or ten days for the destruction of life under these circumstances, in the acute form of starvation, the resolution to abstain can be rarely maintained, and for the purpose of self-destruction starvation would never be resorted to, except where all other means of destroying life were removed. Pretended fasting has been a subject of imposture at various times. The case of Ann Moore, of Tetbury, is noticed by most medical jurists, as showing how easily the public, even the educated public, may be deceived, and how lucrative such an imposition, when it has once taken hold of the public mind, may become. According to her account, she began to abstain from food in March, 1807, and continued fasting for six years. It was then discovered, by close watching, that her daughter secretly gave her food and drink. It is stated, however, that during the last watch she had no food of any kind for a period of nine days and nine nights. (" Beck. Med. ■i92 VOLUNTARY OR PEETBKDED FASTING. Jur.," 1, 58.) An imposture of this kind can only be detected by the most minute observation. The case of Sarah Jacobs, the Welsh Fasting Girl, December, 1869, shows that a watch too strictly kept may have the imposture revealed by the actual death of the person. This girl, set. 13, is stated to have voluntarily abstained from any kind of food for a period of two years. She had kept her bed during that time — lying in it decorated as a bride, visited by hun- dreds of persons — in fact, she was thus publicly exhibited by her parents as a girl of miraculous powers. Her lips were moistened with water once a fortnight, but, according to the parents, no food was taken. Four professional nurses from Guy's Hospital were set to watch the girl, and the result was, that after passing through the usual stages of actual starvation she died on the ninth day ! She refused to take food at any time, and voluntarily accepted a lingering death" rather than reveal the exposure. Her parents and those around her allowed her to die ! An inquest was held, and a post-mortem examination gave the following appearances : The body was plump and well-formed ; the membranes of the brain were much injected, the brain itself was healthy and of proper consistency. There was a layer of fat from half an inch to an inch thick beneath the skin of the chest and abdomen. The con- tents of the chest were healthy. The stomach contained three teaspoonfuls of a semi-gelatinous substance of the consistency of syrup, having a slight acid reaction. The small intestines were empty, and presented no attenuation or thinning of the coats. In the colon and rectum there was half a pound of solid excrement in a hard state, which might have been there, according to the witness, a fortnight or longer. The liver was healthy, the gall- bladder greatly distended with bile ; the kidneys and spleen were healthy, and the urinary bladder was empty. The medical evidence was to the effect that the child had died from exhaustion as the result of starvation, and the jury returned a verdict of death from starvation from the criminal neglect of the parents to administer food. They were tried on the charge of manslaughter, at the Carmarthen Summer Assizes, 1870. {Heg. v. Jacobs and loife.) An attempt was made in the defence to refer death to shock, and not to the want of food. The medical facts relied upon in support of this theory were the presence of fat in. the body, and the absence of any thinning of the coats of the intes- tines ; but, as Dr. Fowler very properly pointed out (" Lancet," 1870, 2, p. 150), these conditions are only like to be met with after long or chronic fasting, where the person has survived many weeks on insufficient or unnutritious food. In the case of this girl, the only proved abstinence from food was during the last eight days of her life, and this period of time would not suffice for the entire removal of the fat and the thinning of the coats of the intestines. The prisoners were convicted qf causing the death of their child by criminal negligence. The father was sentenced to twelve months' imprisonment, and the mother to six months'. (" Lancet," 1872, 2, 132.) VOLUNTARY OE PRETENDED FASTING. 493 The desire of a section of the public to know whether a human being could live two years without food has thus been gratified at the cost of life ! Any one acquainted with the rudiments of phy- siology would know that the application of the tests of watching, if really efficient, could only end in death ! A writer justly re- marks, in reference to this case of lamentable credulity : " It is not science, but superstition, even to inquire into the possibility of any human being living a conscious life without food. The very pro- fession to do so is either disease, fanaticism, or imposture, and should be treated as such." 494 SIGNS OF PREGNANCY. PREGNANCY. CHAPTER XLIII. SIGNS OP PREGNANCY. — SUPPRESSION OP THE MENSES. — PROMINENCE OF THE ABDOMEN. — QUICKENING. — SOUNDS OF THE FCETAL HEART. — CHANGES IN THE MOUTH AND NECK OF THE UTERUS. — FEIGNED PREG- NANCY. — CONCEALED PREGNANCY. — PREGNANCY IN THE DEAD. — IM- PREGNATION IN A STATE OF UNCONSCIOUSNESS. — LEGAL'RELATIONS. Signs of Pregnancy. Suppression of the menses. — It is well known that in the greater number of healthy females, so soon as conception has taken place, this secretion is arrested. But there are certain abnormal condi- tions which must not be overlooked. There are some cases recorded which show that women in whom the menses have never appeared, ma}^ become pregnant. This, however, is allowed by all accoucheurs to be rare ; and when it occurs, which we may readily learn from the account of the woman, it will be necessary to search for other signs in order to determine the question of pregnancy. Irregularity as to the period at which the function takes place is common among females. This irregularity may depend upon the age of the person, or upon disease, either of which causes it will not be difficult to recognize. Their continuance after completion may make a preg- nancy appear short. A case is reported in which a ^voman was married in the summer of 1856, and the menses continued after as before marriage. In October, 1857, they ceased for the first time, and in the following December the woman was delivered of a full- grown child ; as the abdomen was not much enlarged, she thought she was only two mouths pregnant. (" Med. Times and Gazette," April 30, 1850.) It is well-known that there are numerous dis- orders of the uterus under which, irrespective of pregnancy, the menses may become suppressed. The continuance of the men- strual discharge, when once set up, is not a necessary condition for impregnation. Dr. Murphy has reported the case of a woman who for sixteen j-ears went on bearing children, eight in number, • without having had during that period any appearance of the menses. The late Dr. Reid, who quotes this case, mentions five instances that fell within his own knowledge in which females became pregnant notwithstanding a long previous cessation of the discharge. (" Lancet," September 10, 1853, p. 236.) The absence SIGNS OF PREGNANCT. 495 of the menses as a consequence of pregnancy is generally indicated by the good health which a female enjoys ; and although disease may coincide with pregnancy, yet a careful practitioner will be able to estimate from the sj-mptoms to which cause the suppression is due. On the other hand, a discharge perfectly analogous to the menstrual sometimes manifests itself, not merely for several periods in a pregnant woman, but during the whole course of pregnancy. (Dr. Murphy's " Obstetric Report," 1844, p. 9 ; also Henke's " Zeit- schrift der S. A.," 1844, p. 265.) Mr. Whitehead has collected seven well-marked instances of menstruation during pregnancy. (" On Abortion," p. 218.) These facts show that we must be cautious in forming an opinion ; and not assert that because a discharge con- tinues, pregnancy cannot possibly exist, or because there is no dis- charge a female must be pregnant. The retention of the menses within the uterus from any cause, may produce enlargement of the abdomen, and give rise to some of the external symptoms of pregnancy. Feigned menstruation. — The menses may be either suppressed or retained ; but if there be any strong motive for the concealment of her condition, a woman may feign menstruation. Dr. Montgomery detected a case of this kind, by the examination of the areolae of the breasts. The woman had stained her linen with blood in order to make it appear that the menses continued, but she subsequently admitted that this was an imposition. It has been stated that there are differences between menstrual and ordinary blood, but there are no certain chemical means of distinguishing them. Prominence of the abdomen. — A gradual and progressive enlarge- ment of the abdomen is a well-marked character of pregnancy ; the skin becomes stretched, and the navel almost obliterated. This enlargement in general begins to be obvious about the third month, although there are some women of peculiar structure in whom the enlargement may not become perceptible until the fifth or sixth month, or even later; still it may be detected on examination. In fact, this sign can never be absent in pregnancy, although it may not be so apparent in some females as it is in others. The objection which exists to it is, that numerous morbid causes may give rise to prominence of the abdomen. This is undoubtedly the fact, as we have occasion to witness in the various kinds of dropsy, or in sup- pressed and retained menses — diseases which in several instances, have been mistaken for pregnancy by eminent practitioners. On the other hand, instances are not wanting in which, owing to the persistence of menstruation and the absence of quickening, the gravid uterus has been actually tapped by mistake for an ovarian tumor ; the operation being speedily followed by the birth of a full- grown child ! (Whitehead " On Abortion," p. 186) ; but the history of a case will in general enable a practitioner to form a correct opinion. [In the Court of Oyer and Terminer of Cumberland County, Pennsylvania, August, 1859, in the case of Commonwealth v. Mc- Manus, the defendant was indicted for infanticide and for conceal- 498 SIGNS OF PREGNANCY. ment of the death of a bastard child. The evidence on the part of the Common^'ealth was, that the prisoner had walked to the office of a physician residing some considerable distance from her resi- dence, and that he, after an examination, declared that she was far gone in pregnancy, so far indeed that he had distinctly felt the sutures in the head of the child ! A few days afterwards another physician was called in by defendant's mother. He declared that she was with child, and would very soon be confined; whereupon the mother indignantly ordered him from the house. Subsequently, on the same day, an old woman, a neighbor, called at the request of the mother. She found the prisoner and her mother in a room together. The prisoner, who was seated on a bucket apparently undergoing the pains of labor, seemed to pull from herself some- thing which she squeezed violently. The witness heard the falling of a body into the bucket, but saw nothing. This occurred on Friday. On the Monday following, the prisoner went in a wagon to a house some miles distant, carrying with her a covered basket. This she placed in the closet of the room where she was to sleep. While it was there, the woman who owned the house having occa- sion to go into the room, perceived a most disagreeable and offensive odor, which upon investigation she discovered proceeded from the prisoner's basket in the closet. In the evening the prisoner took her basket for the purpose, as she said, of going to the house of an acquaintance, who lived beyond the creek near by ; when she re- turned the basket was empty, and the odor had disappeared. A few days after, the body of a new-born infant was found in the creek several miles beldw where the prisoner had crossed. This, it was alleged by the Commonwealth, was the prisoner's child, which had been strangled by her, and subsequently thrown into the water. It was proved, however, that the prisoner never had given birth to a child, or even been pregnant. That for years she had suffered from suppression of the menses. The physician who originally attended her proved that he had recommended her to sit over a bucket of steaming water as a means of obtaining relief. What the old woman had heard fall into the bucket was a clot of blood, loosened by the effects of hot vapor. The odor in the basket came from a bottle containing a quack lotion of herbs, with which she was in the habit of washing herself, and which had been broken when she jumped from the wagon upon reaching her destination. The defendant was acquitted. — P.] A change in the breasts. — These organs in a pregnant woman are full and prominent, and the areolae around the nipples undergo changes of color Avhich Dr. Montgomery and others regard as highly characteristic of the pregnant state. A mere fulness or pain in the breasts, and even in some rare instances the secretion of milk, may arise from other causes than pregnancy. Severe uterine or ovarian irritation may cause the breasts to become painful and swollen. The fulness of the breasts from pregnancy is not commonly ob- servable until about the second or third month. A more or less transparent fluid is secreted by the gland-tissue of the breast, and SIGNS OF PEEGNANCY. QUICKENING. 497 can be expressed from the nipples. This secretion of milk may occur in a non-pregnant female as a result of uterine or ovarian disease. These cases, however, are not very common ; but after a woman has once secreted milk, the secretion is easily reproduced in the breasts by very slight causes, quite independently of pregnancy. The areola is generally observed during pregnancy to become considerably darker in color, and larger in diameter. The skin of which the areola is formed is soft, moist, and slightly tumid. The little glandular follicles about it are prominent, and often bedewed with a secretion ; the change of color has been the most attended to. The areolae are' commonly well marked in from the second to the fourth month of pregnancy — the- intensity of color being the last condition of the areola to appear. The prominence of the glandular follicles does not always exist in pregnancy, and the are- ola may become large and dark-colored from other causes ; conse- quently, these signs are only to be looked upon as corroborative. In females of dark complexion, the areolae are naturally dark, irre- spective of pregnancy ; and in some advanced cases these changes in the areolae are entirely absent. (" Edin. Month. Jour.," March, 1848, p. 693.) Dr. Montgomery has described as a sign of preg- nancy the existence of a brown line extending from the pubes to the navel, especially in women of dark complexion, and a dark- colored but not raised areola of about a quarter of an inch in breadth around the navel ; but this also may be produced by uterine or ovarian disease. Quickening. — -The signs above given are applicable to the early, as well as to the late stages of utero-gestation ; but that which we have here to consider is one which is rarely manifested until about the fourth or fifth month. Quickening is the name applied to peculiar sensations experienced by a woman about this stage of pregnancy. The symptoms are popularly ascribed to the first per- ception of the movements of the foetus, which occur when the uterus begins to rise out of the pelvis ; and to these movements, as well as probably to a change of position in the uterus, the sensa- tion is perhaps really due. The movements of the foetus are per- ceptible to the mother before they are made evident by an external examination. The term is derived from the old Saxon word " quick," signifying living ; as, at the time when medical science was in its infancy, it was considered that the foetus only received vitality when the mother experienced the sensation of its motion ! On the occurrence of quickening there is generally a great disturb- ance of the system, indicated by syncope, nausea, and other dis- tressing symptoms. After a short time the female recovers ; and if sickness has hitherto attended the pregnant state, it has been frequently observed to disappear when the period of quickening has passed. ■ No evidence but that of the female can satisfactorily establish the fact of quickening; and this it is necessary to bear in mind, since, in some cases in which pregnancy is an object of medico- legal importance, proof of quickening may be demanded by law. 82 498 SIGNS OF PREGNANCY. Dr. Eeid remarks (" Lancet," September 10, 1853, p. 237), with respect to this sign, that few women can tell the exact day on which they first feel it ; and a large proportion cannot place it with- in a range of fourteen days, which is of little assistance in the cal- culation of the probable date of delivery. Women who profess to be most exact in noting the period of quickening, differ from each other as to the time. There is much self-deception as to this symp- tom. The discovery of the movements of a child by an examiner is really a proof that the usual period of quickening is past, but their non-discovery at the time of the examination is no proof whatever that the woman has not quickened, since the move- ments are by no means constant, and may be accidentally suspended even at several successive examinations. Besides, cases every now and then occur in which well-formed, healthy women do not ex- perience the sensation of quickening during the whole course of pi'egnancy ; and, what is of more importance, the movements of the child may be at no time perceptible to the examiner. The un- certainty of quickening as a sign of pregnancy is too well known to require more than adverting to. Wonjen have been known to mistake other sensations for it, and in the end it has been proved that they were not pregnant. A woman may declare that she has felt quickening when she has not ; and unless the movements of the child are perceived by the examiner at the time, how is he to confirm or disprove her statement ? Quickening, then (so far as it concerns the statement of the woman), cannot be relied on as a proof of pregnancy ; but if the movements of a child can be felt by the examiner through the abdomen, this is clear evidence not only of the woman being pregnant, but of her having passed the period of quickening. Taking this general experience of accou- cheurs, quickening happens from the tenth to the twenty-fifth week of pregnancy ; but the greater number of instances occur between the twelfth and sixteenth week, or between the fourteenth and eigh- teenth week after the last menstruation. From these observations, it will be seen that an examiner may sometimes detect the movements of the child about the third or fourth month, at others not until the fifth or sixth, and in other instances not at all, throughout pregnancy. Even in those cases in which the movements of the child have indisputably existed, they are not always to be perceived ; hence, several examinations should be resorted to before any opinion can be fairly expressed from their absence. The best mode of examining the abdomen for fcetal movements is to allow the hand to remain at rest on the abdomen. If the patient has quickened recently, the impulse is slight, and generally at only one spot, which, however, is seldom the same. Should she have advanced further, then the movements will be more rolling, and the parts of the child be detected at the same time. In making these examinations, a diagnosis may be facilitated by previously immersing the hand in cold water, and then suddenly applying it to the abdomen. "When the movements of the child are distinctly perceived through the skin of the abdo- SOUNDS OF THE FCETAL HEART. 499 men, they constitute a certain sign of pregnancy ; but their non- discovery at a particular time is no proof that a female is not preg- nant. The "jury of matrons" probably trust to this sign ; hence, their verdicts commonly turn out to be erroneous. There is another source of fallacy which may present itself when an artful woman is desirous of making it appear that she is pregnant — namely, that a woman may simulate the movements of a child by a peculiar action of the abdominal muscles. Medical practitioners of repute have beeu deceived for a time by this artifice, but this occurred before the discovery of chloroform, or the stethoscope. Sounds of the foetal heart.— Another sign is that which is derived from auscultation. By the application of the ear or a stethoscope to the abdomen, at or about the fifth month of pregnancy (rarely earlier), the pulsations of the foetal heart may be recognized and counted. These pulsations are not synchronous with those in the arteries of the mother ; they are much more rapid, and thus it is impossible to mistake them. Their frequency, according to Dr. Hope, is in an inverse ratio to the stage of gestation, being 160 at the fifth and 120 at the ninth month. Sometimes, however, the foetal pulse maj' descend to 80 or even 60 beats a minute. This sign, when present (like the foetal movements), not only establishes the fact of pregnancy beyond all dispute, but shows that the child is living. The sound of the foetal heart is, however, not always perceptible: when the child is dead, of course it will not be met with; but its absence is no proof of the death of the child, because the hearing of the pulsations by an examiner will depend very much upon the position of the child's body, the quantity of liquor amnii, the presence of disease, and other circumstances. Thus the sounds may be distinctly heard at one time, and not at another ; they may be absent for a week or fortnight, and then will reappear; so that, although their presence afibrds the strongest aflirmative evidence, their absence furnishes uncertain negative evidence ; and several examinations should be made, in the latter case, before an opinion is formed. The earliest time at which the pulsations may be heard, has been stated to be about the fourth month, but they will be best heard after the sixth month. The reason why the sounds of the- foetal heart are not always perceived is owing, not only to changes- in the positions of the child, but to the vibrations having to traverse- the liquor amnii and the soft layers of the skin of the abdomen. The presence of much fat in these layers intercepts them. The point where the sounds can be most readily perceived is in the centre of a line drawn from the navel to the anterior inferior spinous process of the ilium on either side — perhaps most com- monly on the right. "When clearly detected, they furnish an une- quivocal sign of the pregnant state. Besides the sounds of the foetal heart, there are other sounds to which the name of " pla- cental murmur," or uterine sounds,ha.3 been given. These are heard from an earlier date, i. e., at any time after the third month. As they may occur in connection with fibroid tumors of the uterus, they do not necessarily indicate pregnancy. (See a paper on this 500 CHANGES IN THE UTERUS. BALLOTTEMENT. subject by Dr. Druitt, " Med. Times and Q-az.," Jan. 21, 1860 ; also another by Dr. Copeman, of Norwich, " Obstet. Trans.," 1869.) In reference to these signs of the pregnant state, it may be ob- served that if the motions of the child, or sounds of the heart, be perceptible, no other evidence of pregnancy need be sought for. The mere suppression of the menses, prominence of the abdomen, and fulness of the breasts, cannot alone establish the facts ; but unless the morbid causes of these abnormal states of the system be clearly and satisfactorily obvious to the examiner, it is a fair pre- sumption from the symptoms, that the woman is pregnant. In any case in which a doubt exists, we should require sufficient time to form a correct opinion. Changes in the mouth and neck of the uterus. — The signs heretofore mentioned are chiefly relied on in medical practice ; but it must be remembered that no case can possibly occur in civil or criminal juris- prudence, in which it will not be in the power of a medical witness to make an examination of the woman. He may then form a safe judgment from the changes which take place in the neck of the uterus, and from the sensation imparted to the fingers by the pre- sence of a rounded body (like the fcetus) floating in a liquid, when an impulse is given to the uterus from below. Up to the fifth or sixth month of pregnancy, the neck of the uterus may be com- monly felt projecting into the vagina ; it is of its usual length, hard and firm. After that period, the uterus rises into the pelvis, and the neck is spread out, shorter and shorter, the aperture increasing in size and becoming rounded. Towards the end of gestation, the neck of the uterus appears to be lost, becoming like a thin mem- brane, and sometimes no aperture can be felt. A well-marked test of pregnancy is the motion perceptible to the finger, on giving a sudden impulse to the child through the neck of the uterus. Capuron calls this the touchstone in the distinction of the pregnant state ; without it, he considers a medical jurist may be easily deceived. To this passive motion of a child, the name of hallottement is given. It cannot be easily determined before the fifth or sixth month ; but after the latter period, especially as preg- nancy becomes advanced, it is always available. In the Trench schools, the method of applying the toucher and hallottement to pregnant females is systematically taught, and by a little practice it may be easily acquired. This motion to the child can also be given through the abdomen, by external hallottement in two ways: either by the patient lying on her side, the hands placed oa the most depending part of the uterus, or by placing the patient on her elbows and knees ; the uterus will then fall forwards, the child also will fall in contact with the front wall of the uterus, and its pre- sence thus be made more perceptible. This latter mode is best adapted for the early stages of pregnancy. As most of these signs refer to an advanced stage, a witness may be asked what are the unequivocal indications of pregnancy before the fifth and sixth month ? The answer to this question is of little moment to a medical jurist, since he is rarely required to give an FEIGNED PREGNANCY. 501 opinion under these circumstances. In all legal cases, when preg- nancy is alleged or suspected, it is the practice for a judge or mag- istrate, on a representation being made by a medical witness, to postpone the decision, one, two, or three months, according to the time required for obtaining certain evidence. The evidence will consist in plainly distinguishing — 1. A rounded body floating freely in a tumor, which alternately relaxes and contracts. 2. The movements of a foetus ; and 3. The sounds of the foetal heart. The most experienced men agree, that before the sixthmonth, the changes in the neck and mouth of the uterus are of themselves too uncer- tain to enable an examiner to form a safe opinion ; and, d fortiori, it is impossible to trust to external signs alone. Mr. Whitehead dissents from this view, and considers that a specular examination of the mouth of the uterus is not only more satisfactory than any other mode of exploration, but that it will enable a person to determine with certainty the existence of preg- nancy during its earlier stages — from a few days after conception to the middle or end of the fourth month, when auscultation first be- comes available. In the fourth week, the lips of the mouth of the uterus at the centre of their margins are permanently separated to the extent of one or two lines ; and the os tincse (the aperture) itself, which was before a mere chink with parallel boundaries, forms an elliptical or sometimes rounded aperture, which is occupied by a deposit of transparent gelatinous mucus. At six or eight weeks, it is decidedly oval or irregularly circular, with a puckered or in- dented boundary having a relaxed and lobulated character. The whole cii'cumference of the neck is enlarged, and the commissures, or angles of the mouth, are obliterated. The mouth continues of this irregular form throughout the whole period of gestation ; but from the time of quickening to the end of the seventh month, the progressive changes are not so marked as to form a guide for de- termining the period of pregnancy. (" On Abortion," p. 204.) This condition of the mouth of the uterus must not be confounded with its menstrual state in the early stages, nor with a diseased state in the latter stage of gestation. [A bluish or dusky color of the vagina, produced by venous congestion, was originally declared by Jacquemin to be an almost certain sign of pregnancy in females who are not subject to hsemor- rhoids. This statement has been confirmed by Kluge, Parent- DuchStelet, Kilian, Wistrand, and Montgomery, the last of whom says, "In every instance, without a single exception, in which I have found this appearance distinctly marked, pregnancy coex- isted." (Sig. and Symp. of Preg., 2d ed. p. 245.) It should, how- ever, be remembered that pregnancy may exist, although this sign may not be visible. (Wharton & Stilld, Med. Jurisp., 1873, ii. p. 15.) The presence of kiestein in the urine is no longer regarded as aflEbrd- ing 'positive proof of pregnancy. — E.] Feigned pregnancy.-— rregn'a.ncy has been sometimes feigned or simulated for the purpose of extorting charity, of obtaining a settle- ment in a parish, or of compelling marriage; but it is scarcely ne- fPHsarv to observe that a n impostor may be easily detected by a 502 well-informed practitioner, since a woman always feigns an advanced state of pregnancy. Although she may state that she has some of the symptoms depending upon pregnancy (and, unless she has already borne children, she will not be able to sustain a cross-examination even respecting these), j^et it is not possible for her to simulate with- out detection, a distension of the abdomen, or the state of the breasts. If she submits to an examination, the imposition must be detected ; if she refuses, the inference will- be that she is an impostor. Females have been known to possess the power of giving apparent promi- nence to the abdomen, and even of simulating the movements of a child by the aid of the abdominal muscles. By placing them under the influence of chloroform, the abdomen at once collapses, and the imposture is detected. These cases of spurious pi'egnancy are some- times met with in hysteric females. De ventre inspicie7ido. — One of the cases in English law, in which pregnancy i-equires to be verified, is of a civil nature. It is in rela- tion to the Chancery writ " de venire inspiciendo." A woman may assert that she is pregnant at the time of her husband's death, and the heir-at-law may sue out a writ to require some proof of her alleged pregnane^'', as his right to the estate of which the husband died possessed may be materially aftected by the result. Until within a recent period, the decision of the question of pregnancy was left to twelve matrons and twelve respectable men, according to the strict terms of the ancient writ ; but in some late cases it has been considered advisable to depart from this absurd custom, and to place the decision in the hands of skilled medical practi- tioners, or obstetric experts. Plea of pregnancy in bar of execution. — The second case in which pregnancy requires to be verified, in English law, is in relation to criminal jurisprudence. When a woman is capitally convicted, she may plead pregnancy in bar of execution. The judge will then direct a jury of twelve married women " de circumstantibus," to be empanelled, and sworn to try, in the words of the law, " whether the prisoner be with child of a quick child, or not." If they find her quick with child, she is respited ; otherwise, the sentence will take efiiect. In admitting the humanity of the principle by which a pregnant woman is respited until after her delivery, there are two serious objections to the practice of the common law, whereby it is made to fall short of what, in a civilized country, society has a right to expect from it: these are — 1st, that the questionof preg- nancy is allowed to be determined by a jury of ignorant women accidentally present in court ; and 2dly, that the respite is made to depend, not upon proof of pregnancy, but upon the fact of a woman haviUg quickened! This sign of the pregnant state has been known to occur so early as the third, and so late as the sixth month ; some females have even reached the seventh month without observing it ; hence the infliction of capital punishment under these circumstances would be a matter of accident {ante p. 498). Quicken- ing is a sign not easily established, except by extorting a confession from the female, as by making her give evidence against herself; PLEA OF PREGNAlSrCY IN BAR OF EXECUTION. 503 and this is the only possible way in which, in a doubtful case, the question could be determined by a jury of matrons. They com- monly trust to feeling externally the movements of a foetus, but this is at all times a purely accidental circumstance, and they may not be perceptible at the time of the examination. It must be obvious, on the least reflection, that the means resorted to by the English law to determine such a question are bad, and are quite unfitted for the present state of society. • Several modern cases show that a jury of matrons may be easily deceived with respect to this sign of pregnanc3\ In Rex v. Wright (ISTorwich Lent Assizes, 1832) the prisoner was found guilty of the murder of her husband by poison. She pleaded pregnancy in bar of execution. The judge empanelled a jury of matrons ; and they, after a form of examination had been gone through, brought in a verdict of " not quick with child." The woman would have been executed had not several medical practi- tioners of ISTorwich represented to the judge that the method taken to determine pregnancy and quickening was so unsatisfactory that no reliance could be placed upon it. The prisoner was then ex- amined by some medical men, and was found to have passed the usual period of quickening ! The judge respited the prisoner, and the correctness of the medical opinion was confirmed by the female being delivered, within four months afterwards, of a healthy full- grown child. (See " Med. Gaz.," vol. 12, p. 22.) Still the jury of matrons is occasionally resorted to. Thus in the case of Reg. v. Westwood (Stafford Winter Assizes, 1843), the matrons were sum- moned to examine a female capitally convicted, and they negatived the plea ! It is not a little remarkable that, although in so many cases the matrons have given a wrong verdict, and that in no in- stance can they give a right one except as a matter of pure conjec- ture, this antiquated practice still continues. It was revived at the Central Criminal Court in '1847. {Reg. v. Hunt, September, 1847.) This woman was convicted of murder ; she pleaded preg- nancy, and the matrons were empannelled and directed to use " their best skill " to determine whether the prisoner " was big with a quick child or not." It was left to their option to have the assistance of a surgeon. In half an hour they returned a verdict " that she had not a living child within her." The law was di- rected to take its course ; and the woman would have been executed but for the interference of the Secretary of State. He directed that the prisoner should be examined by competent medical men, who ascertained that she was really pregnant, and had actually passed that stage in which quickening is most commonly perceived. She was therefore respited, and the error in the verdict of the matrons was clearly proved by the birth of a child on the 28th December ! The value of the opinion of a jury of matrons upon such matters may be estimated from the following facts. The late Dr. lieid re- cords a case of an expert midwife who, when examined in the cele- brated Gardner Peerage cause, deposed " that she had herself once gone ten months with child — that she was always right in her cal- culations — that she always fainted away at quickening, etc., so that 504 IMPEEaNATION IN A STATE OF UNCONSCIOUSNESS. she could never be deceived." Some time after the trial she applied to Br. Reid, convinced on such grounds that she was seven months pregnant ; but, on examination, Dr. Reid found that there was no pregnancy at all ! The doctrine of quickening has been abandoned in relation to the law of criminal abortion ; and there is still greater reason for its immediate abolition in reference to pregnant females capitally convicted. This change would, however, be attended with but little benefit, if the decision of the question of pregnancy were still to remain in the hands of " matrons." The record of their mis- takes sufficiently establishes the correctness of this view; for if they are unable to recognize the pregnant state of the fifth month, and if, as experts, they are liable to be deceived about their own condi- tion, they cannot fail to be mistaken in their opinions at earlier periods, in examining other women. It is, indeed, an extraordinary circumstance, that when married women advanced in pregnancy are themselves continually deceived, and are obliged to consult medical men respecting their condition, they should be specially selected by the law as the persons best qualified to pronounce an opinion upon the pregnancy of a woman, in a case involving the infliction of capital punishment. It would be considered inhuman to execute, knowingly, a pregnant woman, but the imputation of inhumanity is not the less deserved by a custom which virtually leaves the issue in the hands of ignorant and incompetent persona, who may be accidentally present at a criminal trial. The Ameri- cans are certainly in advance of us in their legislation on this sub- ject. Thus, by the revised statutes of ISTew York, when pregnancy is pleaded in bar of execution, it is enacted that the sheriS' shall summon a jury of six physicians, and shall give notice to the district attorney, who shall have power to subpoena witnesses. Concealed pregnancy. — By the law of Scotland, if a woman con- ceals her pregnancy during the whole period thereof, and if the child of which she was pregnant be found dead, or is amissing, she is guilty of an offence, and is liable to prosecution. Evidence is sometimes given as to outward appearances indicative of pregnancy ; but the main proof of a woman having been pregnant, and that which is relied on for conviction, is clear and distinct evidence of the actual delivery of a child. This is generally furnished by medi- cal witnesses. The Scotch law, by making the concealment of pregnancy, under the circumstances above mentioned, an oflence, proceeds on the principle that every pregnant female is bound to make preparations for the safe delivery of a child ; and it is there- fore assumed that if a child be born clandestinely, without prepara- tion, and is found dead, or is amissing, its death is owing to the want of such preparation. Impregnation in a state of unconsciousness. — It was formerly a question whether a woman could become pregnant without her knowledge. This may undoubtedly happen, when intercourse has taken place during profound sleep (lethargy), or when a woman has been thrown into this state by narcotic drugs, or Vapors. But it is UNCONSCIOUS PREGNANCY. 505 difficult to admit that anj' woman should remain pregnant up to the time of her delivery, without being conscious of her condition, if the intercourse took place during the waking state. A woman endowed with ordinary intellect could not avoid suspecting her con- dition, after the fourth or fifth month ; and this alone would be sufficient to induce her to seek advice, whereby the fact would be- come known to her. When a woman is impregnated in a lethargic state, it is unlikely that she should go beyond the sixth month, without being fully aware of her pregnancy ; and if her motives were innocent, she would undoubtedly make some communication to her friends. Capuron mentions a case of this kind, in which the fact of pregnancy was first ascertained at the end of the fourth month, by the woman having complained to one of her sisters of a strange sensation which she experienced in the lower part of her abdomen. (" M^d. L^g. des Accouchemeus," p. 86.) In a case re- lated by Mr. Skey, a young woman who had had intercourse know- ingly, was supposed not to have been aware of her pregnancy until the seventh month ; but there is reason to believe that this woman was guilty of deception. ("Med. G-az.," vol. 39, p. 212.) There are generally, in these cases, strong motives for falsehood ; hence such stories require close investigation before they are allowed to influence the opinion of a practitioner. A case occurred in Sep- tember, 1857, in which a woman, set. 22, described as modest and decorous in her behavior, then advanced to the sixth month of preg- nancy, asserted that she had not consciously had connection with any one, although she specified a date at which she remembered she had lost her consciousness — at which date intercourse might have been had ! On being questioned, she denied that she had had at any time any soreness or pain in her private parts. Although there may be unconscious intercourse and pregnancy, it is not probable that in the case of a virgin, there should be such inter- course without the production of pain, soreness, or laceration ; and these symptoms, if not perceived at the time, should be felt subse- quently and create a suspicion, if not an actual knowledge, of what had happened. This rendered the account which the woman gave wholly improbable. The fact that she was able to fix a date for her unconsciousness, with an accuracy in accordance with her con- dition, was also a suspicious circumstance. Unconscious pregnancy. — It is quite probable that women who are living in connubial intercourse may become pregnant without being conscious of it. Dr. Ruttel mentions the case of a woman, set. 41, who had been married upwards of sixteen years, and who, while returning from a neighboring village, was suddenly delivered of her first child, when only a few days before she had been com- plaining that she was not likely to have any children. The child was born living and mature. (Henke, " Zeitschrift der S. A.," 1844, ■ p. 264.) Mr. Long met with a case in which a married woman, set. 24, subject to irregular menstruation, consulted him for an attack of spasms. On his arrival, he found that she had suddenly given birth to a seventh-months child. Neither her husband nor 506 EVIDENCE OF PREGNANCY IN THE DEAD. herself had the slightest idea that she was pregnant. She had noticed that she had become somewhat stout, and that her breasts were more full than natural. She attributed her condition to im- proved health, and the cessation of the menstrual discharge was set down to some accidental cause. (" Med. Times and Gazette," June 13, 1857, p. 592. See also a case at full term by Dr. Tanner, " Obstet. Trans.," vol. 4, p. 113.) I am indebted to a distinguished judge for the following fact in reference to unconscious pregnancy : A married lady, who had not had a child for a period of nineteen years, found herself, as she thought, getting unusually stout. She was moving about with her family to different places. At last her size alarmed her, and she thought she was suffering from dropsy ; she consulted a physician, who informed her that she was in an advanced state of pregnancy. She treated this opinion with great contempt. In travelling with her daughter, they arrived at a miserable inn ; on the night of their arrival, this lady was seized with pains of labor, and was delivered of a child. She had made no preparation for the birth, and, up to the moment when slie was seized with labor-pains, she had not, with all her former experience, the slightest idea that she was pregnant. (For other cases in which married women have had no consciousness of pregnancy, see " Lancet," June 16, 1860, p. 609, and June 30, 1860, p. 643.) Instances of this kind are im- portant in reference to alleged unconscious delivery in females charged with infanticide. At the same time, all cases in which there are motives for pleading unconscious intercourse or pregnancy, require close examination ; they will frequently be found to be quite unworthy of belief. Pregnancy in the dead. — There is no special case in law wherein the fact of pregnancy requires to be verified after the death of a woman ; but an examination may be necessary in order to deter- rnine the identity of a body, or to rescue the reputation of a woman from a charge of unchastity. The discovery of an embryo or foetus with its membranes, in the uterus would of course at once solve the question, when the necessity for an examination occurred ; and the practitioner will remember that, even supposing many years to have elapsed since interment, and the body to have been reduced to a skeleton, still, if the foetus had reached the period at which ossifi- cation takes place, traces of its bones will be found amidst the bones of the woman. In examining the body of a female long after death, for the purpose of determining whether she was or was not preg- nant at the time of death, it maybe proper to bear in mind that the uuimpregnated uterus undergoes decomposition much more slowly than other soft organs. In the case of a female who had been missing for a period of nine months — whose body was found in the soil of a privy, so decomposed that the bones separated frpm the soft parts — the uterus was of a reddish color, hard when felt, and its substance was firm when cut. The fact was of importance. It was alleged that the deceased was pregnant by a young man, and that in order to conceal her condition he had murdered her. From the state of the uterus, Casper was able to affirm that this organ was in its DELIVERY. 507 virgin condition, and that the deceased was not pregnant at the time of her death. On this representation the accused was liberated. (" Ger. Leich. Oeffn.," vol. 1, p. 93.) " In examining bodies many months after interment, and in one case upwards of a year, I have been surprised to find, that while other soft organs were decomposed, the uterus had scarcely undergone any change ; its substance was still firm and hard. It may happen that the appearances in the uterus are sufiicient to create a strong suspicion that a woman has been pregnant, but the ovum, embryo, or fcetus may have been ex- pelled ; in this case several medico-legal questions will arise in reference to delivery. DELIVERY. CHAPTER XLIV. DELIVERY IN THE LIVING. — CONCEALED DELIVERY. — ABORTION IN THE EARLY STAGES OF PREGNANCY. SIGNS OF RECENT AND REMOTE DE- LIVERY. — FEIGNED DELIVERY. — DELIVERY IN A STATE OF UNCON- SCIOUSNESS. — SIGNS OF DELIVERY IN THE DEAD. — TRUE AND FALSE CORPORA LUTEA. — CHARACTERS OF THE OYUM OR EMBRYO. — MOLES. — CONCEALMENT OF BIRTH. Delivery is a subject which much more frequently requires med- ico-legal intervention than pregnancy. It will be sufficient to state that the concealment of birth, the crimes of abortion and infanti- cide, with questions relative to supposititious children, are closely dependent on the proof of parturition. This subject will admit of being considered under two heads : 1. As it relates to delivery in the living ; — 2. As it relates to delivery in the dead. In under- taking the investigation, we ought, if possible, to ascertain, either from the female herself, or from those around her, whether there was reason to suspect that she had been pregnant. If we can acquire any knowledge on this point it will materially facilitate our inquiry ; but this is not always possible. It has generally happened, that previous pregnancy has been so concealed that few who saw the woman suspected her condition; then again, as the admission of her delivery may be the strongest proof of her crim- inality, she will perhaps resolutely deny it ; and a medical practi- tioner has no right to extort this admission from her. From this it will be seen that a medical witness must often be prepared to prove the fact of delivery against the woman who is criminally charged. 508 EVIDENCE OF DELIVERY IN THE LIVING, Delivery in the living. Concealed delivery. — The signs of delivery in a living woman vary materially, according to the time at ■which this event has taken place. In common language, if the contents of the uterus are expelled before the sixth month, the woman is said to miscarry, or to have an abortion ; if after the sixth month, she is said to have a premature labor. The law does not admit any such distinction: the expulsion of the ovum, foetus, or child by criminal violence, at any period of utero-gestation, is regarded as a miscar- riage or abortion. It has been well observed that the signs of de- livery are indistinct in proportion to the immaturity of the ovum. Thus, when it takes place at the second or third month, there are scarcely any proofs which can be derived from an examination of the woman. All the ordinary signs of delivery at the full period will be absent — the development of the embryo not having been sufficient to cause any prominence in the abdomen, or to give rise to those changes in the system which take place previously to the birth of a mature child : e. g.^ enlargement of the breasts and dila- tation of the mouth of the uterus. Abortion at this period (the second or third month) is generally accompanied by loss of blood, which may manifest itself by its effects on the body. This, how- ever, can only give rise to a suspicion. At a later period of gesta- tion, there may be a discharge resembling the lochia, and the mouth of the uterus may be found enlarged and soft ; but from the small size of the foetus, the outlet will present no positive evidence of delivery. The quantity of blood lost may be greater, and may have a more decided effect on the system. Of course, if the ovum, foetus, or any of its membranes be found, then the presumption of abortion will be strongly supported : but women who designedly conceal their condition, will commonly take effectual means to prevent the examiner from obtaining evidence of this kind. In order to determine the signs of a " miscarriage," as it is termed by our law, at an advanced period of gestation, it will be necessary to describe those which are considered to be characteristic of deliv- ery at the full period. In these cases there will be only a difference in degree ; the signs being more numerous and more clearly marked in proportion to the lateness of the period at which the contents of the uterus are expelled. The signs of delivery may be enumerated in the following order: — Signs of recent delivery in the living. — The female is weak, the countenance pale, the eyes are surrounded by livid areolae, and there is an appearance of general indisposition. Any severe illness may, however, give rise to similar symptoms. Their sudden occurrence, from a state of previous good health, especially when pregnancy is known or suspected, will create a strong suspicion. The breasts are large and full, especially about the third or fourth day after delivery ; the nipples are enlarged, and the areolae around them present all the characters of advanced pregnancy. 1. The skin of the abdomen is relaxed, sometimes thrown into folds : the cuticle interrupted by light-colored broken streaks, pass- ing especially from the groins and pubes towards the navel, which SIGNS OP RECENT DELIVERY. 509 is more or less stretched and altered in appearance. Any disease which has caused enlargement of the abdomen may give rise to a similar appearance in the skin, so that when taken alone, much con- fidence cannot be placed in these lines or streaks as proofs of delivery. The round form of the enlarged and semi-contracted uterus may be felt at the lower part of the abdomen, generally lying toward one or the other side. The apparent size of this organ will depend upon the degree to which it has contracted, and therefore greatly upon the time at which an examination is made. Dr. Montgomery has pointed out the existence of a dark line extending from the pubes to the navel, with a dark areolae around the latter, in cases of recent de- livery ; but he has found this line to exist independently of preg- nancy and delivery — in one case in a girl aged 10, and in another instance, in a lady laboring under an ovarian tumor. 2. The organs of generation will be found externally swollen, con- tused, or even lacerated, with clots of blood about them. The outlet is much dilated, the vagina relaxed, the mouth of the uterus con- siderably open, and its margin completely relaxed. The neck of the uterus is shortened, and scarcely perceptible; and the body of this organ is from two to four times the size which it has in the unim- pregnated state. It occasionally happens that the neck of the uterus is larcerated on one side during the passage of the head in primipai'se ; should this be found, or a cicatrix, it will much assist in proving delivery. 3. The 'presence of the lochia. — This is a discharge, at first of a sero-sanguineous liquid, but which afterwards appears as a brown or green-colored serum. It commences soon after delivery, and continues from a week to a fortnight, or even longer ; it may be absent after the third day. The discharge has so peculiar an odor that some have regarded this alone as furnishing strong evidence of recent delivery. The signs which have been here enumerated are found only when no delay has taken place in making the examination, and the woman has been recently delivered. In some strong and vigorous females, the body resumes its natural state within a few days, and the traces of parturition may have wholly disappeared or have become so ambiguous as to furnish no satisfactory evidence. In others again, proofs of delivery will be obtainable for a fortnight or three weeks afterwards. In most cases, however, it is difficult, if not impossible, to say, after the lapse of eight or ten days, that delivery has certainly taken place, the signs having commonly by that time disappeared. In all cases, the earlier the period at which an examination is made the more satisfactory will be the evidence obtained. Dr. Montgomery once examined a female__^we days after delivery at the full time, and he was particularly struck with the degree to which the parts had become restored to their ordinary condition, especially the mouth and neck of the uterus, which hardly differed from their natural and unimpregnated form. (" Cyc. Pr. Med.," loc. cit.) This inquiry be- comes of considerable importance in a case of alleged child-murder. When the body of a child is not found until after two or three weeks 510 DELIVERY AT A REMOTE PERIOD, from the time of its birth, and the suspected woman denies that she has been delivered of a child, she will probably not deny her preg- nancy, 'but may assert that she has had an abortion at an early period. (See a case by Dr. "Walther, of Labiau, in Casper's " Yier- teljahrschrift," Oct. 1863, p. 275.) In cases of abortion at an early period, the placenta is not always discharged at the time. ("Med. Times and Gaz.," March 12, 1859.) A microscopical examination of discharges might reveal placental, or chorionic structures. Signs of delivery at a remote period. — A question may arise whether it is in the power of a medical practitioner to determine the period at which delivery took place, i. e., how long a time has elapsed. This becomes necessary when, in cases of concealed birth, abortion, or infanticide (some time after suspected parturition), a child is found, and it is required to determine whether the time which has elapsed since the birth of the child, either dead or living, corresponds with the supposed delivery of a suspected woman. . An opinion may be given within eight or ten days after delivery, from the state of the breasts ; of the discharges (lochia), and of the mouth of the uterus ; but it becomes difficult after the sixth day ; and when the tenth or twelfth day has passed it is still more difficult. After two or three months, it may be regarded as impossible to assign the period of delivery with any degree of precision. (See Devergie, " Med. L^g.," vol. 1, p. 446.) In a case of pretended delivery, contested legitimacy, or disputed chastity, a medical jurist may be required to say whether a woman has, at any antecedent period of her life, been delivered of a child. This question, it must be remarked, can be raised only in respect to delivery at the full period, since there is no doubt that abortion in the early stages of pregnancy may take place, and leave no traces of such an event discoverable in after-life. Indeed, a few days or weeks are sometimes sufficient to obliterate all evidence of the fact. With respect to delivery at the full term, certain signs have been mentioned, which by some are considered indelible. These are: shining streaks on the skin of the abdomen, a brown mark reaching from the navel to the pubes, and the state of the mouth of the uterus, which is said never to close so effectually as in the virgin. In regard to the appearance of the skin of the abdomen, it may be remarked, that any morbid causes giving rise to a dis- tension of the cavity — as ovarian enlargement or dropsy — will produce the same effect ; so, also, to a certain extent, extreme emaciation from a state of obesity. (See " Med. Times and Gaz.," April 17, 1861, p. 450, on False Cicatrices.) Then again, these marks on the skin are not always persistent throughout life. Be- sides, a woman, according to the statements of good observers, may be not only once, but repeatedly delivered, without having these marks produced. ("Med. Times and Gaz.," June 9, 1860, p. 583.) With regard to the state of the mouth of the uterus, it is liable to vary in different women, and to be affected by disease, so that a FEIGNED AND UNCONSCIOUS DELIVERY. 511 certain judgment cannot always be formed from its condition. In a woman who has not borne children the mouth of the uterus is in the form of a slit, the angles being bent down, and giving to it the appearance of the os tincse (tench's mouth). Mr. Whitehead has observed that, in a woman who has borne children, the mouth becomes elongated, and loses the slight bend at each of its extremi- ties ; the labia are thickened, and more nearly of equal size ; the commissures are less clearly defined, and the whole of the neck is enlarged, and not so compact in texture. (" On Abortion," p. 195.) It must he remembered, however, that the condition of the mouth of the uterus, even in the virgin, varies at each menstrual period. Should there be congenital occlusion of the vagina, or the hymen be found imperforate, this will at once negative a previous delivery; but the latter condition will not negative a previous pregnancy, since a woman may have been impregnated, and have had an abortion in an early stage of pregnancy, without a necessary destruction of the hymen. This sort of negative evidence may however, be sometimes of great value. There is a total want of good affirmative evidence of delivery at a remote period in the living, if we except that which is furnished by the presence of cicatrices in the vagina or of a cicatrix as a result of lacerated perineum. It is rare, however, that any decision on this subject is required in medical jurisprudence. It might be demanded, either in a case of infanticide, when a woman was accused of having destroyed her alleged offspring some months or jea,r3 before ; or in a case of contested legitimacy, when a female is accused of having- substituted a child of which she pretends she has been delivered at some remote period of time. Feigned delivery. — Delivery has often been feigned by women for the purpose of extorting charity, compelling marriage, or disinheriting parties who have claims to an estate, and in other cases without any assignable motive. Of course, an imposition of this kind could not be sustained before a medical practitioner ; and detection is rendered easy, because it is recent and not remote delivery which is assumed. The latter would, if pretended, be generally cleared up by an examination, as well as by circumstantial evidence. (See case, " Med. Gaz.," vol. 19, p. 231 ; also another by Oapuron, " Med. L^g. des Accouchemens," p. 110.) [The case of Mrs. Cunningham, in E"ew York, will suggest itself to the mind of the American reader. — P.] Can a woman he delivered unconsciously? — Another important question relative to delivery in the living, is whether a woman can be delivered without being conscious of it. The signs of delivery may be discovered by a practitioner ; the offspring may also be found ; the woman may admit the fact of her delivery, but allege that she was totally unconscious of it. The only medico-legal case in which this plea is occasionally raised is in infanticide ; and as the possibility of the occurrence may be questioned, the practitioner must be provided with a knowledge of those facts which medico- 512 UNCONSCIOUS DELIVEKT. legal writers have accumulated respecting it. There is no douht that a woman may be delivered unconsciously during profound sleep, while laboring under coma, apoplexy, asphyxia or syncope ; or when suffering from the effects of narcotic poisons — e. g., the vapors of chloroform and ether, or intoxicating liquors. It is said, also, that delivery has taken place spontaneously while a female was in the act of dying. This, however, has no bearing on the present ques- tion. It is in those cases where a female, after her recovery, pleads unconsciousness of delivery that medical practitioners are chiefly con- sulted. Besides the cases enumerated, hysteria, when accompanied by loss of sense and motion, has been mentioned as a state in which parturition is liable to occur unconsciously. We need not be sur- prised at delivery taking place under these circumstances, when we consider that the contractile power of the uterus is altogether inde- pendent of volition : but, unless the morbid states already mentioned are accompanied by the most profound lethargy and entire loss of sensation, it can rarely happen that the contractions of this organ in its efforts to expel the child, should not at once rouse a woman into consciousness. We ought particularly to expect this in primi- piarse, i. e., in those who have never borne children. At the same time, it must be remembered that parturition in some women, especially when the pelvis is wide and the child small, may take place with such rapidity and ease as scarcely to be accompanied by pain. It has been observed that, when a woman has frequently borne children, delivery sometimes takes place without effort, and without any consciousness on her part. On other occasions, a woman may lie in a kind of torpor or stupor, or suffer from eclampsia (puerperal convulsions), and have no recollection of her delivery. The follow- ing case is possible : A woman may be delivered while under the influence of eclampsia, which might have attacked her before labor set in ; and after delivery, but before complete recovery, she might become maniacal — a not unfrequent condition — during which inter- val she may have killed or injured her child : or the child may have been born dead, or suffering from some accidental injury. She would with truth assert her entire ignorance of it. Her statement would be verified by a bitten tongue, a congested conj unctiva, or face. Should albumen be found in the urine, this fact would be still more confirmative. Of course, eclampsia might occur without these results. The statement might be disproved by finding her actions had shown care and design in other circumstances, at the time she said she was unconscious. Mr. King has described the case of a woman, aged 36, the mother of nine children. She received his assistance in her tenth labor ; when summoned, she was lying calmly and placidly in bed, and was perfectly insensible. He found that the child had been expelled with the placenta. The woman did not recover her sensi- bility for ten or twelve hours, and then stated that she ha,d no recollection of the birth of the child, or of any circumstances con- nected with that event : she suffered no pain or uneasiness. Another case is mentioned by this gentleman, in which sensation appeared to UNCONSCIOUS DELIVERY. 513 be entirely paralj'zed during labor. (" Med. Times," May 15, 1847, p. 234.) It is beyond doubt that profound lethargy occasionally makes its appearance about the time of delivery. Dr. Schulze met with a case in which a woman remained in a state of sleep for three days, and was delivered while in this unconscious condition: on awaking, she had no recollection of having suffered any pain during delivery. ("Ann. d'Hyg.," 1845, vol. l/p. 216 ; " Med. Gaz.," vol'. 36, p. 40.) Dr. Montgomery relates the case of a lady, the mother of several children, who, on one occasion, was unconsciously deliv- ered during sleep. (" Cyc. Pr. Med."; see also case in "Brit, and For. Med. Rev.," ITo. 9, p. 256.) Dr. Palfrey describes a case in which labor commenced and progressed in a woman to the second stage during sleep. (" Lancet," 1854, vol. 1. p. 36.") The results obtained by the use of the vapors of chloroform and ether show that the expulsive efforts of the uterus are often as ener- getic in the unconscious, as in the conscious state. It may appear extraordinary, however, that a primiparous woman, unless rendered unconscious by narcotic substances, should be delivered without suf- fering pain : nevertheless, a case of this kind is recorded by Dr. Wharrie. The woman's age was 21 ; she had been in labor about six hours ; she complained of no pain, and the child was born with- out effort or consciousness. The child was healthy but small, weigh- ing rather more than four pounds. (" Cormack's Journal," Janu- ary, 1846, p. 12.) Notwithstanding this and other cases, it is in the highest degree improbable that any primiparous female should be delivered during ordinary sleep without being aroused, and brought to a sense of her condition. There is another condition in which a woman may state that her delivery took place unconsciously ; and this, from its being one of the most common species of defence set up by a female charged with child murder, must here claim our attention. Thus, she will allege that while suffering from pain, she felt a strong desire to relieve her bowels : that she went to the water-closet for that purpose, and was- there delivered without knowing anything of the occurrence until it was too late to save the child. This kind of desire is a very com- mon symptom of the parturient state ; and in private practice, it is- often difficult to restrain a woman from yielding to the feeling, when' it certainly would be attended with hazard to the child. (" Med„ Times and Gaz.," April 4, 1857, p. 347.) We must therefore admit that an accident of this kind can occur ; although here, as in every other instance in which unconscious delivery is pleaded, a medical witness ought to inform himself, or be informed, of all the particu- lars which are stated to have attended deliver}^, before he gives an- answer applicable to the case. As a general rule, it cannot be denied that delivery may take place under these circumstances, and a womam not he conscious of it ; but before we make this admission in regard to any- particular instance, we ought to have a statement of all the facts from the female herself. It is thus that we shall avoid the risk of seeing a premature medical opinion set aside by the subsequent production of circumstantial evidence. Besides, it has beenproperly 514 POST-MOHTEM PARTURITION. observed that, after an accident of this kind, a woman cannot be ignorant of her having been delivered. Women who have raised this plea in cases of child-murder have often been known to maintain that they were unconscious of their pregnancy, and thus have at- tempted to excuse themselves for not having prepared the articles necessary for childbirth. It is possible that a woman, especially one who is pregnant for the first time, may not be aware of her preg- nancy in the earlier stage ; but it is rare for one to advance to the full term without being conscious of it. Women who have borne children have not unfrequently consulted medical men ; and al- though nearly at full term, they have been unconscious of their state. In the majority of instances, it may be presumed that a woman thus situated must have had some reason to suspect her con- dition ; and if only a suspicion existed in the mind of one who did not contemplate the destruction of her offspring, there would as- suredly be many circumstances forthcoming which would at once establish her innocence. If this remark applies to married women, it applies with still greater force to those who are unmarried, since the fact of illicit connection, and the fear of its consequences, must render them peculiarly alive to all those changes which, by common repute, take place in the female system during pregnancy. Post-mortem par^Mn'izom.— Several instances of this kind have been recorded (" Med. Press," Oct. 9, 1872), and they have all arisen from the same cause — the extrusion of the foetus from the relaxed uterus, as a result of the accumulation of the gases of putrefaction. Post-mortem parturition formerly gave rise to many superstitious notions, but the facts connected with this condition are now fully understood. (See " Lancet," 1872, 1, 596.) If the body is not in a decomposed state, it is unusual to find the uterus retaining the power of expelling the foetus by its own muscular contractions after the death of the woman. It is obvious that in certain cases this condition might be used to cover and conceal a case of criminal abortion. The subject has been lately brought before the Medico- Legal Society of Paris by ray friend Dr. Louis P^nard. ("Ann. d'Hyg.," 1873, 1, 213.) He was required to report on an alleged case of delivery thirty-six hours after the death of the woman, in which the question of expulsion by gaseous .putrefaction could not arise. In July, 1872, a young woman died under suspicious cir- cumstances, after eight days' illness. It was only just before her death that the medical man in attendance discovered that she was pregnant, and had probably reached the fifth month. He made no examination after death, and when the body was laid out there was no unusual appearance. When raised to be placed in a coflin thirty-six hours after death, a foetus fell from between the legs of the woman. On examining the body the uterus was found with the placenta attached, inverted and extended from the outlet. Dr. P^nard, after fully considering the case as submitted to him, came to the conclusion that after the death of the woman, the uterus would not retain the power of expelling the foetus, and inverting itself by spontaneous muscular contraction. 'Eo doubt there are PROOFS OF DELIVERY IN THE DEAD. 515 great difficulties in admitting that a spontaneous action of the uterus after the death of the woman should be so powerful as not merely to expel the foetus and placenta, but actually to invert or cause prolapsus of the organ ; still the occurrence of such cases rests upon good authority. (See " Obstetric Transactions," 1873, p. 255.) In these rare instances, it is probable that the women had reached the full term, and parturition might have commenced before death. In the case related by Dr. P^nard, the woman had only reached the fifth month, and at this stage of pregnancy it is improbable that the post-mortem contractions of the uterus, without any assignable cause, would have operated to expel the child and invert the organ. It is more reasonable to suppose that in this case there had been criminal interference. ( " Lancet," 1872, 1, 517, 596, and 2, 119.) The subject of post-mortem parturition has been lately brought before the Obstetric Society by Dr. Aveling ( " Obstet. Transactions," 1873, 14, 240), and he has here reported thirty cases of this kind. The principal conclusions at which he has arrived are that the uterus may expel its contents after death save in cases in which no symptoms of natural parturition can be discovered before death. He also considers that expulsion of the placenta, spontaneous evolution of the foetus, and prolapsus, inver- sion and rupture of the uterus, may equally take place post-mortem. He refers these effects either to a contracting power remaining in the uterus after the death of the rest of the body, or to the pressure exerted on the uterus by the gases of putrefaction, the latter being the more frequent cause. His cases have also led him to a conclu- sion having an important bearing on the medico-legal relations of this subject— that after the death of the woman, a child may con- tinue to live in the uterus for many hours, but when a woman dies undelivered, no time should be lost in removing the foetus. (Op. cit. p. 255.) Signs of delivery in the dead body. — It will now be proper to ex- anaine the signs of delivery which are derivable from an examination of the body of a woman after death. Occasionally we may obtain some history of the case during life, by which our labor will be much facilitated ; but, on the other hand, every fact may be studiously concealed from us, and then we may be required to prove not only the delivery but the previous pregnancy. These investigations rela- tive to pregnancy and delivery in the dead body are almost exclu- sively confined to cases of criminal abortion, where the contents of the uterus have been expelled at the sacrifice of the life of the woman. Death commonly ensues in these cases within two or three days after delivery, and then satisfactory proofs are obtainable by a post-mortem examination ; but if the woman has survived three or four weeks, it will be as difficult to determine delivery in the dead as in the living subject. This remark applies to delivery at the full period; for if the uterus have expelled its contents in the first months of pregnancy, the traces of this expulsion will have gene- rally disappeared in the course of a few days. 516 MEDICAL PROOFS OF DELIVERY IN THE DEAD BODY. The following may be taken as the chief appearances when the body of a woman is examined soon after delivery at the full period. The uterus is like a large flattened pouch from nine to twelve inches long, its mouth being wide open. The cavity contains coagula of blood, or a sanguineous fluid ; and its surface is covered with the remains of a decidua — the outermost membrane of the embryo or foetus. In the part to which the placenta has been attached, the substance of the organ appears exposed, presenting several large semilunar, or valvular openings. This portion of the uterus has been found of a very dark color, which has given rise to a suspicion that the organ was gangrenous. The vessels are extremely large and numerous. The Fallopian tubes, round ligaments, and ovaria are so vascular (full of blood) that they have a purple coloi*. The spot whence the ovum has escaped is more congested than the rest of the ovarian surface. Obstetric writers dift'er greatly in their statements respecting the size of the uterus at different periods after parturition ; and these diiFerences may be explained, partly by the fact that the uterus contracts more rapidly in some women than in others, and partly, perhaps, by the circumstance of the birth having been, in some instances, premature. Dr. Montgomery states that, after delivery at the full period, and under perfect contraction of the uterus, if the body be examined within a day or two, the uterus will be found seven inches long and four broad. Its substance, on making a section, will be from an inch to an inch and a half in thickness, and will present the orifices of a great number of large vessels. At the end of a week, the uterus is between five and six inches, and at the end of a fortnight, about five inches in length ; the density of its structure has, during this period, increased, and its substance has considerably diminished. The inner surface is still bloody, and covered partially with a pulpy membrane resembling the decidua. The orbicular direction of the fibres around the internal orifices of the Fallopian tubes is, at this time, very distinct. In about a month, the uterus will have become fully contracted; but the mouth rarely, if ever, closes so completely as in the virgin state. In a case examined by Dr. Barnes, in which a primipara, aged 26, died from puerperal fever, on the sixth day after delivery, the following appearances were met with in the uterus: The internal surface was blackened and congested, especially in those parts to which the placenta had been attached. There was the appearance of suppurative action in this part. The substance of the uterus was healthy ; there was no pus ia the sinuses. The os uteri showed considerable ecchymosis. The vagina was healthy ; the iliac veins contained nothing but loosely coagulated blood. There was in the left ovary a small well-marked corpus luteum, having a cen- tral cavity. ( " Med. Gaz.," vol. 41, p. 294.) This condition of the uterus must not be confounded with the apjaearances which are observed when death takes place during menstruation. Dr. Judee found in the bodies of three women who had died during menstru- ation, that the uterus was somewhat enlarged — its walls being EVIDENCE FROM CORPORA L0TEA. 517 thickened and its interior lined by a reddish gelatinous layer about ^Vth of an inch thick consisting of. a capillary network of vessels, inclosed in a mucous-like membrane. When this was removed, the uterus below was found to be white and firm. The interior of the neck was of a grayish color ; the lips were swollen, of a dull-red, bluish, or even black color. On compressing this part, small drops of blood issued. This was not observed either in the neck or body of the vagina. A section of the uterus presented only the normal fibrous tissue ; but at the level of the mouth (os uteri), there was a mass of tissue resembling a portion of apoplectic lung. The blood daring menstruation, according to this gentleman, issues entirely from the highly congested mouth of the uterus. ( " Gaz. des Ii6pi- taux," No. 39, and "Med. Times and Gaz.," June 23, 1855.) An ecchymosed condition of the neck of the uterus is very commonly found as the result of an easy labor, and therefore forms a good guide where present. This point must be borne in mind in refe- rence to criminal abortion, inasnmch as the neck has the appearance as if violence had been employed. From the statement of appearances given above, it will be seen that there must be considerable difficulty in determining the period prior to death at which delivery took place. The difficulty is in- creased when a woman has been prematurely delivered, or when death has not taken place until some time after delivery. A medi- cal opinion may be then in some degree strengthened by searching for those signs wbich have been described as characteristic of de- livery in the living. These, if present, will always furnish strong corroborative evidence, not only of the fact of delivery, but of the period at which it had probably occurred. Co7-pora lutea. — -The condition of the ovaries has been considered to furnish strong evidence, not so much of delivery as of previous pregnancy. These organs, as it has been already stated, when ex- amined soon after delivery are found of a deep purple color, owing to their extreme vascularity. If the woman has really been preg- nant, we may expect to find, on one of the ovaries, the appearance which is denominated a corpus luteuin. The accounts given by ob- stetric writers of the characters of corpora lutea, and the evidence which they are capable of furnishing in legal medicine, are very confiicting. According to Dr. Montgomery, in a true corpus luteuin {i. e., of pregnancy), the ovary presents a protuberance with a dis- tinct cicatrix on the part whence the ovum has escaped. The pro- tuberant portion will be found on section to have an oval form, and to be of a dull yellow color — hence the name corpus luteum. It is full of blood, and in texture resembles the section of a kidney. It is of its greatest size in the early stage of pregnancy, and gradually diminishes as gestation advances. In the centre of this section there may be either a cavity or a radiated white cicatrix (scar), ac- cording to the period at which the examination is made. The cavity remains for about three or four months after conception, and is sur- rounded by a strong white cyst : as gestation advances, the opposite sides approximate, and a radiated white cicatrix results. The size 518 FALSE COEPORA LTJTEA, and vascularity of the corpus luteum are considerably diminished by the time gestation is completed, and in about five or six months afterwards — i.e., fourteen months after its first formation — it dis- appears altogether from the ovary ; so that the corpus luteum of one conception is not found with that of another, unless a prema- ture expulsion of the contents of the uterus has taken place. (" Cyc. Pr. Med. Pregnancy," p. 496 ; see also " Edinburgh Monthly Jour- nal," Jan. 1845, p. 58.) The presence of a corpus luteum, as it is here described, does not prove that a woman has borne a child. In the opinion of some obstetric authorities, it establishes that concep- tion has taken place ; but the embryo may have been converted into a mole or a blighted foetus, and expelled at an early period. It was formerly supposed that one true corpus luteum only was met with in pregnancy with one child ; but among other facts which show that such an inference is erroneous, is a singular case reported by Dr. Eenaud to the Manchester Pathological Society. He ex- amined the body of a woman who died in the seventh month of her pregnancy, and from whose uterus he extracted a foetus. There were no traces of a blighted ovum. The ovary, however, presented two distinct and well-marked corpora lutea. (" Med. Gaz.," vol. 39, p. 599.) Had the ovary alone been examined, it might have been supposed that this female had had twins. The corpus luteum is of its greatest size in the early stage of pregnancy, and gradually diminishes as gestation advances. From the third month to the full term it has a dingy, yellow color on section. According to Dr. Paterson, the false corpora lutea, or those which are produced irrespective of pregnancy, may be distinguished from the <;■«£, by the following signs: The false bodies have in general an irregular form, and want either a central cavity lined with a distinct membrane, or a, puckered cicatrix: they have no concentric radii, and are frequently numerous on both ovaries. Dr. Eams- botham agrees with Drs. Montgomery and Paterson in considering that the true corpus luteum — i. e., that derived from conception — is known either by its having a central cavity, sometimes unoccupied, at others filled with the blood which was eftused at the time that the coats gave way, or, if it should be of more ancient date, by its presenting stelliform radiated white lines (a puckered cicatrix), re- sulting from the closing of this cavity. (" Obstetric Medicine," p. 49.) In opposition to these views Dr. Knox, an experienced anatomist, asserts that there is no distinctive character whereby what is called the true can be distinguished fi'om the false corpus luteum, the only difference being that the latter is smaller. What have been called corpora lutea may be formed in virgin animals, independently of intercourse ; and the time of their disappearance from the ovary varies from three months to an almost indefinite period. (" Med. Gaz.," Dec. 22, 1843.) That there is considerable difficulty in dis- tinguishing true from false corpora lutea, is proved by reference to a case reported in the " Medical Gazette," (vol. 34, p. 628), in which two experienced observers differed. Dr. Lee thought that a prepa- FORMATION OF CORPOEA LUTEA. 519 ration which was the subject of examination was not a corpus lu- teum, while Mr. Wharton Jones thought that it was— founding his decision on a microscopical examination. This difference of opinion shows that a distinction is by no means so simple a matter as some writers assert. . Mr. W. Jones agrees with' Dr. Knox in considering that a corpus luteum may occur in the ovaries inde- pendently of intercourse, and that the existence of one in this organ would therefore afford no proof whatever of intercourse having taken place. The discovery of the ovmn in the iiterus, in process of development, could alone, in the present state of our knowledge, warrant an affirmative opinion on this point in a court of law ; and this I believe to be the safest view of this much-contested question. On the other hand, the absence of a corpus luteum from the ovary would not in all cases warrant an opinion that conception had not taken place. The researches of Professor Bischoff (" Med. G-az.," vol. 35, p. 443, et seq.) have shown that the production of a corpus luteum is by no means necessarily connected with conception. The ova undergo a periodical maturation, about the time of menstruation, and escape from the ovary or are extruded whether there be conception or not ; hence fecundation is more likely to occur when intercourse is had about this period. This is also the opinion of Raciborski ; indeed some physiologists regard menstruation as the alternative of con- ception (" Dub. Quart. Journ.," May 1846, p. 426), and consider that there is no period so favorable to conception as that which immedi- ately follows the cessation of the menses. The late Drs. Baly and Kirkes, who investigated the subject of true and false corpora lutea, concluded fi'om their researches, that cases seldom occur in which the mere presence of a corpus luteum can be taken as a proof of previous impregnation ; and they con- sider the following rules to be deducible from the facts which they have collected: 1. A corpus luteum in its early stage (that is, a large vesicle tilled with coagulated blood, having a ruptured orifice, and a thin layer of yellow matter within its walls) affords no proof of impregnation having taken place. 2. From the presence of a corpus luteum, the opening of M'hich is closed, and the cavity re- duced or obliterated (only a stellate cicatrix remaining), no conclu- sion as to pregnancy having existed can be drawn, if the corpus luteum be of small size, and does not contain so much yellow sub- stance as would form a mass the size of a small pea. 3. A similar corpus luteum of larger size than a common pea, would furnish strong presumptive evidence, not only of impregnation liaving taken place, but of pregnancy having existed during several weeks at least ; and the evidence would approximate more and more to com- plete proof, in proportion as the size of the corpus luteum was greater. (Op. cit. p. 57.) From this statement, it will be perceived that the difference is only relative and arbitrary, chiefly depending on the size : and as in pregnancy, corpora lutea are found of variable size, while in men- struation they may, under great excitement, attain a large size, it 520 CHABACTEES OF THE OVUM OE EMBRYO.. is obvious that no safe inference can be drawn from their presence, irrespective of other signs of impregnation. The terms true and false, therefore, are inappropriate ; and serious mistakes may arise by a reception of evidence on this point. The law requires absolute certainty, not mei'ely probability or presumption ; and, in the pre- sent stage of physiology, the proof falls shoi't of that which is neces- sary to guide the verdict of a jury. At a trial for attempted abor- tion, Reg. V. Goodall (Notts Lent Assizes, 1846), on examining the body of a woman on whom the attempt had been made, it was alleged that she was no< pregnant : but on inspecting the ovary, a corpus luteum was there discovered. This was described as false, apparently because there was no other proof of impregnation. Had an embryo or its membranes been found in the uterus, or had there been some proof of their expulsion, it would probably have been described as true. Dr. Meigs, an experienced writer, says that cor- pora lutea may vary in size, but in all cases they are real. Physi- ologically speaking, the}' do not admit of a division into true and false. (" Pemales and their Diseases," 1848, p. 43 ; see " Ed. Mon. Jour.," Oct. 1851, p. 805.) From these considerations, therefore, it appears to me that the only conclusion to which we can come is, that medical evidence respecting the nature of a corpus luteum, in an unknown case, if received by a court of law at all, should be received with the greatest caution, and on\y from a witness of great experience. The old doc- trine on this subject, that the presence of such a body on the ovary attbrds certain and undeniable evidence of impregnation, may be regarded as completely subverted. Characters of the ovum or embryo to the sixth month. — Hitherto the examination has been confined to the woman, but it is now neces- sary to describe the characters of the ovum or embryo and its enveloping membranes at the early stages of pregnancy, since, when this can be procured, it may furnish good medical evidence. The " ovum" signifies the embryo and its membranous coverings ; the " embryo" is the body Avhich is afterwards converted into the foetus ; the term " fcetus" is applied to the embryo after the third or fourth month of gestation. If the ovum be expelled within a month after conception, it is scarcely possible to detect it, owing to its small size, and its being enveloped in coagula of blood. Burns examined three uteri within the first month, where no expulsion had taken place, but even under these favorable circumstances he failed in discovering the ovum. At first, the ovum contains no visible embryo, but it appears to consist merely of vesicular membranous coverings. Ac- cording to this authority, when first distinctly seen through its membranes, it is of an oblong form, and about a line (the twelfth of an inch) in length. At the sixth week, it is slightly curved, resem- bling as it floats, a split pea. In the seventh week, it is equal in size to a small bee ; and by the end of the second month, it is bent, and as long as a kidney bean. After the second month, development goes on rapidly ; the features are in part well marked, and the limbs are gradually well formed. At the third month, the fcetus weighs DEVELOPMENT OF THE EMBRYO — MOLES. 521 from one to two ounces ; when stretched out, it measures ahout three inches, and the genital organs, although the sex is not then distin- guishable, are large in proportion to the rest of the body. The membranes are larger than a goose's egg. At the fourth month, the foetus is from five to six inches long, and weighs from two to three ounces: at the fifth month, it measures from six to seven inches, and weighs from five to seven ounces ; and at the sixth month, its length is from eight to ten inches, and its weight about a pound. (For the characters of the child beyond this period, see " Infanticide.") The great difficulty will consist in determining the nature of the supposed ovum or embryo between the second and third month. In making the examination, it should be placed in water, and all coagula gently washed away from the membranous coverings, or removed by some blunt instrument. Alcohol may be used as a substitute for water, after the blood has been removed. If the embrj'o cannot be found, the deeidua and chorion, or portions of them, may be recog- nized ; the former, by its forming the outer investment with its smooth internal and rough external or uterine surface ; the latter, by the villous or shaggy appearance of that portion of it which should have become the placenta. Between the third and fourth month, the foetus may be commonly identified without much difficulty. The ovum in many instances escapes first, leaving the deeidua behind. This comes away after a time, but it is important to remember that in some states of the virgin, decidua-like structures are thrown off from the uterine mucous membrane, which, when examined b}'^ the microscope, resemble the true deeidua. Both are constituted of the innermost portion of the uterine mucous membrane, and contain all its elements. Moles. — The true mole is the result of conception, the foetus of which hasdiedinconsequenceof the effusion of blood into the deeidua and the various membranes, and, should a placenta exist, into its structure. The sac of the amnion has frequently burst, and the ovum has escaped, or it has died and been dissolved by the liquor amnii or serous liquid, which is found turbid. The remains of the umbilical cord are frequently found on the interior of the amnial sac. ISTodules are found projecting into the cavity, which are pro- duced by the effusion of blood outside the sac. Sometimes the cavity is almost obliterated, the main bulk being made up of effused blood. In the varieties of moles it is not difficult to recognize all the membranes ; the microscope will always enable the examiner to detect the chorion villi. Such a mole, of course, proves conception ; but solid bodies are expelled from the uterus which have not this origin, and may occur in the virgin : these are called false moles. A clot of blood may become dense, and, losing some of its coloring matter, exhibit appearances which cannot be distinguished from the true mole except by the microscope. Polypi may also resemble a mole ; but a careful examination would readily show the absence of ovular membranous structures. Sometimes a large exfoliation of the vaginal epithelium may take place, and before its expulsion become condensed, so as to cause suspicion. The microscope will. 522 VESICULAE MOLES OF THE UTERUS. however, show that it consists of only tessellated epithelium. Moles may coexist with true pregnancy, in a case of twins. The symptoms accompanying a mole resemble those of pregnancy; and the appear- ances produced by its expulsion are not to be distinguished from those attending the abortion of a foetus at an early period of gestation. The only means of distinction would be derived from an examina- tion of the expelled matters. The local injury produced by the expulsion of these bodies on the organs of generation is by no means as great as that caused by delivery at the full period. Vesicular mole {Hydatiniform degeneration of the chorion). — Wheu by some accident the foetus dies at any time before the complete formation of the placenta, the villi of the chorion, instead of completely dying, retain a certain amount of vital foi'ce ; the consequence of which is that in some parts growth goes on imper- fectly, serous fluid is effused within, and the part is distended into a globular form. This, occurring frequently in the course of each villus, gives it a beaded appearance, and the whole mass appears some- thing like a bunch of grapes. The size, however, of each vesicular body varies much in different specimens, and also in different portions of the same specimen, some being only detectable by the microscope, while others are as large as the largest grape. On the largest kinds are generally to be found small villi, undergoing more or less the same process of change. Thus it will be observed that the vesicular growths are attached one to another by delicate threads — the unchanged stem of the villus. This will readily serve to distinguish them from true hydatids (Dr. Graily Hewitt, " Obstetric Transactions," vol. 1, p. 249), concerning the distinction between which much confusion has existed, and questions have arisen as to whether the vesicular mole can exist, or be produced in the virgin. From what has just been shown, it will be perceived that this latter cannot arise except as a result of impregnation. It is exceedingly rare to find true hydatids in the uterus at all, still more so for them to be discharged through the cavity of the uterus. Dr. Hicks informs me that no authentic account of such a case is on record. But even if it were not so, the slightest examination by the unaided eye would show whether the vesicles were attached to each other as above mentioned, or whether the smaller were inclosed within the larger cysts, or floating without any attachment whatever. The use of the term " hydatid" does much to perpetuate the error. How long this vesicular mole may remain in utero is uncertain ; accurate infor- mation is required on this point. Certainly it may remain more than a year, and possibly many years. The rapidity with which they grow is very great, but this is readily explained by the fact that it is a simultaneous enlargement of myriads of parts. A woman at the third month of pregnancy may be as large as at the seventh month ; she may ultimately attain a size exceeding that of the full term. Cases of twin-conception are not uncommon, in which one ovum becomes vesicular, the other going on towards maturity. (Dr. Hall Davis, " Obstetric Transactions," vol. 3, p. MISTAKES FROM THE CONDITION OF UTERUS. 523 177.) Again, one ovum may become vesicular, while the other is converted into a fleshy mole. In some rare cases, a portion only of the chorion is changed into this form of mole, while the proper formation of the placenta may go on in the normal manner. The question here arises — Can the mature placenta be so con- verted? Should a portion be left behind in a healthy state, can it assume the vesicular degeneration ? From all that is at present known, this is exceedingly improbable ; from observations made of late years, it appears that the change only takes place in the chorion villi before the formation of a placenta. It is much more probable that, should a woman have no intercourse after labor, but yet expel a true vesicular mole, that it was a twin ovum which was not expelled during labor. In an early stage of pregnancy, a decidual covering will always be found, more or less complete, around the mole ; but if the size of the mass is great, then, although present, it will be less observable, being spread over a larger surface. A corpus luteum will also be found, but not so perfectly formed as in normal pregnancy. The ordinary symptoms of pregnancy accompany this state, although in all forms of mole-pregnancy it is imperfectly marked, or only proceeds to a certain point. (See case " Obstetric Record," vol. 1, p. 21.) It is also to be remembered that the effects of the expulsion of a mole are very similar to those of abortion. These facts may have an important bearing on medico-legal practice, and in this respect the following case, reported by the late Dr. Chowne to the Westminster Medical Society, November, 1844, will be found of interest : A woman was seized with pains resembling those of labor, and a mass of uterine hydatids was expelled, which was supposed to have been in the uterus about five months. When the woman was examined about thirty-six hours afterwards, there were all the signs of recent delivery about her. The parts of gene- ration presented the usual appearances met with in the expulsion of a fcEtus : the breasts were enlarged, the arolse elevated, of a _ brown color, the follicles prominent, and the organs evidently con- taining milk. The occurrence of this case led Dr. Chowne to think that, had the body of an infant been found with marks of violence upon it, concealed in the house where this woman had lived, it would probably have been pronounced to have been her child. A medical man might have strengthened the suspicion of criminality by declaring that there were all the signs of recent delivery about her. It may be observed, however, that in such a case the woman would probably have stated that no child, but some tumor, had come away from her ; and a medical man would not be justified in swearing that appearances of delivery absolutely indi- cated, under all circumstances, that a woman must have been de- livered of a child. On the contrary, it is a well-known medical fact, that similar appearances may arise from the expulsion of the various forms of mole. (See a case of Mr. Pearson's, " Medical Times," Dec. 30, 1848.) Circumstantial evidence would be against her only on the assumption that some person had wilfully concealed 524 CONCEALMENT OF BIRTH. or made away with substantial proofs of her innocence, i. e., the mass which had been expelled. Dr. Fischer met with a case iu which a woman ^ave birth secretly to a child, whose death led to a chai'ge of child-murder against her, and two months afterwards she passed a mole or blighted foetus, in reference to which a ques- tion of superfoetation was raised. (Horn's "Vierteljahrsch rift," 1866, 2, 22.) Concealment of birth.- — Medical evidence respecting delivery is required in two cases : 1st, when the birth of a child is wilfully concealed ; and 2dly, when the contents of the uterus have been prematurely expelled by criminal means. The concealment of pregnancy is no offence in the English law ; but the concealment of delivery or of the birth of a child is a misdemej^nor, by the 24 & 25 Vic. c. 100, sec. 60, the vyords of which are to the following effect : " If any woman shall be delivered of a child, every person who shall by any secret disposition of the dead body of the said child, whether such child died before, at, or after its birth, endeavor to conceal the birth thereof, shall be guilty of a misdemeanor, and being con- victed thereof shall be liable at the discretion of the court to be imprisoned for any terra not exceeding two years, with or without hard labor." A proviso is added to the effect, that any person tried for the murder of any child, and acquitted thereof, may be found guilty of concealment of birth, if it shall appear in evidence that the child had recently been born, and that such person did by some secret disposition of the dead body endeavor to conceal the birth. Various interpretations have been put upon the terms "conceal- ment" or " secret disposition of the body." This part of the evi- dence does not affect a medical witness, unless he himself has found the dead body or was present when it was found. It will rest with the judge to determine whether the body has been so disposed of as to constitute legally a misdemeanor. (-Be^. v. Clarke, Chelms- ford Summer Assizes, 1864.) This is an offence of which women charged with child-murder are commonly convicted in England ; while the Scotch law punishes Avomen for the concealment of pregnancy if the child be dead or missing. (Alison's " Criminal Law," p. 153.) The medical evidence on trials for this misdemeanor is exclusively derived from an ex- amination of the mother; and thus, much will depend upon the time at which this is made. With respect to the child, its body need not even be produced, provided there be satisfactory evidence of its death ; the body may have been secretly buried or burnt, and in the latter case it may be necessary to examine the ashes. According to the statute, the child must be dead — the conceal- ment of the birth of a living child not being any offence, unless it should happen to die before its birth was made known. In the case of The Queen v. Woodman (Kingston Lent Assizes, 1844), the woman was acquitted because the child was living when concealed. Mr. Chitty says, that in order to constitute the offence, the child must have advanced to the end of the seventh month ("Med. Jur.," p. 412) ; but it is to be presumed that the concealment of the birth CONCEALMENT OF BIRTH. 525 ot a dead child at the sixth or under the seventh month, would be as much an infringement of the statute as if it were more advanced. The concealment of the aborted but undeveloped ovum or embryo — of a monster, i. e., a child without human shape, a mole or other morbid growth — would not probably be considered a contravention of the statute. I am not aware that there has been any judicial decision on this point. Mr. Lane communicated to the " Medical Times" (Aug. 1845), a case in which a charge of concealed birth was dismissed by the magistrates of Surrey, because the conceal- ment referred to a child born at the eighth month in Us membranes. The woman stated that she did not consider it to be a child ! If this decision is correct, the main object of the statute (i. e., to pre- vent secret delivery, so often leading to murder) may be efliectually evaded. The case, being entirely new, should have been sent for trial, and the decision left to the proper interpreters of the law ; a magisterial decision can furnish no precedent on a question of this kind. This woman must have been delivered of a child, foetus, or embryo, or of course there would have been no pretence for the charge. That a child may be thus born and removed from the membranes alive is a fact established by experience. Dr. Bruuton • reported to the Obstetrical Society, a case in which the entire ovum was expelled at the seventh month of gestation, and the child was rescued alive, although born fifteen minutes before being taken out of the membranes. ("Med. Times and Gaz.," 1871, 1, 412). In another case of sudden delivery, the child in its membranes with the placenta were discharged into a bucket. It was not rescued in time to save life. (" Amer. Journ. Med. Sci.," April, 1870, p. 430.) It is not material "here, as in the case of alleged infanticide, to prove when the child died — whether before, during, or after its birth ; and thus those subtleties and technicalities which are met with in cases of child-murder ai-e avoided. In regard to proof of concealment, and what constitutes it, these are essentially legal points ; but a medical practitioner may sometimes benefit an accused person, if he can prove that the woman had made application to him on the subject of her pregnancy and delivery. The law is espe- cially lenient under such circumstances. Questions connected with concealment of birth do not fall under the jurisdiction of the coroner; the medical evidence is therefore required by a magistrate. 526 CRIMINAL ABORTION. CRIMINAL ABORTION. CHAPTER XLV. ABORTION FROM NATURAL CAUSES. — CRIMINAL CAUSES. — MECHANICAL MEANS. — MEDICINAL SUBSTANCES. — SIGNS OF ABORTION. — SPECIFIC ABORTIVES. — LOCAL APPLICATIONS. — FEIONED ABORTION. — MEANING OF THE WORD NOXIOUS AS APPLIED TO DRUGS. — ON INDUCING PREMA- TURE LABOR. — PROOF OF PREGNANCY NOT NECESSARY. — ABORTION OF MONSTERS. — MOLES AND HYDATIDS. By abortion is commonly understood, in medicine, the expulsion of the contents of the uterus before the sixth month of gestation. If the expulsion takes place between the sixth and ninth month, the woman is said to have a premature labor. The law makes no dis- tinction of this kind, but the terra abortion is applied to the ex- pulsion of the fffttus at any 'period of 'pregnancy before the term of gestation is completed; and in this sense it is synonymous with the popular term miscarriage. Criminal abortion is rarely at- tempted before the third month ; it is perhaps most common between the fourth and fifth month ; because then a female begins for the first time to acquire a certainty of her pregnancy. The causes of abortion may be either natural or 'violent. The latter only fall under the cognizance of the law; but a medical witness should bp well acquainted with the causes which are called natural, in con- tradistinction to others which depend on the application of violence. These natural causes are so frequent, that according to Mr. White- head's o?jservation, of 2000 pjregnancies, one in seven terminated in abortion. They are commonly ascribable to jjeculiarities in the female system, to the presence of uterine or other diseases, or to some moral. shock sustained by a woman during pregnancy. Any diseases which strongly affect the uterus, or general system of a woman, may give rise to abortion. An attack of smallpox has been known to pjroduce it ; and it has been suggested by Mr, Acton, that the presence of constitutional syphilis in the father is not only a cause of infection in the offspring, but of refjeated abortion in the female. (" Med. Gaz.,"vol. .36, p. 164; Ramsbotham's " Obstetric Medicine," p. 6.5.5.) These facts deserve attention, when it is proved that a woman has really aborted, and an attempt is unjustly made to fix an alleged act of criminality on another. For further information on the numerous natural and accidental causes which may give rise ABORTION BY MECHANICAL MEANS. 527 to abortion, the reader may consult the work of Mr. Whitehead (" On Abortion and Sterility," p. 252 ; also, for the eftects of undue laceration and disease of the placenta, in causing abortion, see " Med. Times and Gaz.," Dec. 4, 1852, p. 580, and March 19, 1853, p. 302.) In- considering the operation of these causes, it is proper to bear in mind that during pregnancy the uterus is subject to a natural periodical excitement, corresponding to what would have been the menstrual period dating from the last cessation. Hence, comparatively trivial causes operating at these periods may lead to an expulsion of the foetus. The violent causes of abortion may be of an accidental, or criminal nature. In general, the distinction will not be difficult ; the kind of violence, and the adequacy of the alleged cause to produce abortion will be apparent from the evidence. In reference to criminal cases, the causes may be referred either, 1st, to the use of mechanical means, or 2dly, of irritating medicinal substances acting upon the uterus, or bowels. They operate with greater certainty just in proportion as the pregnancy is advanced. Mechanical means. — Among the mechanical causes may be men- tioned severe exercise, the violent agitation of the body, as by riding or driving over a rough pavement, — in which case no marks of violence would be apparent. Any physical shock sustained by the body may operate indirectly on the uterus. Violent pressure or blows on the abdomen are sometimes resorted to; but in these cases the marks of violence will be commonly perceptible. Instru- ments have been devised for the purpose of piercing the membranes, destroying the child, and thereby leading to its expulsion. Dever- gie speaks of such instruments being well known in England, and of English midwives deriving a living from the practice of this crime. (Op. cit. vol. 1, p. 285.) Although this must be regarded as an exaggerated statement, it cannot be denied that cases have transpired which show that the crime is frequently perpetrated by persons who basely derive a profit from the practice ; and for one case that comes to light, probably a dozen are effectually concealed. In the evidence given on four trials within a recent period, the case presented no feature of novelty or interest. Instruments were era- ployed, and drugs in large doses were proved to have been admin- istered. Mechanical means are undoubtedly more effectual in producing abortion than medicinal substances ; yet from the fact of such at- tempts being made by ignorant persons, the woman generally dies from inflammation of the womb, or peritoneum, or other serious after-consequences. A case was tried some years since, in which the evidence showed that the prisoner had attempted to produce abortion in the deceased by thrusting wooden skewers in the substance of the uterus. Inflammation and gangrene took place, and the woman died. The prisoner was convicted and executed for murder. (For a similar case by Mr. MTherson, see" Med. Graz."vol. 36, p. 102 ; see also another case in the same journal, vol. 45, p. 693.) [See report of a remarkable case of attempted criminal abortion, by Dr. T. Gail- 528 ABORTION TKOM RUPTUEE OF THE MEMBRANES. lard Thomas in "Am. Jour. Med. Sci.," April, 1873, in which the woman introduced into her own abdominal cavity an umbrella wire 16J inches long. This wire had passed through the vaginal wall and escaped into the peritoneal cavity, traversing below the intes- tines just over the large vessels on the spine, across the abdomen to the liver, then glancing off" from the right lobe backwards to the diaphragm, which it penetrated, and then plunged into the right lung for the distance of two inches. The woman died of pneumo- nia, on the fifteenth day. — E,.] This kind of injury to the uterus always implies the interference of some other person in the perpe- tration of the crime. Mechanical means can seldom be applied to the uterus without leaving marks of violence on the organ, as well as on the body of the child. If the mother should die, a result which generally takes place, an inspection will at once settle the point. ("Ann. d'Hyg." 1834, 191 ; 1838, vol. 1, p. 425 ; 1839, vol. 2, p. 109.) An important case of this kind was the subject of a crim- inal trial in Scotland in 1858 (case of Beid, "Medical Gazette," December 11, 1858). The uterus near its mouth presented two openings in its substance, described as punctured wounds by the medical witnesses for the prosecution, who made the examination — and as the openings of torn bloodvessels by others, who were called for the defence. There was also a rupture of one ovary. The prisoner was convicted ; but the medical man who was supposed to have been the principal agent in the crime, committed suicide. The case is chiefly important as showing that any apparent mechanical injury to the uterus should be minutely examined, so that no doubt of the cause may afterwards be entertained. If, in a case of this kind, the mother survives and the child be expelled, then marks of violence will be found on its body. These marks may not be suffi- cient to account for its death ; but this is not here the question. If it can be proved that they have not resulted from accidental causes during gestation or subsequently to delivery, then their presence may furnish sti'ong corroborative evidence of the actual means by which abortion was attempted. It is said that abortion has been in some instances accomplished by frequent bleeding from the arm. This efiect may follow as a result of shock produced by the loss of blood. An examination of the veins of the arms would show whether any such attempt had been made. There can be no doubt that of all the exciting causes of abortion, the most eflectual, and that which most certainly brings on the ex- pulsive action of the uterus, is the destruction of the'ovum or em- bryo. If by accident or design, the ovular membranes should become ruptured, gestation is arrested, and abortion necessarily ensues. At any period of pregnancy, therefore, a puncture through the mem- branes will sooner or later occasion the evacuation of the uterus. (Ramsbotham's " Obstetric Medicine," p. 655.) This auther re- marks that the performance of the operation demands a most ac- cui'ate knowledge of the anatomy of the ovum and the maternal structures, as well as of the state of development which the neck of the uterus assumes at different periods of pregnancy. ABORTION FROM RUPTURE OP THE MEMBRANES. 529 In medical practice, for the induction of premature labor, the ^ membranes are ruptured, either by the use of a female catheter, or by an instrument of this shape, but including a blade like a tonsil-lancet. Unless the inner membrane or amnion be opened, gestation may still proceed, and abortion will not take place. When the. membranes are completely penetrated, and the waters are dis-^ charged, uterine action is invariably induced ; but the time which elapses from the performance of the operation to the commencement of labor, is subject to great variation. Dr. Ramsbotham states that he has known the uterus begin to act in ten hours after the rupture, but in another case a week elapsed before its action com- menced. As a general rule, uterine action is fully established in fifty or sixt}'^ hours. It must not be supposed, however, that where a criminal intention exists, so long a period is required for remov- ing the contents of the uterus. The cases above referred to were cases of obstetric practice, in which there was no desire to expose the female to the slightest risk, and premature labor was openly induced. In a criminal attempt by a medical practitioner, in which } the woman would be a consenting party to the act, the removal of the embryo or foetus might be effected in a much shorter period of time. At any rate, the time for the completion of abortion could not be measured by cases in which the uterus has been left to undergo spontaneous contraction after the membranes had been punctured, and the waters had escaped. There would, however, be great danger to a woman in the necessary manipulations required. The reader will find reports, by M. Tardieu, of numerous cases of abortion as a result of mechanical means applied to the uterus, in " Anuales d'Hygi^ne," 1855, vol. 1, p. 406 ; and some good practical remarks by the same writer, on the mode in which these inquiries should be conducted, in the "Annales d'Hygi&ne," 1856, vol. 1, p. 141. >^ It is obvious that this mode of perpetrating abortion is only ! likely to succeed in the hands of persons who have a complete anatomical knowledge of the parts. The certain death of the woman will convert the crime to murder, when instruments are introduced into her body by persons who are ignorant of anatomy. It is to be regretted that members of the medical profession have on several occasions misused their professional knowledge, and have exposed themselves to prosecutions for this crime. Sometimes, it is probable the charge has been raised falsely, or through misappre- ' hension on the part of the woman ; at others, the evidence has left^ it very clear that the charge was well founded. Of late years, medi- cal men have rather freely used the speculum. "When this instru ment has been improperly or unnecessarily used on a pregnant woman, a charge of attempted abortion by instruments may be easily raised against a medical practitioner. A trial took place at the Exeter Lent Assizes, 1854 {Reg. v. Griffin and Venn)., in which it . was charged that the accused, Venn (a surgeon), had feloniously ' used an instrument with the intent to procure the miscarriage of the prosecutrix. According to the evidence, Venn had on several occasions passed a round polished instrument into the body of the 34 530 FEOM MEDICINAL SUBSTANCES. woman, once in a coppice, and at another time in a field. The de- fence was, that the surgeon had merely used a speculum to ascertain whether the girl was pregnant, in order to know how to prescribe for her; and that it was absurd to suppose that he had ever in- tended to procure abortion, for this had not followed, and it might have been easily produced by him at any period of pregnancy if the medical man had wished it. The prisoners were acquitted. Admitting the statements of the prosecutrix and the prisoner to be correct, it may be remarked that medical practitioners, in the lawful exercise of their profession, do not commonly use a speculum in open fields or coppices to determine whether a female is preg- nant or not ; and it is a well-known fact that a speculum is not required for determining the question of pregnancy at all. This case conveys a serious caution to members of the medical profession. Medicinal substances. — These are, perhaps, more frequently re- sorted to for inducing criminal abortion than other means; but they rarely answer the intended purpose; and when this result is obtained, it is generally at the expense of the life of the woman. Mineral poisons have been ignorantly employed for this nefarious object — such as arseuic, corrosive sublimate, sulphate of copper, muriate of iron, and metallic mercury {Reg. v. Wright, Abingdon Autumn Assizes, 1855), and other irritants. Croton-oil, gamboge, colocynth, aloes (Henke, " Zeitschrift," 1844, vol. 2, p. 203), hiera picra (a mixture of aloes and can6lla), elaterium, and other drastic purgatives, have also been used for a similar purpose. Purgatives which produce much straining, and powerful emetics or diuretics, will readily excite abortion in the advanced stages of pregnancy; but these violent medicines fail in their efi:ect at the earlier stages. A decoction of fern or of broom-tops has been sometimes used. The decoction of broom acts as a strong diuretic. The substances just mentioned exert an indirect action on the uterus by producing a shock t® the general system. But there is a certain class of bodies, called emmenagogues, which have a specific action on the uterus itself. Among these, the ergot of rye, or Secale cornutum, may be particularly noticed. Other vegetable, animal and mineral substances, which may be enumerated as having acquired popular repute for procuring abortion are savin, cantharides (see p. 192), rue, iron filings, squills, grains of paradise {Reg. v. Rushforth, York Autumn Assizes, 1857), pennyroyal, black hellebore and tansy. M. Tardieu relates three cases in which a strong decoction of rue produced abortion at the fourth, fifth, and beyond the sixth month respectively, and the woman recovered. ("Ann. d'Hyg.," 1855, vol. 1, p. 403.) Its operation as an abortive was generally preceded by well-marked nervous symptoms — e. g. giddiness and stupor, depression of the action of the heart, with nausea and severe pain in the stomach. (" Ann. d'Hyg.," 1856, vol. 1, p. 135.) In April, 1856, a medical man was convicted before the Central Criminal Court of Sydney, of administering extract of belladonna in a sup- pository, with a view to procure abortion. In a case which oc- SPECIFIC ABORTIVES — ERGOT. . 531 curred in France, iodide of potassium was pronounced by three medical men to be an a,bortive (" Med. Times and Gazette," Jan. 29, 1859), but the grounds for tl:iis opinion are not given. ISTone of these substances have any influence on the uterus, except in aftecting it indirectly by their irritant action on the system. In the Coroners' return for 1837-8, there were four cases of the admin- istration of savin and other drugs, with the view of procuring abor- tion. In three of these cases, the mother died undelivered ; in the fourth, the child perished. Specific abortives. Ergot of 7-ye, or Secede cornutum. — -This sub stance has been found, in many instances, to bring on violent action of the uterus at an advanced stage of gestation, or when efforts at parturition had already commenced. There is, however, consider- able difference of opinion respecting its alleged specific properties. According to Dr. Lee, it has no effect, at least in the early stages of gestation, although given in very large doses. (" Med. G-az." vol. 25, p. 10 ; see also " Edin. Med. and Surg. Journ." vol. 53, p. 27.) Dr. Kluge, of Berlin, found that its properties varied according to whether it- was gathered before, or after harvest ; in the former case it had an energetic action, while in the latter, it was powerless. The properties of the secale are but little known to the vulgar in this country ; and this may account for the fact of our rarely hear- ing of cases in which it has been criminally administered by mid- wives to pregnant women. Dr. Beatty states that when used in obstetric practice, it is liable, by absorption into the system of the mother, which may take place within two hours, to endanger the life of the child. (" Dub. Med. Journ." May, 1844, p. 202.) This question was actually referred by the French Government to the Academy of Medicine in 1845, as there was reason to think that, under its employment in the practice of midwifery, children were frequently born dead. ("Ann. d'Hyg." 1846, vol. 1, p. 204; see also " Med. Gaz." vol. 46, p. 680.) In confirmation of Dr. Beatty's- statement, Drs. M'Clintock and Hardy report, that, out of thirty cases in which it was administered, twenty children were born dead.. (" Practical Observations," p. 95.) Dr. Ramsbotham considers that the drug may operate fatally on a child according to the circum- stances under which it is administered ; but that, unless it excites the expulsive action of the uterus, it has no effect on the child's- system. (Op. cit. p. 319 ; also cases by Mr. Paterson, " Edin. Med., and Surg. Journ." vol. 58, p. 142.) According to M. Millet, in commenced, or imminent abortion, ergot procures a safe and prompt termination ; and he never met with a case in which it injured the child. ("Med. Chir. Rev." July, 1855, p. 41.) On trial for criminal abortion, perpetrated or attempted, a medi- cal witness must be prepared for a close examination on the specific emmenagogue properties of the ergot of rye on the uterus, as well as its general action as a poison on the woman and child. A case,, which occurred a few years since {Reg. v. Calder, Exeter Lent As- sizes, 1844), has been reported, with comments on this subject, by 532 SPECIFIC ABORTIVES — ERGOT. , Dr. Shapter (" Prov. Med. Journ.," April 10, 1844.) It was alleged on this occasion, that savin, cantharides and ergot had been respec- tively given by the prisoner, a medical man, for the purpose of pro- curing miscarriage. The prosecutrix was a woman of notoriously bad character, and the prisoner was acquitted. There were three medical witnesses, who agreed that savin and cantharides were only likely to occasion abortion indirectly, i. e. by powerfully aifecting the system — the view commonly entertained by professional men. Some diiFerence of opinion existed with regaVd to ergot. Dr. Shap- ter stated, in his evidence, that he did not think the ergot would act unless the natural action of the uterus had already commenced — a statement supported by a number of authorities. Subsequently to the trial, he collected the observations of many obstetric writers, and so far modified his opinion as to admit that the ergot might occasionally ex.evt a specific action on the uterus, in cases of advanced pregnancy, even when uterine action had not already commenced. His summary on this subject is one of the best which has been pub- lished. Dr. Eamsbotham has reported three cases from which it would appear that the ergot may in some instances exert a direct action on the impregnated and quiescent uterus. In these instances, the women were in or about the eighth month of pregnancy. (" Med. Gaz.," vol. 14, p. 434.) This observation has been fullj' confirmed by further experience on the use of the drug. (" Med. Times and Gaz.," Jan. 7, 1854, p. 8; see also his " Obstetric Medicine and Surgery," p. 198.) Dr. J. H. Davis believes that it is a specific excitant of uterine action, and points out the cases in which, in his opinion, it ma}^ be safely employed. ("Lancet," Oct. 11, 1845, p. 393.) In one instance in which, owing to distortion of the pel- vis, it was necessary to bring on labor six weeks before the full period, Mr. Eaynes found that ergot in the form of infusion in re- peated doses excited the action of the uterus, and delivery was accomplished within fifty-eight hours of the taking of the first dose. The uterus was in a quiescent state before the medicine was given to the patient. (" Med. Times and Gaz.," March 14, 1857, p. 260.) Mr. "Whitehead, who has had considerable experience on this sub- ject, has found that its action is very uncertain. In a case under his care, that of a woman with deformed pelvis, it was considered advisable to procure abortion in the fifth month of pregnancy ; the ergot alone was employed, and at first with the desired efi'ect. It was given in three successive pregnancies ; and in each instance labor- pains came on after eight or ten doses had been administered, and expulsion was efiected by the end of the third day. It was persever- inglj- tried in a fourth pregnancy in the same woman, and failed completely. ("On Abortion," p. 254.) It also failed in a case in the hands of Dr. Oldham. ("Med. Gaz.," vol. 44, p. 49.) Never- theless, the balance of evidence is decidedly in favor of its specific action, as a direct uterine excitant ;. and according to Dr. Griffiths, this is so well known to the inhabitants of the United States, that it is there in frequent use as a popular abortive. Perhaps the differ- ences which have been observed in its action may have depended ACTION OF THE ERGOT OP RTE. 533 on the quality of the drug, as well as on the period at which it was administered. Admitting that the uterus is subject to periodical excitement corresponding to the menstrual periods, it is probable that the action of ergot may he more powerfully abortive at these than at other times. In a case in which I was consulted in 1860, an attempt had been made to administer secretly the ethereal tinc- ture of ergot. A case occurred at Brighton, in October, 1864, in which a ques- tion arose respecting the fatal effects of this drug on a woman who had taken it for a long period, obviously with a view to procure abortion. She died, however, without abortion having taken place ; and the question at issue was, whether this drug had, or had not, caused her death. The dose taken was, I am informed, about a teaspoonful of the tincture of ergot three times a day, for a period of eleven weeks. On inspection, patches of inflammation were found on the mucous membrane of the stomach after death. No other cause for death was apparent, and one medical witness assigned it to the poisonous irritant action of the ergot, as, at the early stage of pregnancy which she had reached (the third month), this sub- stance would not be likely to act as an abortive. Another medical gentleman who gave evidence at the inquest, asserted that death could never be primarily caused by ergot of rye. The qualification introduced into this medical opinion is of small importance. The deceased woman is reported to have taken a large quantity of the tincture, and it is immaterial whether the drug killed her by a primary or secondary operation. M. Tardieu describes the case of a woman, set. 24, who aborted in the fourth month of pregnancy, as a result of the administration of ergot in powder ; she died from peritonitis in about twenty-four hours. The ergot was found in fragments in the lower third of the bowels. (" Ann. d'Hyg.," 1855, vol. 1, p. 404.) At the same time, this medical jurist states that, in his opinion, ergot of rye has no direct action as an abortive. (" Ann. d'Hyg.," 1865, vol. 1, p. 139.) In respect to its operation, it may be observed that the effects produced by its administration are not such as readily to excite susijicion. It does not cause the decided symptoms of irritation observed in the action of savin, nor the nervous symptoms which are usually produced by rue. In medicinal doses, given at proper intervals, the only marked effect which it produces on a pregnant woman is a lowering of the pulse. Sometimes other symptoms of a severe character have presented themselves. ("Ann. d'Hyg.," 1856, vol. 1, p. 140.) If a person dies from the effects of the drug, the results are legally the same whether its operation as a noxious substance is of a primary, or secondary kind. Action of ergot. — In doses of from half a drachm to two drachms, ergot in powder has caused nausea, vomiting, dryness of the throat, great thirst, aversion to food, pain in the abdomen, slight purging, pain in the head, stupor, and dilatation of the pupils. (Pereira, " Mat. Med.," vol. 2, pt. 1, p. 111.) Paralysis is said to have been observed among the symptoms. (See paper by Mr. Wright, " Edin. 534 ACTION OF THE ERGOT OF RTE. Med. and Surg. Journ.," ,vol. 53, p. 14.) The medicinal dose of the powdei''; in uterine diseases is from 5 to 1 5 grains. It is employed in a larger dose (from 20 to 60 grains at intervals of half an hour) to excij;e uterine action either for abortion or parturition. The dose of the tincture is one drachm (a teaspoonful) ; this is con- sidered to be equivalent to 20 grains of the powder. The dose of the ethereal tincture, according to Pereira, when employed for the purpose of exciting uterine action, is one drachm every half hour for three or four doses. (Op. cit. p. 119.) Ergot must be regarded as a noxious substance, and by some authorities it is ranked among narcotico-irritant poisons. It does not easily cause death in one large dose, but its fatal operation appears to be more strikingly developed by its long-continued use in small or medicinal doses. Its active properties are considered to be due to the presence of au oil which is soluble in ether. It also contains a solid principle, ergotin, which exerts a poisonous action on animals. The reader will find a large collection of cases, illustrating the properties of this drug, in Wibmer (" Arzueimittel und Gifte,"'vol. 2, p. 80 — Sphacelia segetum ; see also Pereira, " Mat. Med." vol. 2, pt. 1, 102). Analysis. — The form and characters of the ergot in mass are well known to professional men. In the annexed illustrations, 1 repre- sents the ergot of rye of its usual form and size. The outer coat is dark-colored, almost black, and it is more or less grooved or fluted longitudinally, and pointed at each end. It is brittle, and breaks Fig. 57. The Ergot of Rye. with a spongy or soft rough fracture. 2 2 represent transverse sections of the ergot of rye. The outer coat here forms a dark out- line with depressions. The substance is of a pale reddish-white color. If a thin slice is wetted with a weak solution of potash, and is examined under a low power of the microscope, the outer dark coat gradually assumes a crimson or purple tint. Small frag- ments may be thus identified. . 3 represents a transverse section of the ergot magnified thirty diameters. The spongy character of this substance a with its dark coat' 6,. is here more distinctly de- lineated. The powder of ergot evolves a faint fishy odor, especially if SAVIN — OIL OF SAVIN. 535 rubbed with a solution of potash, and the solution acquires a dingy- red color. In the form of tincture, alcoholic or ethereal, one test is the peculiar odor of the extract Av))en treated with potash. This may, however, be concealed by other odors. Sometimes small particles of ergot, presenting a pink-red color and a dark external coat, may be detected in the sediment by the microscope. When ergot has been taken in powder, fragments of it may be found scattered over the lining-membrane of the stomach or bowels ; these may be identified by the characters described. The ethereal tincture evaporated to an extract, leaves an oily-looking residue, which, when treated with a solution of potash, acquires a light or pinkish-red color. Savin. Oil of savin. — This vegetable substance possesses great popular repute as an abortive. In a case which I was required to investigate in 1845, it was a question whether savin, which had been taken in the state of powdered leaves, and had caused the death of a woman, exerted any specific action on the uterus to induce labor. The reply was given, that in large doses it acted only indirectly as an abortive by irritant properties. See " Med. G-az.," vol. 36, p. 646.) It is proper to remember that the infusion is more powerful than the decoction ; since the poison, being a volatile oil, is dissipated by long boiling. Savin is, however, commonly taken or administered in the form of powdered leaves. The irritant action of this powder has been elsewhere considered (p. 187). Any portion of the leaves dried and rubbed will emit the peculiar odor of savin, by which it may be identified. Unless some traces of the leaves are found in the sediment, there are no tests for detecting the decoction or infusion. For the microscopical appearance of the tips of the leaves see illustration at p. 187. In a case tried at the Cornwall Lent Assizes, 1852 {Heg. v. Pascoe), the accused, a medical man, was convicted and sentenced to trans- portation for administering oil of savin to a woman, with intent to procure miscarriage. The proof of intent rested partly on medical, and partly on moral circumstances. It appeared that the prisoner had given fourteen drops of the oil, divided into three doses, daily — a quantity which, according to the medical evidence at the trial, was greater than should have been prescribed for any lawful pur- pose. The medical dose, as an emmenagogue, on the authority of Christison, is from two to five minims, and according to Pereira from two to six drops. The quantity given by the prisoner, although a full dose, was not, therefoi-e, greater than these authorities recommend ; and his criminality appears to have rested not so much on the dose given, as on the question whetKer he knew, or, as a medical man, had reason to suspect, that the female for whom he prescribed it was pregnant, l^o medical authority would recom- mend oil of savin in full doses for pregnant females ; and with regard to the existence, or non-existence of pregnancy in a special case, medical men are reasonably presumed to have better means of satisfying themselves than non-professional persons. The pri- soner's innocence therefore rested on the presumption that he 536 SPECIFIC ABOETIVES — OIL OF TANSY. implicitly believed what the prosecutrix told him regarding her condition — that he had no reason to suspect her pregnancy, and therefore did not hesitate to select and prescribe a medicine which certainly has an evil reputation, and is rarely used by regular practitioners. According to the evidence of the prosecutrix, she informed the prisoner that she had disease of the heart and liver, and that nothing more was the matter with her. It is absurd to suppose that oil of savin would be prescribed by a medical man for such a disease as this. The prisoner, on the hypothesis of innocence, must have intended the medicine to act on the uterus, and must have inferred the existence of an obstruction of men- struation from natural causes irrespective of pregnancy. The jury do not appear to have given him credit for such ignorance of his profession, and this probably led to his conviction. There can, it appears to me, be no doubt that the oil was administered with a guilty intention. Every qualified practitioner, acting bonS fide, would undoubtedly satisfy himself that a young woman whose menses were obstructed was not pregnant, before he prescribed full doses of this oil three times a day, or he would fairly lay himself open to a suspicion of criminality. If pregnancy — a frequent cause of obstructed menstruation — were only susjoecfed, this would be suffi- cient to deter a practitioner of common prudence from prescribing, in any dose, a drug which may exert a serious action on the uterine system. (A report of the case of Mr. Pascoe will be found in the "Med. Times and Gazette," April 17, 1852, p. 404.) The oil of savin is obtained by the distillation of the tops, in the proportion of about 3 per cent, hj weight. It has a yellowish color, and the peculiar terebinthinate odor of the plant, by which alone it may be recognized. It may be separated from the contents of the stomach by agitating them in a bottle with its volume of ether, in which the oil is very soluble. The ether may be afterwards removed by distillation. The oil of savin forms a turbid mixture with alcohol (.826). "When treated with its volume of sulphuric acid, it acquires a dark-brown color, and when this mixture is added to distilled water, a dense white precipitate is separated. The odor is the best test. Oil of tansy. — Dr. Hartshorne states that in the United States the oil of tansy {Tanacetum vulgare) has acquired the character of a popular abortive, and caused death in several instances. In Eng- land, this oil and the herb have been chiefly employed for the purpose of expelling worms. Dr. Pereira quotes a case in which half an ounce of the oil proved fatal. The symptoms were spasms, with convulsive movements, and impeded respiration ; no inflam- mation of the stomach or bowels was discovered upon dissection. (" Matt. Med.," vol. 2, pt. 2, p. 26.) The cases referred to by Dr. Hartshorne are — 1. A teaspoonful of the volatile oil was taken by a girl in mistake for the essence. She complained of giddiness, and became insensible in ten minutes : convulsions came on, with frothing at the mouth, difiicult respiration, and irregular pulse, and she died in one hour after taking the oil. ("Araer. Jouru. Med. SAFFRON — ^MINERAL IRRITANTS. 537 Sci.," July, 1852, p. 279.) 2. The second case occurred to Dr. Dalton, and is reported by him in the same journal for January, 1852, p. 136. A healthy looking girl, set. 21, took eleven drachms of oil of tansy about six hours after a hearty dinner. She was found insensible and in convulsions soon after she had taken the drug. She died in three hours and a half. A strong odor of tansy was observed in the breath before death, and on inspection in the peritoneal cavity, stomach, and even the interior of the heart. The uterus contained a well-formed fcetus about four months old, which did not, either in itself or its membranes, present any evidence of having been disturbed. 3. In a third case (reported in "Amer. Journ. Med. Sci.," for May, 1835), a woman but a few weeks pregnant, took half an ounce of the oil ; she did not entirely lose her consciousness until three-quarters of an hour had elapsed, although she was convulsed at intervals before that time. She died, without abortion being produced, within two hours after taking the poison. (For another case see " Med. Times and Gazette," April 13, 1861.) These facts show that, while oil of tansy possesses no specific action on the uterus as an abortive, and does not even affect this organ or its contents by sympathy, it is capable of acting as a powerful poison on the brain and nervous system, and of de- stroying life rapidly. The oil would be easily recognized, either before or after distillation of the contents of the stomach, by its peculiar and penetrating odor. It is very soluble in ether; and this may be employed for its separation. Saffron. — A decoction of the dried stigmas of saffron [Crocus sativus), has been employed as a popular abortive. Dr. Thomsen, of Schleswig, has reported a case in which aboi'tion occurred in a woman who had taken repeated doses of a decoction of saffron with starch. There was reason to believe, however, that manipu- lations per vaginam had also been resorted to, and these may have had the principal share in bringing about the result. • (Horn's " Vierteljahrschrift," October, 1864, p. 315.) According to Pereira, although saffron was formerly used as an emmenagogue and to pro- mote uterine contractions, it is not established by any trustworthy observations that it possesses any medicinal properties. (" Mat. Med.," vol. 2, pt. 1, p. 219.) In modern medicine, its chief use is to give color and flavor to liquids. It has been observed, that when administered to pregnant women, the yellow coloring-matter has been absorbed, and the foetus in utero has been stained by it. This appearance in the body of the fcetus might lead to a suspicion ot its use, although no injury to the woman may have resulted. It is remarkable that the action of the most powerful mineral irritant poisons has sometimes failed to affect the gravid uterus. In July, 1845, a case was referred to me for examination by Mr. T. Carter, of Newbury, in which a female, aged 22 years, who had passed the fifth month of pregnancy, took a large dose of arsenic, and died in less than seven hours, having suffered fi'om severe vomiting and purging during that time ; yet abortion did not take place! The effects of mineral substances upon the body have been 538 ABORTION FROM LOCAL APPLIOATIOKS. fully described in the section on PoisoNiNa. Among them, atten- tion may be especially directed to the action of mnriate of iron. (See p. 146.) In a case tried at the Lincoln Summer Assizes, 1863, {Reg. V. Rumble), the prisoner, a druggist, was convicted of supply- ing this compound for the purpose of procuring the abortion of a pregnant woman. It had not that effect, but it very seriously injured her health ; the prisoner also gave cantharides in pills. In reference to the medicinal use of mercury, it may be proper to state that Dr. Solomon has reported two cases, in which premature delivery appeared to follow the mercurialization of the system. (Casper's " Wochenschrift," June, 1845 ; " Med. G-azette," vol. 36, p. 658.) Local applications. Injections. — In a case which occurred in France, it was proved that abortion had been caused by the injec- tion of some corrosive or irritating substance into the vagina. The female genitals, as well as the abdominal viscera, were found in a high state of inflammation. (" Med. G-az.," vol. 37, p. 171.) This is an unusual mode of perpetrating the crime, but it is one which can hardly escape detection. An analysis of the tissues might be required, in order to determine the nature of the sub- stance used. It appears from the trial which took place at the York Summer Assizes, 1853, that this mode of attempting to pro- duce criminal abortion has been the subject of a prosecution in this country. It was established by the evidence that some liquid was injected into the vagina with a syringe, but there was no proof of the nature of this liquid ; and as it was not shown to be of a noxiovs nature, the learned judge who tried the case directed an acquittal. (" Lancet," July 23, 1853, p. 89.) If it is essential that medical proof should be given that the liquid injected was of a noxious nature, then a loop-hole is left for the perpetration of the crime with impunity. I am informed by an obstetric practitioner of ex- perience that an abortion might be induced by the frequent employ- ment of injections of water alone, and that this is occasionally resorted to in practice, as a safe and convenient mode of eft'ectin^it. Numerous innocent liquids might be substituted for water. The words of the recent statute, however, by " other means whatsoever," would doubtless be considered to cover the use of any liquid, whether noxious or innoxious. In general, when the criminal means taken tO procure abortion are effectual in causing the expulsion of the child, it comes into the world dead ; but it may be born alive, and die after its birth. Under these circumstances, although no violence is applied directly to the body of the child, but its death is simply the result of immaturity or the feeble state in which it was born, the person causing such abortion might render himself liable to an indictment for murder. Signs of abortion in the living and dead. — These have been already considered in a previous chapter. (See " Delivery," ante, pp. 507 and 515.) The examination may extend to the woman either living or dead. In the former case, there will be some difficulty, if the abortion has occurred at an early period of gestation, and several APPEAEANC^S IN THE BODY, 539 days have elapsed before the examination is made ; in the latter case, the investigation is not always free from difficulty. One fact here requires to be especially noticed. It is believed by many phy- siologists that menstruation is a state in some measure vicarious to conception, and the appearances presented by the generative organs, during the menstrual period, are somewhat similar to those which are observed after conception in its early stage. Mr. Whitehead remarks, that in persons who have died while the menses were flowing, the uterine walls were thickened and spongy, and the mucous lining was more or less swollen and suffused. The neck and lips of the uterus were swollen, the orifice was open, and the vagi- nal membrane and clitoris involved in the increased action. One of the ovaries was found larger and more congested than ordinarily, presenting evidences of the recent escape of an ovum. (" On Abortion," p. 196.) Unless these facts are attended to, an ex- aminer may form an erroneous opinion respecting the chastity of a deceased female. For some remarks on the mode of conducting the examination of the woman, and of the embryo or foetus in cases of abortion, see " Annales d'Hygi^ne" for 1856 (vol. 1, pp. 149 and 153). Important questions may arise when it is alleged that abortion has been caused by th.e use of instruments, and death is i-eferred to peritonitis as the result of their employment. In these cases, a medical opinion should not be based upon the statements either of the female or of her friends, but upon some distinct and satisfactory medical proofs, that mechanical violence has been done to the uterus, its contents, or its appendages. Peritonitis, or inflammation of the lining membrane of the abdomen, may arise from a variety of causes. If we assign it to a particular cause, and thus implicate another in a felonious cause, we should do this only upon medical facts obtained by an examination of the dead body ; we should deal with such cases as if we knew nothing of their history. In May, 1863, 1 was consulted by Mr. Lewis, coroner for Essex, in reference to the death of a woman named Susannah barker. It was sup- posed that her death had been caused by attempts made to produce criminal abortion. The medical gentleman who examined this case thought that the fatal peritonitis had been caused by the introduc- tion of instruments into the vagina, and that this might occur with- out leaving after death any traces of their employment. At the same time it was admitted that a speculum used in the ordinary way would not produce peritonitis, and it was alleged in defence, that a speculum only had been used. The connection of the peritonitis with the alleged manipulations of the unlicensed practitioner rested more on surmise than proof. The absence of any bruise, puncture, or larceration affecting the vagina, uterus, or foetus, with the fact that, whatever may have been the instruments used, the membranes were left entire, rendered it impossible to assign the peritonitis with absolute certainty to the acts of the person who was charged with causing the death of the •woman. For anything that appeared to the contrary, he might 5i0 ABORTION — L.EGAi RELATIONS. have used a speculum, and it is well known that this instrument, although frequently introduced into the vagina, does not cause peritonitis. The connection of the peritonitis with instrumental violence, therefore, was not in this case established, and the jury by their verdict discharged the suspected person. They could not have done otherwise, for there was not the slightest medical proof that any instrument had been introduced into the vagina with a felonious intention. Feigned abortion. — For various motives, into the consideration of which it is here unnecessary to enter, a woman may charge another with having attempted or perpetrated a crime of abortion. Such a charge is not common because, if untrue, its falsity may be easily demonstrated. A young woman, admitted into Guy's Hospital in April, 1846, charged a policeman (who, according to her statement, had had forcible intercourse with her) with having giving her some substance to produce abortion, and with having subsequently ef- fected this mechanically. She was not examined until nearly two months after the alleged perpetration of the crime, when the late Dr. Lever found that there was no reason to believe she had ever been pregnant. This was a case of 'feigned abortion. When charges of this serious kind are brought forward, they are always open to the greatest suspicion, unless made immediately after the alleged attempt, as it is then only that an examination can determine whether they are true or false. If so long delayed, as in this in- stance, without any satisfactory reason, the presumption is that they are false. Legal relations. — [See " Revised Criminal Code of Pennsylvania," §§ 87, 88. — P.] In the statute for the consolidation of the criminal law (24 & 25 Vic, chap., 100, ss. 58 and 59), the nature of this crime, and the proofs required to establish it have been more explicitly stated than in former acts. By clause 58 (on attempts to procure abortion), it is enacted that " Every woman, being vnth child, who, with intent to procure her own miscarriage, shall unlawfully ad- minister to herself any poison or other noxious thing, or shall ua- lawfully use any instrument or other means whatsoever with like intent, and whosoever, with intent to procure -miscarriage of any woman, whether she be or be not with child, shall unlawfully adminis- ter, etc., shall be guilty of felony." Formerly, women who endeav- ored to produce abortion in themselves were not guilty of any offence against the law. In Reg. v. Warboy (Cent. Crim. Court, August, 1862), the prisoner, a widow, was convicted as an accessory before the fact to the feloaious using by one Morgan of a certain instrument upon herself with intent thereby to produce miscarriage. The latter portion of clause 58 makes it immaterial whether the woman were or were not with child, in accordance with the de- cision of the judges in Reg. v. Goodhall{l Dem. C. C. p. 187), and Reg. V. Goodehild (2 C. & K. p. 293.) Clause 59 is to the follow- ing effect: "Whosoever shall unlawfully supply or procure any poison or other noxious thing, knowing that the same is intended to be unlawfully used or employed with intent to procure the mis- "noxious" substances. I 541 carriage of any woman, whether she be or be not with child shall be guilty of a misdemeanor ; and being convicted thereof, shall be liable, at the discretion of the court, to be kept in penal servitude for the term of three years, or to be imprisoned for any term not ex- ceeding two years." This clause is intended to check the obtaining of poison, etc., for the purpose of causing abortion, by making both the person who supplies, and the person who procures it, guilty of misdemeanor. It will be observed in reference to these clauses, that the means employed, whatever their nature, must have been used with an ivtei^t to procure the miscarriage of a, woman, a point which will be sufficiently established by a plain medical statement of the means employed. Supposing that a drug has been used, the witness will have to state whether it is " a poison or other noxious thing;" for this must be proved in order that the prisoner should be convicted of the crime. I must refer the reader to what has been said elsewhere (ante, p. 83), in order that he may be able to judge how far the substance administered would fall under the description above given. Whether it would, or would not, have the effect intended, i. e., of inducing abortion, is perfectly immate- rial. Some uncertainty may exist as to the strict meaning of the word noxious. All will allow that the word implies something injurious to the system ; but a difference of opinion may arise among medical witnesses with respect to its application to the substance under dis- cussion — as, for example, with respect to rue or savin. To confine the term " noxious," therefore, to what is strictly speaking a poison per se, would be giving a latitude to attempts at criminal abortion, which would render the law inoperative. The small quantity of the substance taken at once does not affect the question, provided the dose be frequently repeated. In a trial which took place at the !N"orwich Lent Assizes, 1846 {Beg. v. Whisker), it was proved that the prisoner had caused to be taken by the prosecutrix a quantity of white hellebore, in powder, for the purpose of procuring abortion. One medical witness said he considered hellebore to be noxious to the system, but he knew of no case in which it had produced death ; and under these circumstances he did not feel himself justified in calling it a poison. Another medical witness stated that, in his opinion, it belonged to the class of poisons. The judge, in summing up, told the jury that that was to be regarded as a poisonous drug which, in common parlance, was generally understood and taken to be such ; and he thought the evidence sufficiently strong to bring hellebore within the meaning of the statute. The jury found the prisoner guilty, alleging that in their belief white hellebore was a poison. (" Med. Gaz., vol. 37, p. 830.) The only circumstance calling for remark in this case is, that any doubt should have been entertained by a medical practitioner respecting the poisonous pro- perties of white hellebore. It is a powerful vegetable irritant, and has caused death in several instances ; yet on this occasion it appears to have been admitted to be noxious, but not poisonous ! The nature of the substance administered, and that it is noxious, should be 542 CRIMINAL ABORTION — JUDICIAL DECISION'S. proved. Ifo speculative evidence is favorably received when some portion of the substance cannot be procured. In Reg. v. Taylor (Exeter Winter Ass., 1859) some powders had been given by the prisoner to a girl with the view of inducing abortion. No portion of the powders could be obtained for examination: but two medi- cal gentlemen who heard the evidence gave their opinion that the powders were of a noxious nature. In the defence, it was urged that this had not been proved. The jury adopted this view, and returned a verdict of acquittal. In reference to the proof of this crime, it is not required under the circumstances, that any specific injury should have been done to the woman, or that abortion should have followed in order to com- plete the offence. There is every reason to believe that the crime is frequent, but its perpetration is secret. Applications are continu- ally made to druggists by the lower class of people for drugs for this purpose : the applicants appear to have no idea of the criminal- ity of the act. (See, in reference to the frequency of this crime, a paper in the " Medical Gazette," vol. 46, p. 487 ; also " Med. Times and Gaz.," ITov. 21, 1857, pp. 524, 537.) [The frightful frequency of intentional abortion in this country has long been notorious, no less than the extraordinary ignorance as to its criminality, even among well-educated persons. The recent able efforts of Profs. Storer, Hodge, and others, especially of Dr. Storer, with the formal action of the American Medical Association (" Trans.," xii. p. 75) will do much towards effecting a much needed reformation of public opinion, as well as of legal practice, in this matter. Dr. Storer (in chap. vii. of his series of articles on Criminal Abortion, published in vol. iii. 1859, of the " K A. Med.-Chir. Eev." of Philada.) gives a complete and comprehensive exhibit of the laws of each of the United States and of the ruling decisions in relation to criminal abortion. His concluding summary is suffi- ciently important to justify our quoting it in full, at the same time that we must refer to the previous pages of the same paper for a minute and well arranged statement of the statutory and judicial practice in each of the individual States. " The destruction of an unborn child is not at the present day murder at the common law, though such was formerly the case (1 Russell, ' Crimes,' 671 ; 1 Vesey, 86 ; 8 Coke, 'Inst.,' 50 ; 1 Hawkins, C. B., s. 16 ; 1 Hale, 434 ; 1 East, P. C, 90 ; 3 Chitty, ' Crim. Law,' 798 ; Wharton, 'Crim. Law,' 537) ; to constitute which crime, the person killed must at the time of death have been alive (Davis, ' Crim. Justice,' 486), as we have shown the fcetus to be from the time of conception, and ' a reasonable creature in being' (Archbold, 'Crim. Pleading,' 490) ; a quality in this connection denied to the child by the law, though in all other relations it inconsistently allows and affirms it ; as it does also, and always, from the moment of birth, even though the funis is undivided and the placenta still attached. {Regina Y.Trilloe, 2 Moody, C. C, 260, 413.) " To cause abortion after quickening is not, as such, murder or CRIMINAL ABORTION — JUDICIAL DECISIONS. 543 manslaughter at common law, but a high misdemeanor. {The State V. Cooper, 2 Zabriskie, 52 ; Hanes, ' U. S. Digest,' 5.) " Whether to cause, or to attempt, abortion before quickening is a penal oftence at common law, has been differently decided. In several of the States, as Maine, Massachusetts, and 'New Jersey, it has been ruled by the Supreme Court not to be indictable, even as an assault, if done with the consent of the woman ; on the ground that only in case of high crimes is the person assaulted incapable of assenting. {The Commonwealth v. Parker, 9 Metcalf, 263 ; The Com- monwealth V. Bangs, 9' Mass. 387 ; The State v. Cooper, 2 Zabriskie, 57 ; Hanes, ' XI. S. Digest,' 5 ; Smith v. State, 33 Maine (3 Eed.), 48.) The Pennsylvania court, however, has discarded this doctrine, and has decided that the moment the womb is instinct with embryo life, and gestation has begun, the crime may be perpetrated. (Bishop, 'Grim. Law,' 386; Mills v. The Commonw., 1 Harris, Pa., 631, 633.) " The distinction alluded to with regard to quickening, is allowed by an acknowledged legal authority (Wharton, ' Crim. Law of the IT. S.,' 537), to be at open variance not only with medical experi- ence but with all other principles of the common law. (1 Russel, 'Crimes.' 661 ; 1 Vesey, 86 ; 3 Coke, 'Inst.,' 50 ; 1 Hawkins, c. 13, s. 16 ; Bracton, i. 3, c. 21.) The civil rights of an infant in utero are respected equally throughout gestation ; at every stage of which process, no matter how early, it may be appointed executor (' Bac. Ab.,' tit. Infants), is capable of taking as legatee (2 Vernon, 710), or under a marriage settlement {Doe v. Clark, 2 H. Bl. 399 ; 2 Vesey, Jr., 673 ; Thellusson v. Woodford, 4 Vesey, 340 ; Swift v. Duffield,% Serg. & Rawle, 38), may take specifically as 'a child' under a general devise (Fearne, 429), and may obtain an injunction to stay waste. (2 Vernon, 710 ; The Commonwealth v. Demain, 6 'Penn. Law Journ.' 29 ; Brightly, 441.) " When, in an attempt to procure an abortion, there is an evident intent to produce the death of the mother, and her death does actu- ally occur, such attempt becomes murder at common law. (1 Hale, 90 ; The Commonw. v. Chauncey, 1 Ashmead, 227 ; Smith v. State, 33 Maine (3 Eed.), 48) ; but when nothing more is intended than to commit the misdemeanor, it is only manslaughter (Ibid.; Hanes, 'U. S. Digest,' 6), being an instance of homicide from individual malice toward a third party, when the fatal blow falls on the de- ceased by mistake. It has been said, however, that this last is not the true doctrine, the destruction of an infant in utero being, even at common law, in some respects felonious, and the act in its nature malicious and deliberate, and necessarily attended with danger to the person on whom it is performed. (Wharton, 'Law of Homicide,' 44.) " The use of violence upon a woman, with an attempt to produce her miscarriage without her consent, rules Chief Justice Shaw of Massachusetts, is an assault highly aggravated by such wicked pur- pose, and would be indictable at common law. So where, upon a similar attempt, the death of the mother ensues, the party making 5ii CRIMINAL ABORTION — JUDICIAL DECISIONS.- such an attempt, with or without her consent, is guilty of murder, on the ground that it is an act done without lawful purpose, danger- ous to life, and that the consent of the woman cannot take away the imputation of malice, any more than in case of a duel, where in like manner there is the consent of the parties. {The Gommonio. V. Parker, 9 Metcalf, 263, 265 ; Davis, 'Grim. Jus.,' 281.) "Though to kill the foetus in utero is as such, by the common law, no murder, yet if it be born alive, and die subsequently to birth from the wounds it received in the womb, or from the means used to expel it, the offence becomes murder in those who cause or employ them. (1 Blackstone, 129; Sex v. Senior, 1 Moody, C. C, 346 ; 3 Inst., 50 ; Wharton, C. L., 537 ; Ibid., 'Law of Homicide,' 93.) If a person, intending to procure abortion, does an act which causes the child to be born earlier than its natural time, and there- fore in a state much less capable of living, and it afterwards die in consequence of such premature exposure, the person who by this misconduct brings the child into the world, and puts it into a situa- tion in which it cannot live, is guilty of murder, though no direct injury to the child be proved ; and the mere existence of a possi- bility that something might have been done to prevent the death, does not lessen the crime. {Hex v. West, 2 Carr. & Kir. 784; 1 Bishop, C. L., 255 ; Wharton, 'Law of Homicide,' 93.) " The earlier English statutes, from their peculiar 'phraseology, held pregnancy essential for the commission of the crime {Hex v. Seudder, 1 Moody, 216 ; 3 Car. & P. 605 ; overruling Bex v. Fhillips, 3 Campbell, 73 ; Russell, Cr., 763, note) ; yet an attempt to produce abortion is now indictable at common law (if made without her consent?) though it fail by reason of the woman being, in fact, and. contrary to the belief of the party, not pregnant. {Regina v. Good- child, 2 Car. & Kir. 293 ; Rex v. Goodhall, 1 Den., C. C, 187 ; 3 Campbell, 76.) For though as no man would attempt what he absolutely knew he could not in fact perform, nor would be deemed in law to have so attempted, and as every one being conclusively presumed to understand the law, no man can legally intend what is legally impossible, the rule as to facts is different ; for men are not conclusively held by the law to know facts. And if a man fails in what he undertakes, because of an impossibility in fact, which he did not know, he is just as answerable as if the failure were from any other cause. (1 Bishop, ' Crini. Law,' 518.) " If our previous assumptions of the actual character of criminal abortion be granted, and we believe that they have been proved to a demonstration, it must follow from the subsequent remarks, that the common law, both in theory and in practice, is insufficient to control the crime ; that in many States of this Union, the statutory laws do not recognize its true nature ; that they draw unwarrantable distinctions of guilt ; that they are not sufficiently comprehensive, directly allowing many criminals to escape, permitting uncon- summated attempts, and improperly discriminating between the measures employed ; that they require proofs often unnecessary or impossible to afford ; that they neglect to establish a standard of PREMATURE LABOR — MEDICAL RESPONSIBILITY. 545 justification, and thereby sanction many clear instances of tlie crime ; that by a system of punishments wholly incommensurate with those inflicted with all other offences whatsoever, they thus encourage instead of preventing its increase ; and that in many respects they are at variance, not merely with equity and abstract justice, but with the fundamental principles of law itself." "Con- tributions to Obstetric Jurisprudence." By Horatio R. Storer, M. D., of Boston. "Criminal Abortion," part vii., from " 'N. Am. Med.-Chir. Eev.," vol. iii., No. 5, Sept., 1859, pp. 851 to 854. See also the other five numbers of vol. iii. of the same journal for the remainder of this excellent series of papers on the subject. — .H.] On ivducing -premature labor. Medical responsibility. — It may be proper to oft'er here a few remarks upon the common practice of inducing premature labor, in certain cases of disease, of defor- mity of the pelvis, and in cases of excessive vomiting from pregnancy. This practice has been condemned as immoral and illegal ; but it is impossible to admit that there can be any immoi-ality in performing an operation to give a chance of saving the life of a woman, when, by neglecting to perform it, it is almost certain that both herself and the child will perish. (See on the morality, safety, and utility of the practice, Ramsbotham's " Obstet. Med.," p. 315.) The question respecting its illegality cannot be entertained; for the means are administered or applied with the bonS, fide hope of benefiting the female, and not with any criminal design. It is true that the law makes no exception in favor of medical men who adopt this practice, nor does it in the statute on wounding make any exceptions in favoj: of surgical operations ; but that which is performed without evil intentions would not be held to be unlawful. The necessity for the practice ought to be apparent: thus, for instance, it-should be shown that delivery was not likely to take place naturally, without seriously endangering the life of a woman. It is questionable whether, under any cir- cumstances, it would be justifiable to bring on premature expulsion, merely for the purpose of attempting to save the life of a child, since the operation, unless performed with care, is accompanied with risk to the life of the mother. The grounds upon which manjr eminent authorities have objected to this practice, are : 1.. That there are few cases in whicli parturition, if left to itself, might not take place at the full period ; 2. The toleration of the practice would lead to great criminal abuse ; 3. It is attended with danger to the mother and child. It is undoubtedly true that par- turition will sometimes take place safely at the full time, even. when the deformity of the pelvis is apparently so great as to lead many accoucheurs to suppose natural delivery to be utterly impos- sible. Dr. Lilburn has reported the case of a woman who labored^ under great deformity of the pelvis, but who was twice delivered in safety and the child survived. (" Med. Gaz.," vol. 19, p. 983.)' It is therefore not improbable that many cases of the kind are- prematurely treated, which if left to themselves, would probably do well without interference. Hence, a cautious selection should. •65 546 CHEMICAL EVIDENCE — BLOOU STAINS. be made, because the operation is necessarily attended with some risk to the woman and child. All that we can say is, that, accord- ing to general professional experience, it places her in a better position than she would be in if the case were left to itself. It appears to me that before a practitioner resolves upon performing an operation of this kind, he should hold a consultation with others; and, before it is performed, he should feel well assured that natural delivery cannot take place without greater risk to the life of the mother than the operation itself would create. These rules may not be observed in practice ; but the non-observance of them is neces- sarily attended with some responsibility to a practitioner. In the event of the death of the mother or child, he exposes himself to a prosecution for a criminal offence, from the imputation of which even an acquittal will not always clear him in the eyes of the public. If the child were born alive, and died merely as a result of its immaturity, this might give rise to a charge of manslaughter. Within a recent period, several practitioners have been tried upon charges of criminal abortion^ — whether justly or unjustly it is not necessary to consider; but they had obviously neglected to adopt those simple measures of prudence, the observance of which would have been at once an answer to a criminal charge. Because one practitioner maj' have frequently and successfully induced premature labor, without observing these rules, and without any imputation on his character, this cannot shield another who may be less fortunately situated. A charge is only likely to arise when a man has been unfortunate; and the responsibility of one operator cannot be measured by the success of others. Proof of pregnancy is not essential to the crime of abortion. The attempt on a woman, proved not to be pregnant, involves a person in equal responsibility. So, if the body expelled is a monster, an extra-uterine conception or a blighted foetus (a mole), the crime of abortion is as complete as if the woman was delivered of a child. It will be observed that in the statute the word miscarriage is used. In a popular sense (and here a popular appears to have been pur- posely selected in preference to a medical term), miscarriage signifies the violent expulsion not merely of a child, but of moles and other diseased growths, or even of coagula of blood. In these last- mentioned cases, the woman is not actually pregnant although she and the accused may imagine that she is. But whether the uterus contains these morbid growths, or whether the organ is in the virgin state, the person who has used the means with intent may still be convicted of an attempt to procure abortion. Chemical evidence. Blood in abortion. Liquor amnii.- — In the event of an abortion having taken place, stains produced by blood or by the waters (liquor amnii) may be found on the linen of a woman, and a practitioner may be required to say whether these stains are of a nature to throw any light upon the perpetration of the crime. A woman who has aborted may allege that the stains are those of the menstrual discharge. Speaking generally, there is no practical distinction between menstrual and other bjood. The ABORTION — BLOOD STAINS, 547 menstrual blood contains less fibrin, is commonly acid and watery from admixture witli the mucous discharges, and when examined by the microscope it presents epithelial scales, or cells derived from the mucous membrane. These scales or cells belong to the columnar variety. Not much reliance can be placed upon their discovery, since the mucous membrane of the organs of respiration is lined with similar cells. Hence, expectorated blood might be mistaken for menstrual. Cells of a similar shape line the whole of the mu- cous membrane from the stomach to the anus. The blood of piles might thus be confounded with menstrual blood. The blood dis- charged in abortion will present the usual characters of blood else- where described ; but it may be diluted by the waters simultane ously discharged (p. 291). This question received the special attention of the French Academy a few years since, in reference to the crime of abortion ; and the report made was to the effect that in the present state of science, there was no certain method by which the blood of menstruation could be practically distinguished from the blood discharged in a case of abortion or infanticide (" Ann. d'Hyg.," 184fi, vol. i. p. 181). In a more recent case, MM. Devergie and Chevallier were required to state whether certain stains on the dress of a woman, supposed to have aborted, were or were not caused by the waters (liquor amnii). A chemical analysis merely revealed the presence of an albuminous liquid. The most elaborate experiments satisfied the i-eporters that neither by the odor, nor by any other process, could tlie liquor amnii, dried on linen, be iden- tified. (See "Ann. d'Hyg.," 1852, vol. 2, p. 414.) It may, however, be of importance to observe that this liquid slightly discolors and stiffens the fibre of the stuff' on which it has been effused, and that it can be readily extracted by cold water. The solution possesses all the properties of albumen. The amount of albumen contained in the liquor amnii decreases as gestation advances. At the fourth month, it forms 10.77 per cent, of the liquid; at the fifth month 7.67; at the sixth month, 6.67; and at the ninth month, only 0.82. M. Chevallier's experiments show that the amniotic liquid has all the usual chemical properties of a very diluted solution of albumen ("Ann. d'Hyg.," 1856, vol. i. p. 156). 548 INFANTICIDE. INFANTICIDE. CHAPTER XLVI. NATtlEB OF THE CRIME. — PROOF OF LIFE. — MEDICAL EVIDENCE AT INQUESTS. — ^UTERINE AGE, OR MATURITY OF THE CHILD. — VIABILITY. — CHARACTERS OF THE CHILD PROM THE SIXTH TO THE NINTH MONTH. — SIGNS OF MATURITY. — RULES FOR INSPECTING THE BODY. The subject of child-murder has of late years attracted the atten- tion of medical jurists by reason of the facility with which the crime may be perpetrated, and the great difficulty of bringing it home to the offender. The reports of inquests show that the deaths of infants are very numerous, and that they frequently occur under circumstances involving great suspicion. In his annual report for 1862-63, Dr. Lankester, coroner for the central division of Middlesex, states that there were 68 deaths of new- born children in his district, and in 53 of these, verdicts of wilful murder were returned against persons unknown ; it appears accord- ing to this report, that the crime is more frequent amongst women in domestic service than in any other class. There is usually con- siderable reluctance on the part of a jury to return a verdict of wilful murder, when the mother has been discovered. In all instances in which the evidence of guilt has been so clear that coroners' juries have found verdicts of wilful murder, the prisoners have been subsequently acquitted on their trials. Such is the history of cases in which the crime has been detected, and as the present state of the law offers every facility to a woman thus detected, to escape punishment, the extensive existence of the crime of infanticide will not excite surprise. (" Annual Report," 1864, p. 83.) In the report of the Committee appointed to inquire on the best means of preventing the destruction of the lives of infants (July, 1871), it is stated that the number of infants found dead in the Metropolitan and City Police districts during the year 1870, was 276, and the return up to May 19, 1871, showed a total of 105. The greater number of these infants were less than a week old. From the statistics of crime in Ireland published in December, 1871, the same failure in the administration of the law is observed there. Infants form less than 3 per cent, of the popu- lation according to the census, but murders of infants aye in England and Ireland considerably more numerous than murders of adults. In Ireland, according to Dr. Hancock, the latter are NATURE OF THE CRIME. 549 37 times the number of murders occurring in the rest of the popu- lation ; in England and "Wales, 55 times. Out of 139 cases in which a coroner's jury fovind that infants had been murdered, arrests were made in 95 instances ; but it is a striking proof of the strong feeling against capital punishment for infanticide that, though 4'2 persons were convicted of lesser offences, not one con- viction for murder was obtained. Nature of the crime. — By infanticide we are to understand in medical jurisprudence, the murder of a new-horn child. The Eng- lish law, however, does not regard child-murder as a specific crime; it is treated like any other case of murder, and is tried by those rules of evidence which are admitted in cases of felonious homicide. In stating that infanticide is the term applied to the murder of a new-born child, it is not thereby implied that the wilful killing should take place within any particular period after birth. Pro- vided the child be actually born, and its body entii'ely in the world, it matters not whether it has been destroyed within a few ■ minutes, or not until several days after its birth. In the greater number of cases of infanticide, however, we find that the murder is commonly perpetrated either at the time of birth, or within a few hours afterwards. M. Lanjardiere, a skilled advocate of the Erench Bar, says that to constitute infanticide, there must be — 1, a wilful killing ; 2, the child must be living; and 3, it must be new-born. The wilful killing is proved by direct or circumstantial evidence ; the fact of living is taken as synonymous with breathing, and the words new- born, recens natus, may be applied to a child from a few moments after birth until the cicatrization of the navel is completed. (See "Ann. d'Hyg.," 1868, 1, 463.) Although the law of England treats a case of infanticide as one of ordinary murder, j'et there is a difterence in the nature of the medical evidence required to establish the murder of a new-born child. It is well known that many children come into the world dead, and that others die from various causes either during, or soon after birth ; in the latter, the signs of their having lived are frequently indistinct. Hence, to provide against the danger of erroneous convictions, the law assumes that every new-born child has been born dead, until the contrary' appears from the medical or other evidence. The onus of proof that a living child has been destroyed is thereby thrown on the prosecution, and no evi- dence imputing murder can be received, unless it is first made certain, by medical or other facts, that the. child- survived its birth, and was legally a living child when the alleged violence was offered to it. Hence, there is a most difficult- duty cast upon a medical witness on these occasions. In the greater number of cases, the woman is delivered in secrecy, and no one is present to give evidence respecting the birth of the child. It is under these circumstances that medical evidence is especially required. ; : - In cases of child-murder, medical evidence i^lcommonly founded on an examination of the bodv of the child ;■ but it must be borne 550 UTEEINE AGE OR MATURITY. in mind, that a woman may be found guilty of the crime, although the body of the child is not discovered: it may have been destroyed by burning," or otherwise disposed of, and a medical witness may have only a few calcined bones to examine. ("Ann. d'Hyg.'," 1845, 2, 129.) In these cases of the non-production of the body, good legal evidence of the murder would, however, be demanded ; and this evidence should be such, as would fully establish a matter of fact before a jury. The production of the body of the child, is therefore no moi'C necessary to conviction than in any other case of murder. A woman has been tried within the last few years for the murder of her child, the body of which was never discovered. In most instances, however, the body of the child is found, an inquest is held, and medical evidence is demanded. Utei'ine o.ge, or maturity of the child. — One of the first questions which a witness has to consider in a case of alleged child-murder is that which relates to the age, or probable degree of maturity which the deceased child may have attained in utero. The reason for making this inquiry is, that the chances of natural death, in all new-born children, are great in piroportion to their immaturity; and that, supposing them to have survived birth, the signs of their having breathed are commonly obscure. It is found that the greater number of children who are the subjects of these investigations, have reached the eighth or ninth month of gestation ; yet charges of murder might be extended to the wilful destruction of children at the seventh month, or under, provided the evidence of life after birth was clear and satisfactory. The following are the characters whereby we may judge of the uterine age of a child from the sixth to the ninth month of gesta- tion, a period which may be considered to comprise cases of abor- tion as well as child-murder : — 1. Between the sixth and seventh month : The child measures from the vertex to the sole of the foot, from ten to twelve inches, and weighs from one to three pounds. The head is large in pro- portion to the trunk ; the eyelids are adherent, and the pupils are closed by membranes (membrange pupillares). The skin is of a reddish color, and the nails are formed ; the hair loses its silvery lustre which it previously possessed, and becomes darker. Ossifi- cation proceeds rapidly in the chest bone, and in the bones of the foot ; the brain continues smooth on its surface ; there is no appearance of convulsions. In the male, the testicles will be found in the abdominal cavity, lying upon the psose muscles, immediately below the kidneys. 2. Between the seventh and eighth months: The child now mea- sures between thirteen and fourteen inches in length, and weighs from three to four pounds. The skin is thick, of a more decidedly fibrous structure, and covered with a white unctious matter which appears for the first time. Fat is deposited in the cellular tissue, whereby the body becomes round and plump ; the skin previously to this is of a reddish color; and commonly more or less shrivelled ; APPEARANCES INDICATIVE OP UTERINE AGE. 551 tbe nails, which are somewhat firm, do not quite reach to the extremities of the fingers ; the hair is long, thick, and colored ; ossification advances throughout the skeleton; valvulse conniventes appear in the small intestines, and meconium is found occupying the caecum and colon. The testicles in the male about this period commence their descent ; or rather, the child's head being down- wards, their ascent towards the scrotum. The time at which these organs change their position is probably subject to variation. According to J. Hunter, the testicles are situated in the abdomen at the seventh, and in the scrotum at the ninth month. Burns believes that at the eighth month they will commonly be found in the inguinal canals. The observation of the position of these organs in a new-born male child is of considerable importance in relation to maturity, and it may have an influence on questions of legiti- macy as well as of child-murder. Mr. Curling thus describes their change of position: At different periods between the fifth and sixth months of foetal existence, or sometimes even later, the testi- cle begins to move from its situation near the kidney towards the abdominal ring, which it usually reaches about the seventh month. During the eighth month it generally traverses the inguinal canal, and by the end of the ninth arrives at the bottom of the scrotum, in which situation it is commonly found at birth. ("Diseases of the Testis," 2d ed., p. 17.) Its absence from the scrotum does not necessarily indicate that the child is immature, because the organ sometimes does not reach the scrotum until after birth. 3. Between the eighth and ninth months : The child is from fif- teen to sixteen inches in length, and weighs from four to five pounds. The eyelids are no longer adherent, and the membranse pupillares have disappeared. The quantity of fat deposited beneath the skin is increased, and the hair and nails are well developed. The surface of the brain is grooved or fissured, but presents no reg- ular convolutions ; and the cineritious matter is not yet apparent. The meconium occupies almost entirely the large intestines ; and- the gall-bladder contains some liquid resembling bile. The testi- cles in the male may be found occupying some part of the inguinal canal, or they may be in the scrotum. The left testicle is some- times in the scrotum, while the right is situated about tlie exter- nal ring. 4. Ninth month. Signs of maturity. — At the ninth month, the average length of the body is about eighteen inches, and its weight from six to seven pounds ; the male child is generally rather longer, and weighs I'ather more than the female. Extraordinary deviations in length and weight are occasionally met with. Mr. Owens has recorded a case in which a child at delivery measured twenty-four inches in length, and weighed seventeen pounds twelve ounces (" Lancet," December, 1838), and Dr. Meadows has reported an- other in which a child measured after death thirty -two inches, and weighed eighteen pounds two ounces. It survived four hours. ("Med. Times and G-az.," August 4, 1860.) In a case which I was required to examine in June, 1842, the child, a male, measured 552 SIGNS OF MATURITY. twenty-two inches, and weighed twelve pounds and a half. (For some practical remarks on this subject, by Dr. Ellsasser, seeHenke's " Zeitschrift, 1841, vol. 2, p. 235.) According to Dr. Duncan, the length and weight of a child vary according to the age of the mother. They are greatest among children when the mother is from 25 to 29 years of age. When a woman is 25, the child weighs less. The child of a woman at 22, weighed seven pounds three ounces, and that of a woman at 30, seven pounds seven ounces. The length varied in a less degree, being, for the different ages, at or about nine- teen inches. (" Ed. Monthly Journal," Dec. 1864, p. 500.) At the full period, the head of a child is large, and forms nearly one-fourth of the whole length of the body. The cellular tissue is filled with fat, so as to give considerable plumpness to the M'hole form, while the limbs are firm, hard, and rounded : the skin is pale; the hair is thick, long and somewhat abundant; the nails are fully developed, and reach to the ends of the fingers — ^an appearance, however, which may be sometimes simulated in a premature child, by the shrinking of the skin after death. The testicles in the male are generally within the scrotum. Ossification will be found to have advanced considerably throughout the skeleton. The surface of the brain presents convolutions, and the cineritious or gray matter begins to show itself. The internal organs, principally those of the chest, undergo marked changes, if the act of respiration has been performed by the child before, during, or after its birth. The characters which have been "here described as belonging to a child at the different stages of gestation, must be regarded as repre- senting an average statement. They are, it is well known, open to numei'ous exceptions ; for some children at the ninth month are but little more developed than others at the seventh. Twins are gene- rally smaller and less developed than single children : — the average weight of a twin child is not more than five pounds, and very often below this. The safest rule to follow in endeavoring to determine the uterine age of a child is to rely upon a majority of the charac- ters which it presents. That child only can be regarded as mature, which presents the greater number of the characters described, that are met with in children at or about the ninth month of gestation. If the age of the child has been determined : whether it be under or over the seventh month, the rules for a further investigation will be the same. Should the child be under the seventh month, the medical presumption will be, that it was born dead ; but if it has arrived at the full period, then the presumption is that it was born alive. . Conclusions. — The following may be taken as a summary of the principal facts upon which our opinion respecting the uterine age of a child may be based : — 1. At six months. — Length, from nine to ten inches ; weight, one to two pounds ; eyelids agglutinated ; pupils closed by membi'anse pupillares ; testicles not apparent in the male. 2. At seven months. — Length, from thirteen to fourteen inches ; weight, three to four pounds ; eyelids not adherent ; membranse pu^ INSPECTION OF THE BODY. 553 pillares disappearing; nails imperfectly developed; testicles not apparent in the male. 3. At eight months. — Length, from fourteen to sixteen inches ; ■weight, from four to five pounds; membranse pupillares absent; nails perfectly developed, and reaching to the end of the fingers ; testicles in the inguinal canal. 4. At nine months. — Length, from sixteen to twenty-one inches ; weight, from five to nine pounds ; membranfe pupillares absent ; head well covered with fine hair ; testicles in the scrotum ; skin pale ; the finger nails well formed and reaching to the ends of the fingers ; features perfect — these and the body are well developed even when the length and weight of the child are less than those above assigned. 5. The point of attachment of the umbilical cord, with respect to the length of the hody, aftbrds no certain evidence of the degree of maturity. Inspection of the hody. — The questions which a medical jurist has to solve, in examining the body of a new-born child, are — 1. To detei'mine its age, or the stage of uterine life which it has reached ; 2. "Whether it has lived to breathe ; 3. Whether it has been born alive ; 4. The period of time which has elapsed since its death ; 5. The cause of death — whether violent or natural. Hence, before commencing the inspection — 1. The length (measured from the summit of the head to the sole of the foot) and weight of 'the body should be taken ; 2. The presence or absence of external fcBtal peculiarities noticed ; 8. Any peculiar marks or indications of deformity whereby identity may be sometimes established ; 4. All marks of violence, in the shape of wounds, bruises, or lacerations, and the kind of instrument or weapon by which they were probably produced ; 5. Whether the umbilical cord has been cut, or tied, or lacerated ; the appearance of the divided vessels, and the length of that portion which is still attached to the body of the child ; 6. The presence or absence of vernix caseosa about the groins, arm-pits, or neck — the presence of this substance proves that a child has not been washed or attended to ; 7. It will be necessary to state whether there are about the body any marks of putrefaction, indicated by a separation of the cuticle, change of color in the skin, or oflensive odor. It is obvi- ous, that unless these circumstances are noticed before the inspec- tion is commenced, they may be entirely lost as evidence. Notes should be made on the spot, and the original retained, even if copies be subsequently made. A medical man cannot be too careful in noticing upon the body of the child any characters which may serve as proofs of identity. He must remember that the defence may be that the child is not that of the woman charged with murder. This observation applies especially to the examination of the bodies of children that may have survived their birth for some days. The body may be found wrapped in paper or in some articles of clothing which may help to establish identity. If the child has survived its birth, it would 554 PROOFS OF LIFE BEFORE RESPIRATION. be proper to form an opinion at once for how many days. The state of the umbilical cord, and whether the part to which it is attached is in the process of healing, or already healed, ai'e facts which may help a medical opinion respecting the date of birth. In addition to these points, the sex and color of the hair should be noted, any particular marks on the skin (mother's marks), and, of course, all wounds or other injuries, their cause or mode of production, and their situation. CHAPTER XLVII. EVIDENCE OF LIFE BEFORE RESPIRATION. — PUTREFACTION IN UTBRO. — EVIDENCE OF LIFE AFTER RESPIRATION.— COLOR, VOLUME, CONSISTENCY, AND ABSOLUTE WEIGHT OF THE LUNGS. — STATIC TEST. — WEIGHT IN- CREASED BY RESPIRATION. The question whether a child was, or was not, born alive, is of great importance in a case of alleged child-murder; and it is un- fortunately one which, in respect to the proofs upon which medi- cal evidence is commonly founded, has given rise to considerable controversy. When it is stated that in most cases of alleged in- fanticide which end in acquittals 'in spite of the strongest moral presumptions of guilt, the proof fails on this point only, it must be obvious that this question especially claims the attention of a medical jurist. The medical evidence of a child having been alive when violence was offered to it at its birth or afterwards, may be divided into two parts: 1, that which is obtainable before the act of respiration is performed ; and 2, that which is obtainable after- wards. At present, it will be proper to confine our attention to the question, whether the child was legally living when it was maltreated — the fact of its having been born alive will be a matter for future consideration. These two questions have been fre- quently but improperly associated, thus rendering the subject con- fused ; but it must be so obvious as scarcely to require stating, that violence of a murderous kind may be offered to a living child before it is entirely born ; and that owing to this violence it may come into the world dead. Proofs of life before respiration. — ^It was formerly supposed, if the lungs contained no air, that the child could not have breathed, and must have been born dead ; but this is now proved to be an error. Children have been known to breathe feebly, and continue in existence many hours, without visibly distending the cells of the lungs with air; the absence of air from the lungs, therefore, fur- nishes no proof either that respiration has not been performed, or that the child has not lived. The restoration of many children apparently born dead is a clear proof that many are born living who might be pronounced dead, simply because breathing and life SIGNS OF PUTREFACTION IN UTERO. 555 have been considered synonynaous terms. That our law-authorities will admit evidence of life in a-child before the establishment of respiration, is clear from the decision of Eex v. Brain, in which the judge said, that a child might be born alive, and not breathe for some time after its birth (" Archbold, Crim. Plead.," 377), as also from the charge of Coltman J. in the case of Rex v. Sellis (K'orf. Spr. Cire. 1837). In this instance it was alleged that the prisoner had murdered her child by cutting off" its head. The judge directed the jury, that if the child was alive at the time of the act, it was not necessary, in order to constitute murder that it should have breathed. In fact, it would appear that respiration is regarded as only one proof of life ; and the law will, therefore, receive any other kind of evidence which may satisfac- torily show that the child has lived, and make up for the proof commonly derived from the state of the lungs. It will be first necessary for a medical practitioner to prove that the child under examination has recently died, or in other words, that there are good grounds for believing it to have been recently living. Hence, if the body is highly putrefied, either from the child having died in the uterus some time before birth, or from its having been born and its body not discovered until putrefaction had far advanced both internally and externally, the case is utterly hopeless. The medical witness will in general be compelled to abandon the in- vestigation, because the body can furnish no evidence whatever of life after birth. The examination of the thoracic organs would throw no light on the case, for here we are assuming that the lungs are in their foetal condition. Signs of putrefaction in utero. — The phenomena of putrefaction in air have been elsewhere described ; but the changes which ensue when a child dies and is retained within the uterus, may be briefly adverted to, because they may sometimes form a subject for judicial inquiry. In an advanced state of uterine putrefaction, the body of the child is so flaccid, that when placed on a table it becomes almost flattened by the mere gi'avitation of its parts. The skin is of a reddish- brown color, not green, as in a putrefied body exposed to air. The cuticle covering the feet and hands is white, and sometimes raised in blisters ; the cellular membrane is filled with a reddish-colored serum, the bones are movable, and readily detached from the soft parts. In the opinion of Devergie, the principal difference between uterine and atmospheric putrefaction in the body of a new-born child, is seen in the color assumed by the skin ; but it must be remembered, that should the child remain exposed to the air after its expulsion, the skin may acquire the color observed in cases of atmospheric putrefaction. The changes which have just been de- scribed are such as we may expect to find when a child has been retained in the uterus eight or ten days after its death. When it has remained for some weeks in the uterine cavity, the body has occasionally been found in an adipocerous state, or even incrusted with phosphate of lime. If in any case we are able to state dis- 556 EVIDENCE FROM MARKS OF VIOLENCE. tinctly that the body of a child has undergone uterine and not atmospheric putrefaction, it is clear that it could not have come into the world alive, and no question of murder would arise. Under ordinary putrefaction in air, a child may have been really brought into the world living, and the process may have destroyed every proof of that fact. A medical man cannot rely upon the presence of offensive dis- charges before birth as absolute evidence of the death of the foetus. In two instances Dr. Hicks met with well-marked putridity of the discharges before the birth of the child, yet in one of these, the child was born alive and strong. In the other, there was evidence of life in the child (loc. cit.). Evidence from marks of violence. — It has been proposed to seek for evidence of life, under these circumstances, by observing the characters presented by marks of violence on the body. In general, when children are murdered, the amount of violence inflicted is considerably greater than that which is required to destroy them, whereby satisfactory proofs of the crime are occasionally obtained. On the other hand, the body of a still-born child, dead from natural causes, is often covered with lividities and ecchymoses ;*the foetal blood does not coagulate with the same firmness as in the adult : hence the evidence derivable from the extent, situation, and charac- ters of marks of violence, is generally of too vague and uncer- tain a kind to allow of the expression of a medical opinion that the child was living when the violence was offered to it. The characters which have been already described as peculiar to wounds and contusions inflicted during life, may be met with in a child whether it has breathed, or died without breathing. So, again, these characters are open to the exceptions there pointed out ; for they will be equally present, supposing the wounds to have been inflicted immediately after the cessation of respiration or circula- tion in the child, or after the cessation of circulation only — if the act of respiration has not been performed. Marks of violence on the body of a child that had died in utero twenty-four or forty- eight hours before it was born, would not present the characters of injuries inflicted on the living. There would be no ecchyraosis and no efi^used coagula of blood. These marks, when they exist, although they may establish that a child was either living, or but recently dead at the time they were inflicted, can never show that it was born alive. Injuries met with on the bodies of children alleged to have been born dead ought, however, to be of such a nature as to be readily explicable on the supposition of their having arisen from accident. If, from their nature, extent, or situation, they are such as to evince a wilful design to injure, it is a fair ground for a jury — not for a medical witness, to inquire why these extensive wounds, or other marks of violence, were inflicted on a child, if, as it is alleged, it was really born dead. It must be con- fessed that in such a case, there would be a strong moral presump- tion of murder, although medical proof of life, or actually live birth, might totally fail. PROOFS OF LIFE AFTER RESPIRATION. 557 As a summary of these remarks, it may be observed, that although physiologically, a child may live for a certain period after its birth without breathing — and legally its destruction dur- ing this period would amount to murder, — -yet there are at present no satisfactory medical data to enable a witness to express a posi- tive opinion on this point. If other evidence were adduced of a child having lived and been destroyed under these circumstances — as where, for example, a woman causes herself to be delivered in a water-bath, or an accomplice covers the mouth of an infant in the act of birth, or immediately after it is born — a medical witness would be justified in asserting that the absence of the signs of respiration in the lungs was no proof that the child had been born dead. Indeed, it is apparent that the process could not be esta- blished, owing to the criminal means actually employed to prevent it. Whether a jury would convict upon such evidence is doubtful ; but this is of no importance to the witness: — -his statements ought always to be made according to correct and well-ascertained medical principles, and not for the purpose of procuring either the convic- tion or acquittal of persons accused of offences against the law. In general, those cases in which questions relative to life before respiration might arise are stopped in the Coroner's Court^ — -the usual practice being, when the signs of respiration are absent or imperfect, to pronounce that the child was born dead. If the lungs sank in water, the presence of marks of violence on the body would be considered as furnishing no evidence : — for the sinking of the lungs would, in general, be talcen as a proof of still-birth. There is a class of cases in which a child is born alive, but its lungs remain in the fcetal condition, i. e., they present no appeai'- ance of having received air by the act of breathing. These are cases of atelectasis (p. 564). The appearances in the body are the same as in still-born children. Prof. Bonders, who met with one of these cases in which he pronounced the child to be still-born when it was distinctly proved that it had lived twelve hours, says truly, " Where the signs of an extra-uterine life, which does not betray itself by air in the lungs are to be found, futurity must declare." The absence of air from the lungs may really be the result of the forcible prevention of respiration in the act of birth. There cannot be the slightest medical doubt that living children are occasionally thus destroyed : they die, not from the actual infliction of violence, but because, either through design or accident, the performance of that act which is n-ecessary to maintain existence when the child is born, is prevented. Such a case has not yet been decided, although from the dicta of our judges, it would probably involve a charge of murder. Proofs of life after respiration. — There is no doubt that the proof of the act of respiration furnishes the best and strongest evidence of a child having lived at or about the time it was born. It does not, however, show that a child has been born alive. The physical changes in the body of a child, which result from the establishment -558 EXAMINATION OF THE LUNGS. of this process take place in the lungs immediately, and in the heart and its appendages more slowly. It is therefore chiefly to the lungs that a medical witness looks for proofs of respiration. Sometimes, however, these organs are found in their foetal condition, or nearly so ; — for although a child may have survived its birth many hours, there may be no evidence of the fact from the state of the lungs. To such cases, the remarks now about to be made cannot of course apply: — the proofs of life must then be sought for elsewhere, and if none can be found, the case is beyond the reach of medical evidence. But it is obvious that the occasional occurrence of cases of this description can present no objection to our still seeking for proofs of life in the state of the lungs, any more than the fact of poison not being alwaj^s discovered in the body of one who has died from poisoning, would be a bar to our seeking for the proofs of poison in any unknown case which pre- sented himself. It is the more necessary to insist upon this point, because some have held, that, as we cannot always derive proofs of life from an examination of the lungs of new-born children, we should abandon all evidence of this description and leave the case in its original obscurity. The very object of medical jurisprudence is to endeavor to remove these difficulties, and to show in every department of the science, the degree to which we may safely trust the medical proofs of crime, however insufficient, inconsistent, or co!itradictory they may at first sight apjoear. Examination of the lungs. — ^The cavity of the chest may be con- veniently laid open by carrying incisions from below the clavicles downwards, on each side from about half the length of the ribs backwards. The diaphragm should be separated from the carti- lages without opening the abdomen ; the ribs sawn or cut through, and the flap formed by the anterior parietes of the chest turned upwards. The difterences in the relative position of the organs of the chest before and after respiration may be thus stated : 1. If a child has not breathed, the thymus gland, as large as the heart, will be found occupying the upper and middle portions of the chest; the heart within its membrane (pericardium) is situated in the lower and middle portion, and is rather inclined to the left side. The lungs are placed quite in the back part of the chest, so as often to give the impression that they are wanting. In some instances, they pi'oject slightly forwards by their anterior margins, but in no instance, unless congested, infiltrated, or otherwise dis- eased, do they cover and conceal the heart. The thymus gland is sometimes of a pale fawn, at others of a deep livid color; but there is no perceptible dilterence in this organ in new-born children, before or after the performance of respiration. 2. On the other hand, when a child has fully breathed, the most sti-iking differences will be observed in the color and prominence of the lungs. They are of a light red hue, project forwards, appear to fill the entire cavity of the chest, and cover, and in great part conceal by their anterior margins, the heart and its membrane. We may meet with every variety in the appearances between these two extremes ; for EXAMINATION OF THE LUNGS. 559 the process of respiratioD often requii'es a considerable time in order that it should be fully established, especially in children which are of a weakly constitution .or prematurely born. Hence the lungs will be found to occupy their respective cavities to a greater or less extent, and to cover the pericardium more or less, not according to the length of time which a child has lived, but according to the perfection with which respiration has been performed. Although, as a general rule, the lungs are more perfectly filled with air in proportion to the time during which a child survives its birth, yet this is open to numerous exceptions. The physical characters of the lungs now require notice. Color. — The color of the lungs before respiration is bluish-red, or deep violet, but it is subject to variation. Some medical jurists have compared it to the color of the spleen. A short exposure to air will materially brighten the color in the parts exposed, so that it should be observed and recorded immediately on opening the chest. After respiration, the lungs acquire a light red hue in pro- portion to the degree in which the process has been performed. If impei'fectly established, they will be mottled, generally about the anterior surfaces and margins, the patches of light red being inter- mixed with the livid foetal hue, and being slightly raised, as if by distension, above the general surface of the organs. The light red tint changes after a short exposure to air, to a oright scarlet. This change in the color of the lungs is not a necessary, nor is it an invariable consequence of a child having lived after its birth. I have known a'child to live twenty-four houi's breathing feebly, and on examining the body, the color of the lungs was identical with that of the organs in the fcetal state. The change of color is then a usual, but by no means a necessary, consequence of the enjoyment of life; so that the retention of the foetal color does not furnish positive evidence of still birth. Again, the circumstance of the lungs having a light i-ed color is not an infallible criterion of the child having lived and breathed ; for the artificial introduction of air by a tracheal tube, or otherwise, in the attempt to resuscitate a still-born child, is attended with the same physical change. In the course of numerous experiments, purposely made, I have found no appreciable difference. Bernt says, that artificial inflation will not produce a scarlet red color in the organs, and therefore that this is a criterion of respiration. (" Ed. Med. and Surg. Journ.," vol. 26, p. 367.) I have not only observed this color to be absent after res- piration, but have actually produced it by artificial inflation in the lungs of a dead child. Dr. Falk, of Berlin, has made numerous observations on the color of the lungs during uterine life and after birth. (" Ann. d'Hyg.," 1869, 2, 462.) It has been already stated that the color varies much in new-born children, irrespective of respiration. Volume. — Before respiration, the lungs are in general scarcely visi- ble, unless forcibly drawn forwards in the chest. When it has been perfectly accomplished, the volume is so much increased, that the bag of the heart (pericardium) is almost concealed by them. Res- 560 EXAMINATION OF THE LUNGS — STATIC TEST. piration mnst, however, have been perfectly performed in order that this condition should exist to the full extent described. Consistency. — The lungs, before respinaiion, feel like the liver, or any other of the soft organs of the body. They are firm under the finger, but their substance may be lacerated by violent compression. After respiration has been fully performed, there is a distinct sensa- tion of what is termed crepitation, on compressing them, i. e., air is felt within them. If a thin section of the lung is submitted to examination with a low power of the microscope, before respiration, it will present the solid appearance of a section of the liver, spleen, or kidney; after respiration, air-cells will be distinctly seen in it. These conditions of the lungs must, of course, depend on the degree to which respiration has been carried. The lungs of children that have lived for a considerable time after birth will sometimes give no feeling of crepitation under the finger. Crepitation may also result from putrefaction, and from artificial inflation. Generally speaking, lungs of this kind present the other fcetal -characters ; thus, they are small and of a livid color, and no air-cells may be detected on a microscopical examination. Absolute weight of the lungs. The static test. — The absolute weight of the lungs before respiration is less than that which they have after the establishment of the process. From this an inference has been drawn that the absolute weight of the lungs in an unknown case, compared with certain averages, will aid the inquirer in ascer- taining whether respiration has or has not been performed. In order to detei'mine the weight of the lungs, these organs should be carefully separated by dissection from the heart and thymus gland, and removed with the trachea and bronchi attached. Previously to their removal, ligatures should be placed on the pulmonary ves- sels, so that no blood may escape from the lungs. They should now be weighed, and the weight accurately noted in grains. The average weight before respiration, derived from nine cases, was found to be 649 grains. According to Dr. Traill, the weight varies from 430 to 600 grains. It is of importance in taking the weight of these organs, to observe whether the ciiild is at or near maturity, and whether its body is fully developed, or of about the average size and weight ; owing to a neglect of this rule, it is highly probable that comparisons have been made of the absolute weight of the lungs in childi-en oi' dift'erent ages, which a full statement of the facts would not have justified. If it be small and immature, or unusually large, the lungs will weigh either less or more than the average. The average weight of the lungs after respiration derived from three cases, was 927 grains ; but in making an estimate of this kind, much will depend upon the degree to which respiration has been carried. In three cases, in which the children lived half an hour, six hours, and twenty -four hours respectively, the process had been so imperfectly performed, that the lungs varied but little in weight from the average before respiration. (" G. li. Eep.," JS"©. Y.) The truth is, we cannot compare the lungs of children as to weight, by the time which they may have survived birth, but BEFORE AND AFTER RESPIRATION. 561 rather by the degree to which the hings have been penetrated by air. Another circumstance must also be considered in basing an opinion on the absolute weight of the lungs. Although there does not appear to be any strict normal relation between the weights of the body and lungs in new-born children, yet it is certain that in the bodies of children of unusual weight, the lungs will be found much heavier than the average, whether the child has breathed or not. The body may vary from six to eighteen pounds ; the lungs under these circumstances will also differ in weight. The healthy lungs of mature new-born children, become heavier after respiration, and according to its degree; and where a deviation from this rule is observed, it may probably be explained by the circumstance that the lungs of an immature, have been compared with those of a mature child ; the lungs of an undeveloped twin with those of one not a twin ; or the lungs of one which has breathed imperfectly with those of another in which respiration has become well established. The following table represents the weight of the lungs, in four cases: it will show how much the organs are liable to vary in weight after birth, according to the degree of respiration : — Case 1. Born dead Weight, 687 grs. 2. Lived 6 hours .... "774 3. Lived 24 hours .... "675 4. Lived 9 hours .... "851 Relying upon the mere weight of the lungs, it might be inferred from this table, that the organs would weigh less in a child which had survived its birth twenty -four hours, than in another which had been born dead, and that there would be very little difference in the weight, whether the child lived six hours or nine days; but when it is stated that in Case 3 the lungs had every fcetal character possessed by those in Case 1, and that in Case 4 respiration had been obviously very imperfectly performed, the difficulty is removed. Such cases should rather be compared with the lung^ in the foetal, than in the respired state. They merely show what is very well known and admitted by all medical jurists, that there are some instances in which the fact of respiration cannot be determined by the application of the static, or any other test to the luijgs, simply because they contain no air. Increased weight, therefore, is only one among several circumstances, to which a medical jurist should attend. Great weight of the lungs can obviously furnish no proof of respi- ration, unless this is accompanied by the other physical changes indicative of the process; as, for example, increase in volume from the presence of air, crepitation, and the detection of air-cells by the microscope. If the lungs are heavy, and at the same time contain little or no air, the increase of weight must depend upon disease or other abnormal causes — not upon respiration. In one case which I had to examine, the lungs were large, and weighed upwards of 1200 grains. They contained no air; when divided into thirty pieces, not one portion floated, nor could any air be seen on the closest examina- tion. It was therefore clearly impossible to ascribe a weight so much 562 SPECIFIC GRAVITY OF THE LUNGS. above the average to the effects of respiration. On the other hand, in a case communicated to me by Mr. Cann of Dawlish, the lungs of a new-born child apparently full-grown, although fully distended with air, weighed only 626 grains. In this case, the body of the child weighed only six pounds, and a quantity of blood had no doubt escaped from the lungs, owing to the pulmonary vessels not having been tied before their removal from the chest. It must not be for- gotten that all the physical characters presented by lungs that have respired are liable to certain fallacies ; but, as in the evidence derived from tests used in poisoning, these may be removed, or the force of the objection diminished, by not basing an opinion on one or two conditions only. We should take the whole combined ; for it would be as wrong to regard great weight in the lungs taken alone as an absolute proof of respijjation, as it would be to draw the same in- ference from a mere change in the color, volume, or consistency of the orsjans. M. Ploucquet proposed to determine whether the act of respira- tion had taken place or not, by a comparison of the absolute weight of the lungs with the weight of the body of a child. This, which has been called the test of Ploucquet, is based on the fallacy that there is an invariable relation between the weights of the lungs and bodies of new-born children. No such relation exists; and this method of arriving at a solution of the questionof respiration has been abandoned by all medical jurists. The specific gravity of the lungs. — The specific gravity of the lungs is greater before, than after respiration ; for although the organs become absolutely heavier by the establishment of the process, this is owing, not to the air, but to the additional quantity of blood re- ceivedinto them. The air thus received so increases the volume of the lungs as to more than counteract the additional weight derived from the blood, and thus apparently to diminish their specific grav- ity. Under these circumstances, they readily float on water. From several experiments, I have found that the specific gravity of the lungs before respiration, 2. e. in the foetal condition, varies from 1.04 to 1.05. They are about one-twentieth pai't heavier than their bulk of water. After respiration, the specific gravity of the lungs with the air contained in them, I found in one experiment to be 0.94 ; i. e. the organs were about one-seventeenth part lighter than their bulk of water. The introduction of a small quantity of air will render the lungs buoyant in water ; and an alteration of the volume sufiicient for this purpose, would not be perceptible to the eye. It will be understood that the specific gravity of the substance of the lungs is unchanged ; the organs are rendered only apparently lighter by the air contained in their cells, on the same principle as a bladder filled with air. Hence it follows that the apparent diminution of specific gravity will take place whether the air is derived from respiration, artificial inflation, or putrefaction. It is on this property of the lungs that the application of what is termed the hydrostatic test, or the docimasia pulmonaris, is founded — a subject which may be ap- propriately considered in anotlier chapter. THE HYDROSTATIC TEST. 563 Gonclnsio7is. — The general conclusions which may be drawn from the contents of this chapter ai-e : — 1. That a child may be born alive, and be criminally destroyed before it has breathed. 2. That the presence of any marks indicative of putrefaction in the uterus proves that the child must have come into the world dead. 3. That there are no certain medical signs by which a child which has not breathed can be proved to have been living when it was maltreated. 4. That a new-born child may be destroyed by the prevention of respiration during delivery. 5. That by taking together the color, volume, consistency, abso- lute weight, and buoyancy of the lungs, we may be able to draw an inference whether the child has or has not breathed. 6. That the lungs increase in weight according to the degree to which respiration is established, and not necessarily according to the period which the child has survived birth. 7. That no reliance can be placed upon the test of Ploucquet, or the proportionate weight of the lungs to the body. CHAPTER XLVIII. THE HYDROSTATIC TEST. — SINKING OP THE LUNGS FROM DISEASE OR ATELECTASIS. LIFE WITH PERFECT ATELECTASIS OR ENTIRE ABSENCE OF AIR FROM THE LUNGS. ERRONEOUS MEDICAL INFERENCE FROM SINKING OF THE LUNGS. — FLOATING OF THE LUNGS FROM PUTREFAC- TION.- — EFFECTS OF PUTREFACTION ON THE LUNGS. The hydrostatic test. — The mode of employing this test is extremely simple. Having removed the lungs from the chest, they should be- placed, still connected with the air-tubes, upon the surface of dis- tilled, or river water. If they sink, it should be noted whether the sinking takes place i-apidly or slowly. If they both sink, the two lungs should be tried separately; for it is sometimes found that one, commonly the right, will float, while the other will sink.. Supposing that both lungs sink, it will then be proper to divide each into twelve or fifteen pieces, and place these pieces separately on water. If, after this, they all sink, the inference is, that although the child may have lived and survived its birth, there is- no evidence of its having breathed. On the other hand, the organs when placed on water may float ; it should then be noticed whether they float high above the surface, or at or below the level of the water ; sometimes they indifferently float Or sink. These differences will lead to a conclusion respecting the degree to which respiration has taken place. It will now be proper to separate the lungs, and 564 SINKING OF THE LUNGS IN "WATER. determine whether the buoyancy is due to one or both. Each lung should be divided, as before, and each piece separately tried. If all the pieces float, even after. firm compression, we have good evidence, cceteris paribus, that respiration has been very perfectly performed. Should any of the divided portions sink in water, either before or after compression, our opinion should be modified accordingly. Some have recommended that the lungs should be placed on water with the heart and thymus gland attached ; but there appears to be no good reason for this, since it is as easy to form an opinion of the degree of buoyancy possessed by the lungs, from the readiness with which they float, as by observing whether or not they have the power to support these two organs. "With regard to the inference derivable from the use of this test, it should be observed that the floating of the lungs in water is not, as it is often incorrectly represented to be, a proof that a child has' been born alive ; nor is the fact of their sinking in water any proof that a child was born dead. The floating, under the limitations to be described, proves only that a child has breathed, the sinking, either that it has not breathed, or breathed but imperfectly. The fact of a child having been born living or dead, has, strictly speak- ing, no relation to the employment of the hydrostatic test. There are eases of infanticide which may be readily established without resorting to this test, and others which cannot be proved by its use ; all that the law requires is proof that a child has been born living ; and whether this proof be furnished by the state of the lungs through the hydrostatic test, or in any other manner, is of no moment. The signs of life are commonly sought for in the lungs, because it is in these organs that the changes produced by a new state of existence are most distinctly perceived; but this examination may be dispensed with when the woman confesses that the child was born alive; when others have seen it manifest life by motion or otherwise after its birth ; or, lastly, in cases where, without being seen, it has been heard to cry. The crying of a child has been admitted as evidence of live birth on several trials for infanticide; although, as it is elsewhere stated, a child may utter a cry and die before its body is entirely born. Among the objections which have been urged to the employment of the hydrostatic test, we have first to consider those which concern the sinking of the lungs in water. Sinking of the lungs from disease or atelectasis. — It is said that the hydrostatic test cannot show whether a child has or has not survived its birth, because the lungs of children that have lived-for a con- siderable period have been observed to sink entirely in water. In some instances, this may depend on disease, tending to consolidate the air-cells, as hepatization or scirrhus ; in others, on oedema or con- gestion : but these cases can create no difiiculty, since the cause of the lungs sinking in water, would be at once obvious on examina- tion. The hepatized portion of lung may be known by the firmness with which it resists cutting with a knife, as also by the fact that it is impossible to distend it artificially with air. On the other CASES OF ATELECTASIS. 565 hand, there are cases in which the lungs appear healthy and unaf- fected ; all that we can perceive is, that they retain their fcetal condition. This is a very different state from that pf hepatization, because the lungs may, in this case, be made to receive air by arti- ficial inflation. It is remarkable that life should continue for many hours, and sometimes even for days, under such a condition ; but the occasional existence of this state of the lungs in a living child is placed beyond all dispute ; the explanation of the causes upon which it depends — how it is that a child may live for hours or days, and no signs of respiration be discovered in its body after death, is, however, involved in difficulty. The lungs appear to be simply unexpanded, or to retain their foetal condition ; a state to which the name of atelectasis has been given. This condition may be found in the whole, or in a part of the organs. Dr. Albert met with a case, in which a child died thirty-six hours after its birth, having been attacked by convulsions at intervals during that time. On inspection, the whole of the right, and the lower portion of the left lung were found to be in their fcetal con- dition, and they immediately sank when immersed in water. There was no diseased appearance in the organs, and the undistended por- tions were easily tilled by blowing air into them. (Henke's " Zeit- schrift," 1837, vol. ii. p. 422.) M. D(^paul found that in many cases in which children had died suddenly after breathing for several hours or days, there was no other morbid appearance to be per- ceived than an unexpanded condition of a large portion of the lungs. (" Med. Gaz.," vol. xxxix. p. 283.) It is quite necessary for a medical jurist to be aware that the state of the lungs which is here called atelectasis, is by no means unfrequent among new-born children, although attention has been only of late years drawn to the subject. When no portion of air is found in the lungs of a child, there is no test by which such a case can be distinguished from one in which the child has come into the world dead. These cases of atelectasis are ordinarily set down as exceptions to a general rule ; but I believe they are more common than some medical jurists are inclined to admit. In ex- amining the body of a child,, the history of which is unknown, it is proper that the possible occurrence of such cases should be well borne in mind. It appears to me not improbable that many such come yearly before coroners in this country, and that they are dis- missed as cases of stillborn children, notwithstanding that marks of violence are often found upon the bodies. If, as it has been already observed, the lungs sink in water, this fact alone is com- monly, although improperly, regarded as sufficient evidence of still- birth. This is assuredly putting the most humane interpretation on the circumstances, and so far the result is not to be objected to ; but- we should take care, in carrying out this principle, that we do not throw obstacles in the way of a subsequent judicial inquiry, and lead to the concealment of crime. Professor Bernt met with an instance in which a seven-months' child died two hours after birth; and when its lungs were divided and placed in water, every 566 ERRONEOUS MEDICAL EVIDENCE. • portion sank. Eenier has reported another, in which the lungs sank in water, both entire, as well as when divided, although the child had survived its birth at least four days. (Henke, "Lehrbuch der G. M.," p. 374.) In this case the navel-string separated natu- rally before death. Orfila found, in a child which had lived eleven hours, every portion of the lungs when divided, to sink on immer- sion. In three other instances, in which the children survived birth four, six, and ten hours, the lungs also sank when divided ; two of these were mature. ("M^d L^g.," vol. i. p. 375.) Dr. Vernon attended a healthy woman, who was delivered of a child at about the sixth month of her pregnancy. The child was born before his arrival, and he heard it crying strongly from under the bed-clothes as he entered the room. After removal from the mother, the child cried at intervals, and it was observed that its chest rose and fell as in ordinary breathing. It lived live hours, and it then appeared to die from feebleness and exhaustion. It was a female child, and very small; the body weighed 2 lbs. 13 oz., and its length was 12| inches ; the eyelids were adherent. The lungs were of a purplish-red color, and slightly overlapped the bag of the heart ; they sank in water both entire and when divided into small pieces ; they were not crepitant, and broke down under firm com- pression ; there was no appearance of air-cells in a section of the lungs when examined by the microscope. The ductus arteriosus and foramen ovale were in the fcetal state. (" Lancet," Feb. 3, 1855, p. 121.) A still more remarkable case recently occurred to Prof. Bonders of Utretch. (Eeport by Dr. Moore, " Dublin Medical Press," ISTov. 22, 1865, p. 456.) The body of the child was sixteen inches in length, and weighed nearly five pounds. It was pi'obably a seven months'- child. The lungs were of a brown color, and sank in water entire and when divided. There was no crepitation, and on pressure only a reddish fluid without air escaped. The bladder was empty ; there was no food in the stomach, but there was me- conium in the large intestine. From this state of facts, Prof. Bon- ders concluded that the child was immature — stillborn — only a short time dead, and remaining in the uterus only a short time after death. It transpired, howevel', that the child had been born alive, had survived its birth twelve hours, and had cried distinctly after it was born. As the lungs could be readily inflated, and as the child had cried, he concluded that air had been received into the lungs, and had been again slowly expelled, the child dying in a kind of asphyxiated state. I may add to these instances two which have occurred under my own observation. In one, the case of a mature male child, the lungs sank in water, although the child had survived birth for a period of six hours. In the other, the case of a female twin, the child survived twenty-four hours ; and after death the lungs were di voided into thirty pieces ; but not a single piece floated ; showing therefore that, although life had been thus pro- tracted, not one-thirtieth part of the structure of the lungs had received from respiration sufficient air to i-ender it buoyant. (" Gruy's Hospital Reports," E"o. 5, p. 855.) In the latter instance no par- FAILURE OF HYDROSTATIC TEST. 567 ticular remark was made, during life, respecting the breathing of the child. These cases show most clearly that buoyancy of the lungs is not a necessary consequence of a child having lived and breathed for some time after birth. Probably, had these cases called for medico- legal inquiry, the lungs would have been cut to pieces ; the sinking of the divided pieces in water, either before or after compression, would have been set down as negativing the act of respiration, and, unless other strong evidence had been forthcoming, it would have been asserted that the children had been born dead. Here, again, we perceive the necessity of not hastily assuming that a child has been born dead because its lungs sink in water. There may be no good medical evidence of such a child having lived after birth, but assuredly the mere sinking does not warrant the common and posi- tive dictum, that the child was necessarily dead when born ; it would be as reasonable to pronounce, in a question of poisoning, that the fact of an individual having died from poison was nega- tived by the non-discovery of a poisonous substance in the stomach of the deceased. It must be apparent, on reflection, that cases of this description are beyond the reach of the hydrostatic, as well as of all other tests applied to the respiratory organs ; because the lungs do not receive and retain a sufficient quantity of air to give buoyancy after death, although the children may have lived some hours. The hydrostatic test is no more capable of showing that such children as these have lived, than it is of indicating from what cause they have died. Facts of this kind demonstrate that a passive existence may be for some time maintained under a state of the respiratory process not to be discovered after death. In the opinion of some, these cases form a serious objection to the hydrostatic test ; but it is difficult to under- stand how they can affect its general application — or why, because signs of respiration do not always exist in the lungs of children that have lived, we are not to rely upon them when they ai'e actually found. These singular instances prove that we are greatly in want of some fact to indicate life after birth, ivhen the signs of ?^espi ration are absent. Until we discover this, we must, of course, make the best use of that knowledge which lies at our disposal ; taking care to apply it to those cases alone to which experience shows it to be safely adapted. In the mean time, the common inference that a child has been born dead because its lungs sink in water, is never likely to implicate an innoceut party ; it can only operate by some- times leading to the liberation of the guilty. It has been recommended that medical jurists should consider as dead every child that has not breathed, i. e., whose lungs sink in water; but they who give this advice at the same time admit that children may come into the world living without breathing, and the law holds, under the decision of its expounders, that respiration is only one, and not an exclusive, proof of life. In order to establish life, or even live birth, respiration need not always be proved, either in civil or criminal cases. A medical jurist would, thei-efore, be no 568 FLOATING OF THE LUNGS IN WATER. more justified in asserting that all such children were necessarily born dead, than that they were born living : and in stating what is the plain and obvious truth, it is not possible that his statement can ever be the means of involving an innocent person. It is certain, however, in departing from the truth, and stating what is contrary to well-known facts, that when the lungs of a child sink in water, it is safe and just to consider such child as having been born dead, he is incurring the risk of exculpating a really guilty person ; for it cannot be too strongly borne in mind, that a woman is not now charged with murder, merely because the lungs of her child float or sink in water, but because there are upon its body marks of vio- lent injuries apparently sufficient to account for the death of a new- born child, or there are strong moral presumptions of her guilt. Floating of the lungs from other causes than respiration. — Another series of objections has been urged to the hydrostatic test, based on the fact that the lungs may receive air and acquire buoyancy from other causes than respiration. These causes are two: putrefaction and artificial inflation. Patrefaetion. — The lungs of a stillborn child, when allowed to remain in the chest, are slow in undergoing putrefaction; but, nevertheless, they sooner or later acquire sufficient air to render them buoyant in water. When the lungs are putrefied, this will be determined, in general, by putrefaction having extended throughout all the soft parts of the body. The organs, according to the degree of putrefaction, will be found soft, of a dark green or brown color, and of a highly offensive odor ; the serous membrane covering the surface will be raised in large visible bladders, from which the air may be forced out by very moderate compression. It has been remarked that, under the same conditions, gaseous putre- faction takes place as rapidly in the liver, heart, and thymus gland of a new-born child, as in the lungs ; we should, therefore, notice the general state of the body. The distension of the lungs with gas from putrefaction cannot be easily overlooked or mistaken for the air of respiration. The answer to any objection founded on the putrefied state of these organs, must at once suggest itself. It is impossible that any well-informed medical witness can expect to obtain satisfactory evidence from experiments on lungs in such a condition. He should abandon the case, and declare that in regard to the question of respiration, medical evidence cannot establish either the affirmative or the negative. The fact of his not being able to give the evidence required cannot be imputed as a matter of blame to him, or ascribed to any deficiencies in the hydrostatic test ; this is due to purely accidental circumstances. In a case reported by Henke, the lungs and other organs in the body of a child were found in an advanced state of putrefaction. A medical witness gave an opinion that the child was born dead, but the prisoner afterwards confessed that it had been born living. The medical opinion could have been no more than a conjecture, the condition of the body not allowing any correct conclusion to be drawn. This fact shows that it is always better to leave a doubtful case as we find it, than to expi-ess a positive opinion that the child ARTIFICIAL INFLATION OF THE LUNGS., 569 has been born living or dead. If on these occasions a witness were simply to assure a jury, that medical evidence could not solve the question whether the child had lived or not — if he were to assert, what is really the fact, that his experiments would not allow him to say whether the child had or had not breathed — it is certain that no innocent person would ever be convicted, or a guilty person ac- quitted, upon his evidence. It is for a jury only to judge of guilt from all the circumstances laid before them ; but it is assuredly not for a medical witness to prevent further investigation, and put an end to the case, when there is good reason for doubt. It is his duty to state that doubt, and leave the decision of guilt or innocence in the hands of the court. Conclusions. — The general conclusions which may be drawn re- specting the application of the hydrostatic test in cases of infanti- cide, are the following : — 1. That the hydrostatic test can only show whether a child has, or has not breathed — it does not enable us to determine whether a child has been born living, or dead. 2. That the lungs of children that have lived after birth may sink in water, owing to their not having received air, or to their being in a diseased condition. 3. That a child may live for some time when only a portion of the lungs has been penetrated by air. 4. That a child may survive birth even for twenty-four hours, when no part of its lungs has been penetrated by air. 5. Hence the sinking of the lungs (whether whole or divided) in water, is not a proof that a child has been born dead. 6. That the lungs of children which have not breathed and have been born dead, may float on water from putrefaction. 7. That the lungs, as situated in the chest, undergo putrefaction very slowly; — that if but slightly putrefied, the gases may be easily forced out by compression, and if much putrefied, either the case must be abandoned, or other sources of evidence sought for. CHAPTER XLIX. FLOATING OF THE LUNSS FROM ARTIFICIAL INFLATION. — INFLATION NOT DISTINGUISHABLE FROM IMPERFECT RESPIRATION. — RESULTS OF COM- - PRESSION. IMPROPER OBJECTIONS TO THE HYDROSTATIC TEST. RES- PIRATION BEFORE BIRTH. — RESPIRATION A SIGN OF LIFE, NOT OF LIVE BIRTH. — GENERAL CONCLUSIONS. Artificial inflation. — It has been alleged that the lungs of a still- born child may be made to assume, by artificial inflation, i. e., by blowing air into them, all the characters assigned to those which have undergone respiration. Thus, it is said, a child ma}^ not have 570 ARTIFICIAL INFLATION OF THE LUNGS. breathed, and yet the application of the hydrostatic test would, in such a case, lead to the inference that ithad. It will be seen that the force of this objection goes to attack directly the inference derivable from the discovery of air in the lungs. There is only one form under which this objection can be admitted, namely, as it applies to lungs which have been inflated while lying in the cavity of the chest. Any experiments performed on them after their re- moval from this cavity, can have no practical bearing, since, in a case of infanticide, we have to consider only the degree to which the lungs,' may be distended with air by a person who is fairly endeavoring to resuscitate a stillborn child. Assuming that the experiment has been successfully pei'formed, and that the lungs have been artificially inflated, they would resemble, in their partial distension with air and other physical characters, those of children which had breathed imperfectly. Like them, they may float on water ; but on cutting them into pieces, some of these would be found to sink. If the pieces which float are firmly compressed either by means of a folded cloth, or between the fingers, they will lose their air and sink. "When this pressure is produced under water, it will be seen that bubbles of air escape, but mere, pressure with the fingers will not, in general, sufiice to expel the whole. The same result is obtained when the divided portions of lungs, which have breathed imperfectly, are submitted to pressure. If, however, the act of breathing has been perfectly performed, and the air-cells are well filled, the air cannot be expelled by pressure, or by any force short of the destruction of the substance of the lungs. This, difiference in the effect of pressure has been hitherto regarded as a criterion to distinguish lungs that have fully breathed from those which have been simply inflated ; but Dr. Hicks met with a case which shows that pressure will not always effect the expulsion of air, artificially introduced into the lungs of a child born dead ; hence, by an exclusive reliance on this method, a medi- cal man might be led to infer that a lung, artificially inflated, had received air by respiration. Dr. Hicks delivered a woman of a full-grown child; it was stillborn, and there was no effort at respi- ration. An attempt was made to resuscitate the child, but unsuc- cessfully, by blowing air into the lungs through a catheter. On inspection, the lungs were observed to be of large size, but they did not present the usual appearances of lungs which had breathed. Although about three-fourths of the organs had received air by inflation, they were of a pale fawn color, like the thymus gland ; still the air was contained in the minute air-cells. They floated on water, as well as all the pieces (fifteen or sixteen) into which they were divided. When compressed between the fingers under water, small bubbles of air escaped : but no amount of compression, short of destroying their structure, caused these pieces to sink. A fact of this kind, although perhaps exceptional, shows that the non- expulsion of air from lungs by compression must not be regarded as an absolute proof of respiration. It must be taken with other circumstances, e. g., absolute weight and color, as a fact, to show APPLICATIONS OP HYDROSTATIC TEST. 571 that the child has either breathed, or has had its lungs perfectly inflated in a bond fide attempt to restore life after birth, either by the mother, or by some person present at the birth. In cases of this kind, the only course left open to a medical witness is, to state that the evidence derived from experiments on the lungs left it uncertain whether the child in question had breathed, or had had its lungs artificially inflated. A jury will then know how to return their verdict ; for it must be remembered, they have always circumstances, as well as medical opinions, to guide their judgment; and it is upon the whole, and not upon a part, of the evidence laid before them that their verdict is founded. If asked to state in what cases the pulmonaiy tests are capable of assisting a medical jurist, the answer, it appears to me, would be : 1st. They will clearlj^ show that a new-born child has lived, when, during its life, it has fully and -perfectly breathed. Cases of this description form a certain number of those which come before our courts of assize. To them the most serious objections are not applicable ; and the few which might be made to the medical in- ferences are not difficult to answer. 2dly. They will allow a wit- ness to say, that the lungs must have received air either by respira- tion, or by artificial inflation. These are the cases in which a child has died soon after birth, and where the respiratory changes are but imperfectly manifested in the lungs. They probably form a large proportion of those which fall under the jurisdiction of the criminal law. It might be considered that the qualification in the inference here drawn would neutralize its force ; but it must be remembered, that there are few instances of actual and deliber- ate child-murder wherein artificial inflation could become even a possible defence for an accused person. So unusual is this kind of defence, that among the numerous trials for infanticide which have taken place in this country for many years past, I have not been able to meet with a single instance in which it was alleged, as an objection to the medical evidence derived from the buoyancy of the lungs, that the prisoner had inflated them in order to re- suscitate her child. The reason is obvious; had such a defence been attempted, the whole of the circumstantial evidence would at once have set it aside. When, in the suspected murder of an adult, a medical man swears that a fatal wound was such that the de- ceased might have inflicted it on himself, or that the prisoner might have produced it, he is placing the jury in a position very similar to that in which he places them in a case of child-murder, when he says that the child might have breathed, or its lungs might have been artificially inflated. How would a jury decide in the two cases ? Assuredly, by connecting certain facts with which a medi- cal witness is not concerned, but which may, in their opinion, satis- factorily supply the place of what is deficient in his evidence. It is not for him to speculate on the probabilities of respiration, or of artificial inflation ; but it is for them to consider whether the accused was, or was not likely, under the particular circumstances of the case, to have resorted to an experiment of this nature. It 572 APPLICATIONS OF HYDROSTATIC TEST. has been suggested that some person might inflate the lungs of a dead child, in order to raise a charge of murder against its mother ; but this suggestion presupposes, on the part of a criminal, a pro- found knowledge of the difficulties of medical jurisprudence ; and even then the question of murder does not depend merely on the presence of air in the lungs. Such a case is very unlikely to pre- sent itself; indeed, its occurrence is no more probable than that in poisoning it should be considered a good defence that some person might have introduced poison into the body by injections, after death. The circumstances of the case will commonly furnish a sufficient answer to such hypothetical views. The hydrostatic test ought not, therefore, to be lightly con- demned or rejected upon a speculative objection, which, in nine- teuths of the cases of child-murder, could not possibly exist. Let it be granted to the fullest extent, that a conscientious medical jui'ist cannot always draw a positive distinction between the eftects of respiration and artificial inflation on the lungs ; still a jury may be in a situation to relieve him from this difficulty. In short, it would be as reasonable to contend that all persons charged with murder should be acquitted because homicidal are not always to be distinguished from suicidal wounds, as to argue that all cases of infanticide should be abandoned because these two conditions are not distinguishable by any certain medical signs. If juries do frequently dismiss such cases, it is, I apprehend, to be ascribed rather to their great unwillingness to become the means of admin- istering what they consider to be severe laws, than to their want of power to balance and decide on the probabilities laid before them. If the pulmonary test were wholly set aside, it is easy to conceive what would be the consequences. Let us suppose that a new-born child is found, under suspicious circumstances, with its throat cut ; we are called upon to admit that it is impossible for medical evidence to establish whether the child has lived or not, and therefore we are to decline making an inspection of its body. But this would be the same as declaring that child-murder could never be proved against an accused party, and that new-born children might henceforth be destroyed with impunity! It appears to me that conduct of this kind on the part of a medical witness, would be wholly unwarrantable ; for we may some- times acquire, by an inspection, as great a certainty of respira- tion having been performed, and therefore of a child having lived, as of any other fact of a medico-legal nature. Gases of poisoning often give rise to greater difficulties to a medical jurist ; as where, for example, he attempts to found his opinion of the cause of death on symptoms alone, or on appearances in the dead body. But we may put the question in this light. In the body of a healthy full-grown child, which has but recently died, we find the lungs filling the cavity of the chest, of a light red coloi', spongy, crepitant beneath the finger, weighing at least two ounces, and, when divided into numerous pieces, each piece floating on water, even after violent compression. Is it possible in such a case to RESPIRATION BEFORE, OR DURING BIRTH. 573 doubt that respiration has been performed ? If there is no certainty here, it appears to me that medical experience is but little fitted in any case to guide us in our inquiries. It would be difficult to point out an instance in M^hich an affirmative medical opinion would be more surely warranted by the data upon which it was founded. Respiration before, or during birth. — It has been already stated that the pulmonary tests are fitted to prove only whether a child has, or has not lived to breathe. Neither the hydrostatic, nor any other test can positively show that the body of a child was entirely born alive when the act of breathing was performed. As this is a subject which generally gives rise to some discussion in cases of child-murder, I shall here make a few remarks on it. 1st. Respira- tion may be performed while the child is in the uterus, after the rupture of the membranes — -the mouth of the child being at the os uteri. This is what is termed vagitus uterinus ; its occurrence, although extremely rare, seems to me to rest upon undisputed authority. 2dly. A child may breathe while its head is in the vagina, either during a presentation of the head, or of the breech. This has been termed vagitus vaginalis. It is not very common, but it must be set down as a possible occurrence, lidly. A child may breathe while its head is protruding from the outlet ; in this position respiration may be as completely set up in a few moments by its crying, as we find it in some children that have actually been born, and have survived their birth for several hours. This is the most usual form of respiration before birth. In the vagitus uterinus or vaginalis the lungs receive but a very small quantity of air; in respiration after protrusion of the head the lungs may be sometimes found moderately well filled, although never, perhaps, possessing all the characteristic properties of those which have fully respired. The well-known occurrence of respiration under either of these three conditions, strikingly displays the fallacy ot making this process, as some have done, the certain boundary of extra-uterine life. A child may breathe in the uterus or vagina, or with its head at the outlet, and die before its body is born ; the discovery of its having respired would not, therefore, be any sort of proof of its having enjoyed what has been termed " extra-uterine life." (For a well-marked case of this kind, see "Med. Glaz.," vol. 38, p. 394; and another, communicated to me by Dr. Crothers, of Coy, will be found in "Guy's Hospital Reports," October, 1850, p. 231.) The death of a child which has breathed in the uterus or vagina from natural causes, before its entii'e birth, is a possible occurrence; but its death from natural causes before birth, after it has breathed by the protrusion of its head from the outlet, is an unusual event. All that we can say is — it may take place ; but death under these circumstances would be the exception to a very general rule. Oberkamp states that, in four successive deliveries of the same woman, the children breathed during delivery, but died before they were born. 574 HYDROSTATIC TEST — GENERAL CONCLUSIONS. Respiration a sign of life, not of live birth. — The hydrostatic test is only capable of determining that respiration has taken place; it can- not show whether this process was established during birth or after- wards. The fact of a child having the power of breathing before it is entirely born, does not therefore constitute the smallest objec- tion to its employment; although upon this ground, we find the use of it in any case denounced by many eminent members of the medical and legal professions. Thus, Archbold says, "Very little confidence is placed in this test as to the lungs floating, particularly if the child were dead any length of time before the experiment was made." ("Criminal Pleading," p. 367.) Mathews speaks of the test as being "quite exploded" ("Digest," p. 251); and Jervis makes the same remark ("On Coroners," p. 127). It is obvious that most members of the law who have treated this subject have adopted, without sufficient examination, the statements of Dr. William Hunter. This author observes: "A child will commonly breathe as soon as its mouth is born or protruded from the mother; and in that case may lose its life before its body be born, especially when there happens to be a considerable interval between what we may call the birth of the child's head and the protrusion of its body. And if this may happen where the best assistance is at hand, it is still more likely to happen when there is none, that is, where the woman is delivered by herself." ("On the IJncertainty of the Signs of Murder in the Case of Bastard Children," p. 33.) Dr. Hunter here exposes, in plain language, the fallacy of trust- ing to signs of respiration alone as evidence of a child having been. born alive. The truth of his remarks is, in the present day, gene- rally admitted; and if, among medico-legal writers, we find some still treating of respiration as a certain proof of live birth, it is from their not having sufficiently considered the probability of a child breathing and dying before its body is entirely, extruded. Conclusions. — The general conclusions respecting the employment of the hydrostatic test, to be drawn from the contents of this chapter, are : — • 1. That the artificial inflation of the lungs of a child born dead will cause them to float in water. 2. That lungs artificially inflated while in the chest resemble those organs in which respiration has been only imperfectly estab- lished. 3. That in cases of inflation of the lungs in the chest, the air may be generally expelled from the divided portions of lungs by firm compression, so as to cause them to sink. 4. That the same result occurs with lungs in which respiration has been imperfectly established. 5. That when lungs have undergone perfect respiration, the air cannot be expelled by compression of the divided parts, so as to cause them to sink. 6. That the artificial inflation of foetal lungs causes no alteration of weight; and as the weight increases in proportion to the degree WHAT CONSTITUTES LIVE BIRTH? 575 of respiration, so in healthy lungs with great buoyancy, there should be great weight if the air has been derived from respiration. 7. That we should base our judgment of a child having breathed upon great weight and great buoyancy of the lungs combined ; that the one condition without the other is open to the objection that the air may not have been derived from respiration. 8. That a floating of the lungs in water proves, cceteris paribus, that a child has breathed either at, during, or after birth ; it does not prove that a child was born alive, or that it has died a violent death. 9. That the sinking of the lungs, as a result of the expulsion of air from them by compression, does not necessarily prove that the child was born dead. It merely proves that the air contained in them was derived either from artificial inflation, or from the im- perfect establishment of the respiratory process. 10. That the hydrostatic test is not applicable to determine the fact of respiration, or non-respiration in all cases of alleged cliild- murder ; but that, with ordinary precautions, it may be safely employed in the majority of such cases. 11. That a child may breathe before, during, or after birth ; but the hydrostatic test will not enable us to say, in the greater number of cases, at which of these periods the act of respiration was per- formed. 12. That respiration is a sign of life, and not necessaiily of live birth. 13. Hence, medical evidence is required to show whether a child breathed after it was entirely born, and whether the act of violence which caused its death was applied to it while so breathing. These conclusions are here expressed with brevity. Some of them may require qualification ; but for the circumstances which qualify them, the reader is referred to the contents of the chapter. CHAPTER L. ON THE PROOFS OF A CHILD HAVING BEEN BORN ALIVE. — EVIDENCE PROM RESPIRATION. FROM MARKS OF VIOLENCE. — PROM NATURAL CHANGES IN THE FCETAL VESSELS. FROM THE DISCOVERY OF FOOD IN THE STOMACH. GENERAL CONCLUSIONS. On a trial for child-murder, the important medical question has hitherto been : Was the child completely born alive? The inter- pretation set upon these words by all the judges was that the whole body of a child should be entirely delivered from the body of the mother, before the question of its death from violence could be entertained. Some learned judges even held that a child was not legally born alive until it was severed from the body of the mother. In cases in which death had obviously taken place from criminal 576 PROPOSED CHANGES IN THE CRIMINAL LAW. violence, the medical witness was suddenly stopped in his evidence hy being asked for some infallible proof of live birth in a legal sense. As a medical man, not present at the delivery, could rarely be in a condition to offer such proof, the case broke down, and the accused was acquitted of the charge of murder. If a medical witness ventured to say that he formed his opinion of live birth from the presence of air in the lungs, and the usual appearances produced in these organs by the act of breathing, he was immedi- ately met with the objection that a child might breathe during the act of birth, and die befoi'e its body was born, and yet the appear- ances would be the same. To this there was generally no reply ; but every medical man could perceive that an exceptional condition was thus strained into a rule, simply to procure an acquittal on a capital charge. Some children are wilfully injured and destroyed during delivery, but the greater number are, no doubt, destroyed soon after they have been entirely born ; still, there is nothing of a medical nature to distinguish one set of cases from another. In each the child may have breathed, and the lungs may contain air ; while, at the same time, the fatal violence — whether indicated by wounds, fractures, burns, or marks of strangulation on the neck — M'ould be the same ; there would be no medical difference; and it is obvious, from the nature of things, there could not be any appear- ances, by which the partially born could be distinguished from the completely born child. Medical evidence went, on these occasions, as far as it could be reasonably carried. It established two facts: 1, that the child was living at or about the time of its birth, and when the violence was inflicted upon it ; and, 2, that the violence itself was sufficient to cause death, and was, in fact, the cause of > death. The Capital Punishment Commission, whose attention had been especially directed to the frequent failures of justice in trials for infanticide, have in their recent Report (Dec. 1865), made some important suggestions, which, if cai-ried into legislation, will relieve medical evidence of some of those insuperable difficulties which it has hitherto had to encounter in cases of infanticide, and at the same time remove that which has hitherto been a stigma upon our criminal la■w^ I quote the following passages from this report : — " The crime of infanticide, as distinguished from murder in gene- ral, is not known to the English law. The moment a child is born alive, it is as much under the protection of the law as an adult. " 14. We have considered whether the failure of justice, which undoubtedly often occurs in such cases, may not be obviated by some change in the law which shall add to the protection of new- born children. The principal obstacle which now prevents the due enforcement of the law is the extreme difficulty of giving positive proof that the child alleged to have been murdered was completely born alive. "15. We have given this important and difficult subject our serious attention, and we have arrived at the opinion that an Act should be passed making it an offence, punishable with penal ser- PROPOSED CHANGES IN THE CRIMINAL LAW. 577 vitude or imprisonment, at the discretion of the court, unlawfully and maliciously to inflict grievous bodily harm or serious injury upon a child during its birth, or within seven days afterwards, in case such child has subsequently died. No proof that the child was completelj'^ born alive should be required. With respect to the offence of concealment of birth, we think that no person should be liable to be convicted of such offence upon an indictment for murder, but should be tried upon a separate indictment. The accused should not be entitled to be acquitted in either of the above cases, if it should be proved on the trial that the offence amounted to murder or manslaughter." It would appear from these paragraphs that provided a child has died from injuries unlawfully inflicted upon it, either during its birth or within seven days afterwards, the person guilty of such violence may be convicted of a statutable offence involving a severe punishment. It will not be necessary that the medical evidence should prove that the child was completely born alive, or severed from the body of the mother at the time that the violence was in- flicted upon it. This will not, however, alter the state of the law, or aftect criminal responsibility, when the facts establish an act of murder or manslaughter. The proposed change is intended to meet the two medical dijEculties of proof of complete birth, and of vio- lence inflicted during or after birth. The operation of such an Act will be practically to repeal the punishment of death in cases of infanticide, because, judging from past experience, the greater number of these charges will resolve themselves into the statutable offence punishable with penal servitude, or imprisonment. Under the proposed new system of legislation, the proof of entire or com- plete birth would be no longer necessary ; but proof of live birth is not dispensed with when the charge is one of murder, or man- slaughter. Two sets of cases may present themselves for medical evidence: 1, those in which violence is applied to the child during birth, but the child is born alive, and dies from the violence either immediately or within a few days ; and, 2, those in which the vio- lence is applied, and the child dies from its effects, before it is born,. or in the act of being born, — as in that form of infanticide in which a woman is delivered in a bath, and the child, when born, dies- from the prevention of respiration, or where a child is deliberately strangled or suffocated when its head presents. In the second set of cases, there can be no medical proof of live birth ; hence, these are likely to be treated as cases of stillbirth. The complete de- struction of children during birth by wilful violence can apparently neither be defined, nor punished as a legal offence. This exception, in the proposed legislation on infanticide obviously depends on the impossibility of distinguishing a child which has died from natural causes in the act of birth, from one which has been destroyed by in- juries inflicted during its birth. Marks of violence may be found on the dead bodies of both or neither ; but allowing that they are of a fatal character, and that the proof of the exact time of their infliction is unimportant, how is a witness to be in a position to say 37 578 LIVE BIRTH — EVIDENCE FROM RESPIRATION. that the child died from the injuries subsequently to its birth ; and yet without proof of this, a criminal may escape. The material part of the medical proof, then, on these occasions will be to show to the satisfaction of a coui't that the injuries did not prove fatal until after the birth of the child. The legal assumption in the defence will be that the child died from them before it- was born, and that it came into the world dead. A difficulty of this kind may, however, be removed by the terms of the proposed new statute. One learned judge has strongly expressed his opinion that the wilful destruction of a child during birth, or before it is completely born, should be treated as a distinct oiFence, and that there should not be an ac- quittal on the ground that the medical evidence did not prove the child to have been completely born ; leaving it to the discretion of the judge to direct a charge of murder to be made. As the question of live birth may still therefore incidentally arise, it will be necessary to consider the medical facts upon which reliance is placed as furnishing evidence of a child having come into the world living, or of its having been born alive. Evidence from respiration. — As a general rule, there will be no perceptible difference in the state of the lungs, whether the act of respiration is performed by a child during birth, or after it is born, provided that its death speedily follow its birth. But should we find that this process has been ferfectly established., i. e., that the lungs present all those conditions which have been described as characteristic of full and perfect breathing, there is great reason to presume that the process, even if it had commenced during birth, must have continued after the child was entirely born. This pre- sumption becomes still stronger when the child is immature ; for generally speaking, such children must be born and continue to breathe for many hours after birth, in order that their lungs should present the characters of complete respiration. The process is seldom so established before birth as to give to these organs a feel- ing of crepitation under pressure ; the existence of this character should, therefore, be sought for. A witness who relied upon it as a conclusive proof of breathing after birth, might be asked by counsel, whether it were not possible for some children to remain so long at the outlet with the head protruding, as to render the lungs crepitant from frequent respiration before birth. Admitting the bare possibility of this occurrence, he should endeavor to ascer- tain whether there were any probable cause which could thus have protracted delivery while the head of the child was in this position ; as also, what natural cause could have produced its death when its head was protruding and respiration had been so freely performed as to give crepitation to the lungs. The presence or absence of the usual scalp-tumor might throw some light Upon the case. If, when present, it did not prove live birth, it might indicate protracted delivery, and show that the child had been recently living. The late Professor Casper, of Berlin, has cut the Gordian knot of this difficulty, by assuming, that breathing before birth takes place only in protracted delivery, in which the assistance of an accou- EVIDENCE FROM THE UMBILICAL CORD. 579 cheur is required. In those cases which are likely to give rise to criminal investigations, he assumes that the birth of the child takes place quickly, and that in rapid delivery the child does not breatlie until it is born alive. Hence his conclusion is — if in the body of a child (seci-etly disposed of) the lungs are found to contain air by the hydrostatic test, this air did not enter the lungs at or before birth but afterwards, and the child was born alive. (" Gerichtl. Medicin," vol. 1, p. 710.) Such a conclusion is not in accordance with the facts ascertained regarding the act of respiration in new- born children ; it may be that they rarely die from natural causes after they have once breathed, but that they can breathe and cry during birth is a fact which cannot be disputed. Further, there is no test known by which air received into the lungs during birth, can be distinguished from that which has entered these organs after the child has been born alive. Evidence from marks of violence. — If marks of violence, appa- rently inflicted about the same time, are found on different and remote parts of the body, and these marks bear the characters of those produced during life, it is rendered probable that the whole of the body of the child was in the world when they were caused. Marks of severe violence on one part, as the head or breech, would not always justify such a presumption, because it might be fairly objected that they had been unintentionally produced by the woman in her attempts at self-delivery, and yet the child not have been born alive. It would be for a witness to form an opinion from the circumstances accompanying the particular case, whether they had been thus occasioned. From this it will be seen that, in making an examination after death, it is proper that every mark of injury on the body of a child, even if slight, should be noted down. Abra- sions of the skin, burns, and punctures, should be noted, and the throat examined for marks of pressure by a cord, or by the lingers. Evidence from certain changes in the body. — In a child that has been born alive, or has survived its birth for a period of from twelve to twenty-four hours, that portion of the umbilical cord which is contiguous to the abdomen undergoes certain changes ; it dries and becomes slowly shrivelled, and in from three to five days, it sepa- rates from the body without cicatrization. The cord does not separate at the part which is tied, but close to the abdomen. It separates generally within five days, by a process of sloughing, the skin connected with the dead portion of the cord presenting a red line, arising from capillary congestion. During the separation of the navel-string, the umbilical vessels are gradually closed. According to Billard, the obliteration of these vessels is ett'ected in a peculiar manner. The calibre diminishes as a result of a concentric thickening of the coats, so that, while the vessel retains its apparent size, its cavity is gradually blocked up. A quill would represent the form of the vessel in the foetal state, and a tobacco- pipe in the obliterated state. It is only by cutting through the vessel that the degree of obliteration can be determined. The state 580 EVIDENCE FEOM HEART AND FCETAL VESSELS. of the umbilical cord has furnished good evidence of live birth, when the other circumstances of the case have yielded no information. The changes iu the umbilical cord, especially those indicative of its separation and cicatrization, clearly prove that a child has sur- vived its birth, whatever may be the results of experiments on the lungs ; but the difficulty is, that they require some days for their production, and in practice it is necessary to procure some signs of survivorship of only a few minutes, or at furthest of a few hours. The same remark applies to the exfoliation of the cuticle, in a new- born child ; such a condition of the skiu can rarely be found in cases of infanticide. The absence of meconium from the intestines, and of urine from the bladder, are not proofs of live birth, for these may be discharged during birth, and yet the child not be born alive. State of the skin. — In the greater number of new-born children, the skin has a dark-red color, probably owing to the first effect of the atmosphere upon it. "Within an hour it begins to get of a lighter red, and so it remains for one or two days. According to Dr. Elsasser, it becomes again darker about the end of the second, or on the third day, and is then of a brownish-red color. This lasts for three or four days, unless a yellowness appears from jaundice. It is then more or less yellow. It is about the sixth or seventh day that the skin acquires a reddish-white color sych as it afterwards retains. (Henke's "Zeitschrift der S. A." 1842, vol. 2, p. 223.) Evidence from changes in the heart and fcetal vessels. Docimasia circulationis. — It has been supposed that the state of the ductus arteriosus, ductus venosus, and foramen ovale would aid a medical jurist in forming an opinion whether a child had survived its birth. In general, as a result of the establishment of respiration, it is found that the communication between the auricles of the heart by the foramen ovale becomes closed ; and that the two vessels or ducts, after gradually contracting, become obliterated, or are converted into fibrous cords. Whatever may be the conclusions from experi- ments on the lungs, it has been contended that the closure of the foramen and of these vessels would infallibly indicate that a child had breathed. This inference, however, has been too hastily drawn. Recent researches have shown that there are some serious objec- tions to any conclusions based on the state of these foetal vessels ; their closure, as a natural process, always takes place slowly, and sometimes is not completed until many years after birth. Thus, then, in the generality of cases of infanticide, in which necessarily the child survives but for a short period, no evidence of the fact will be procurable from an examination of the heart and foetal vessels. Ductus arteriosus {Arterial duct). — The ductus arteriosus is a vessel about half an inch long, which in the foetus forms a direct commu- nication between the right ventricle of the heart and the aorta ; it conveys the larger proportion of the blood from the heart to the aorta without passing through the lungs. So soon as respiration is established its function is at an end, and it then begins to close. EVIDENCE FROM HEART AND PCBTAL VESSELS. 581 In Figs. 58 and 59 the different parts of the foetal heart are seen in outline — in Fig. 58 as they appear before, and in Fig. 59 as they appear after, perfect respiration: 1, the aorta ; 2, the pulmonary artery ; 3 3, the right and left branches of the pulmonary artery going to the right and left lungs ; 4, the ductus arteriosus, short and wide in Fig. 58, and in Fig. 59 contracted at the end where it joins the under part of the arch of the aorta. Professor Bernt of Fig. 58. Fig. 59. Heart of the Dew-bom child with Heart of the child with the dact andergoing con- tha ductus arteriosus in its foetal tractions as the result of the establishment of res- state, piration. Vienna, who has made many observations on this subject, drew the following conclusions respecting the period required for the closure of the ductus arteriosus in children which have been born alive and have lived after birth : 1. If a child has lived only a few seconds, the aortal end of the duct appears contracted, and the ves- sel, instead of being cylindrical throughout, acquires the form of a truncated cone. 2. If a child has lived for several hours, or a whole day, the duct becomes again cylindrical, although shortened and contracted in diameter. Its size is about equal to a goose-quill ; it is, therefore, much smaller than its root, and about as large as either of the two branches of the pulmonary artery, which have in the mean time become increased in size. 3. If a, child has lived for several days or a whole week, the duct contracts to the diameter of a few lines — about equal to a crow-quill, while the two branches of the pulmonary arteries are equal in size to a goose-quill. 4. The duct is found perfectly closed and quite impervious at a much later period, i. e., after the lapse of an uncertain number of weeks or even months. As a general rule, the peculiar parts of the foetal circulation are rarely obliterated by a normal process before the eighth or tenth day after birth. The obliteration, according to Bernt and Orfila, takes place in the following order: 1. The umbilical arteries; 2. The ductus venosus ; 3. The ductus arteriosus ; and 4. The foramen ovale. (Orfila, "MM. L^g.," 1848, vol. 2, p. 210.) The circum- stances connected with the closure of these foetal vessels have been satisfactorily investigated by Dr. Elsasser. Among 70 stillborn children, they were found open in 69. Among 300 children who 582 LIVE BIRTH — EVIDENCE FROM died soon after birth, 80 out of 108 prematurely born and living from one to eight days, presented all the passages open ; 127 out of 192 infants born at the full time had all the passages open, but partly contracted. The ductus arteriosus was open in 55 cases, and completely closed in 10 cases ; the ductus venosus was open in 81, and completely closed in 37 cases; while the foramen ovale was open in 47, and completely closed in 18 cases only. These facts, according to Dr. Elsasser, prove that the vessels peculiar to the ff.etal circulation remain open as a rule, for some time after birth, and that it is not possible to determine accurately, by days, the period of their closure. This physiologist remarked that the closure commenced and was often completed in the ductus venosus, before it manifested itself in the other vessels. The complete closure, in hy far the greater number of cases, takes place within the first six weeks after birth, and the instances of obliteration before birth, or before the period mentioned after birth must be regarded as rare exceptions. (" Med. Times and Gaz.," May 21, 1853^ p. 530.) From these facts, the "docimasia circulationis" may be considered as useless to a medical jurist. It either proves nothing, or it maj"^ lead to a fatal error. It is the more necessary to point out the fallacies to which it is liable, because hitherto medical jurists have been disposed to place great reliance upon it, in cases in which medical evidence from the state of the lungs was wanting. Evidence from the state of the alimentary canal. — Good evidence of live birth may be sometimes derived from the discovery of certain liquids or solids in the stomach and intestines, such as blood, milk, or farinaceous or saccharine articles of food ; for it is not at all probable that these substances should find their way into the stomach or intestines of a child who was really born dead. 1. Starch. — In the case of a new-born child. Dr. Geoghegan dis- covered, by the application of iodine-water, the presence of fari- naceous food in the contents of the stomach ; hence the question of live birth was clearly settled in the affirmative. On another occasion Dr. Francis employed this method of testing with satis- factory results, in a case in which the investigation was beset with unusual difficulties. He was required by the coroner to examine the body of a new-born child, found under suspicious circumstances. The examination of the lungs left no doubt that respiration had taken place ; and the fact that the child had been born alive was fully established by the discovery in the stomach of a small quantity of farinaceous food. On digesting in diluted water a fragment of the pulp found in this organ, and adding a drop of a solution of iodine, an intense indigo-blue color appeared imme- diately. The application of this chemical test, therefore, removed any doubts which might have been entertained on the question of live birth. (" Med. Gaz.," vol. 37, p. 460.) The quantity of starch present may, however, be too small to produce with water a solu- tion which would be colored by iodine in the manner described. A portion of the contents of the stomach should then be placed on CHEMICAL ANALYSIS OF CONTENTS OF STOMACH. 583 Fig. 60. a glass slide, diluted with a little water if viscid, and examined under the microscope with a power of about 300 diameters. The granules (if present) may then be dis- tinctly seen, having the shape peculiar to each variety of starch, and not unfre- quently mixed with oil-globules and epi- thelial scales derived from the mucous membrane. By the addition of strong iodine- water, their shape and size will be brought out by the intensely blue color which they acquire. Blue fragments of an irregular shape indicate the presence of bread. The annexed engraving (Fig. 60) represents two varieties of starch, either of which may be found in the stomachs of infants ; in a the rounded granules of wheat starch are represented, and in b the ovoid granules of arrowroot. The micrometrical measurements of the granules show, for those of wheat, which are irregularly spherical, diameters varying from Granules of wheat starch. Granules of arrowroot. Magnified 319 diameters. SIS rVffth to TT25'' diameter of ^^Vuth of an th of an inch in size. Many have an average inch. The ovoid granule of arrowroot is gjf^th of an inch in length, and TsVuth of an inch in width. 2. Sugar. — In a case which I was required to examine, the pre- sence of sugar was readily detected in the contents of the stomach by the application of Trommer's test. In order to apply this test, a few drops of weak solution of sulphate of copper should be added to a portion of the cold concentrated aqueous extract of the contents of the stomach. An excess of a solution of pure potash is then added, and the liquid boiled. If sugar be present, the sub- oxide of copper is immediately precipitated of a yellowish or red- dish color. "With white sugar the same decomposition is effected, but more slowly. If starch only be present, black oxide of copper may be thrown down, but there will be no production of a red precipitate. The formation of the red oxide of copper under these circumstances proves that some saccharine substance is present. In reference to the application of the sugar-test, however, it must be re- marked that starch is easily convertible into sugar by a chemical action of saliva or mucus, so that the test may appear to indicate sugar in small quantity, when the result may be really due to the presence of some converted starch. 3. Milk. — This liquid may be found in the stomach of a new-born child; it may be identified microscopically in the fluids of the stomach by the numerous aud well-defineii oil-globules which it contains. It is not possible to distinguish human from cow's milk under these circumstances. In both, the globules which are sphe- rical in all aspects, are remarkable for their transparency in the centre, and their dark margin. They vary considerably in size. I have fbund those of the cow to have by measurement the follow- ing diameters : Maximum, 2 ijVTytli of an inch ; mmimum, jg^ Tyijth ; 584 EVIDENCE FKOM EPITHELIAL SCALES. and medium size, 5 g'tjTjth of an inch. They are distinguished from blood-corpuscles by their shape and lustre, and from starch granules by the fact that they are not colored, or changed by iodine-water. Colostrum is the name applied to the milk first secreted after delivery; it contains, in addition to oil-globules, numerous sphe- rical granular bodies (Fig. 62, b). "When milk is present, lactine Fig. 61. Oil-globules of 011-globnles of Human Milk, Cow's Milk. Magnified 319 diameters. Oil-globules of Coloslrnm with Human Milk. granular bodies. Magnified 450 diameters. or sugar of milk is generally found in the contents of the stomach by the appropriate sugar-test (supra). The casein, or solid prin- ciple of milk, precipitates oxide of copper from the sulphate; but on adding an excess of a solution of potash, the oxide is redissolved, forming a purple or violet-colored solution. It is rapidly coagulated by the digestive principle (pepsine) contained in the gastric juice, so that the casein may be found in small soft masses adhering to the lining membrane of the stomach. It should be observed that albumen forms a deep violet-colored solution with sulphate of copper and potash, but the red suboxide of copper is not precipitated on boiling, unless sugar is mixed with it. 4. Epithelial scales. — The epithelial scales commonly found asso- ciated with articles of food in the sto- mach are of various shapes and sizes ; they are flat, oval, or rounded, and sometimes polygonal. They are nu- cleated, and from their pavement-like appearance they are called "tessel- lated." In Fig. 63, 6, an epithelial scale from the mucous membrane of the inside of the mouth, is represented magnified 570 diameters. In the long axis it was the ^^-^th. of an inch, and in the shortest ^^^th of an inch in diameter. The central nucleus was 4i5VTTth of an inch in diameter, and the small granules around it Tj^V^jth of an inch. These epithelial scales are very numerous, much intermixed, and so thin and trans- Tessellated epithelial scales. a from Sharpey : b from observation. EVIDENCE FROM BLOOD. 585 parent that they are often only distinctly seen at the edges, which are occasionally folded, or slightly turned over. Besides the substances mentioned, other solids and fluids, such as blood and meconium (the fecal discharges of the fcetus) may be found in the stomach of a new-born child, and a question may arise whether their presence indicates' that the child was fully born. It is not impossible that a child might be fed, and exert a power of swallowing when its head protruded from the outlet, and its body was still in the body of the mother. Children have been known to exert a power of sucking or aspiration under these circumstances, and with this a power of swallowing might be exercised. In defending a prisoner on a charge of child-murder counsel would scarcely resort to a defence of this kind. That the starch, sugar, or milk, etc., found in the stomach, should have been given to a child when its body was only half-born, is so improbable an hypo- thesis, that the most inexperienced lawyer would hardly resort to it to account for the presence of food in this organ. When the substances found in the stomach are not in the form of food, but are fluids connected with the child or the mother, the case is difterent. These may penetrate into the lungs or stomach during birth, either by aspiration or the act of swallowing: they thus indicate that the child was living, but they do not necessarily show that its body was entirely in the world when they were swallowed. 5. Blood. — An instance is related by Dr. Doring in which a spoonful of coagulated blood was found in the stomach of a new- born child. The inner surfaces of the gullet and windpipe were also covered with blood. Dr. Doring inferred from these facts that the child had been born alive ; for the blood, in his opinion, could have entei-ed the stomach only hy swallowing, after the birth of the child, and while it was probably lying with its face in a pool of blood. Taken alone, however, such an inference would not be justifiable from the facts as stated. Blood might be accidentally drawn into the throat from the discharges of the mother during the passage of the child's head through the outlet, and yet the child may not have been born alive. The power of swallowing may be exerted by the child during birth, either before or after the act of breathing. This power appears to be exerted even by the foetus in utero. Blood may be recognized in the contents of the stomach not only by the color which it imparts to the mucous liquids present, but by the aid of the microscope. This subject has been already fully considered in another part of this work (p. 303). Dr. Eobinson has made some researches on the contents of the foetal stomach during uterine life. He finds that the substances which naturally exist in the stomach of a fcetus before birth are of an albuminous and mucous nature. His observations were made on the stomachs of two human foetuses, and on those of the calf, lamb and rabbit. The conclusions at which he arrived were : 1. That the stomach of the foetus, during the latter period of its ute- 586 THE MECONIUM. rine existence, invariably contains a peculiar substance differing from the uterine liquid (liquor amnii), and generally of a nutri- tious (?) nature. 2. That in physical and chemical properties, this substance varies in different animals', being in no two species pre- cisely similar. 3. That in each foetal animal the contents of the stomach vary at different periods ; in the earlier stages of its de- velopment consisting chiefly of liquor amnii, to which the other peculiar matters are gradually added. 4. That the liquor amnii continues to be swallowed by the foetus up to the time of birth, and consequently after the formation of these matters and their appear- ance in the stomaGh. 5. That the mixture of this more solid and nutritious substance with the liquor amnii constitutes the material submitted to the process of chymification in the foetal intestines. He considers the contents of the alimentary canal to be chiefly derived from the salivary secretion, and that gastric juice is not secreted until after respiration has been established. The medical jurist will perceive, therefore, that the discovery of farinaceous food, milk, or sugar in the stomach will furnish evidence of birth, since substances of this kind are not found naturally in this organ. Dr. H. J. Grosse states that in the early stages of uterine life the alimentary canal contains merely a mucous liquid. At the third month, there is a more copious secretion — a clear non-albuminous acid liquid is found in the stomach, and a soft chymous liquid is present in the small intestines. Up to the fifth month, the small intestines contain meconium of a grayish color. After this period the meconium becomes gradually of a deeper color, and it passes into the large intestine. When the child has attained uterine ma- turity, the meconium in the jejunum is whitish ; in the ileum, yellow ; in the csecum, greenish-yellow ; in the ascending colon, green, with less yellow ; and in the rectum, green-black, like poppy- juice (hence the name from, from /kxi^v, " a poppy"). It is a mixture of the constituent parts of bile-colored granules, of epithelium from the mucous membrane lining the intestines, and of mucous matters probably derived from the destruction of the epithelial cells. Me- conium is generally discharged from the bowels of a child within forty-eight hours after birth, or at the latest on the third day. It then appears of the consistency of honey, of a very dark-green (almost black) color, with very little yellow coloring-matter in it. It has no disagreeable odor. Its specific gravity is 1.148. (" Des Taches au Point de vue M^dico-l^gale," 1863, p. 75.) 6. Meconium. — This name is applied to the excrementitious matter produced and retained in the intestines during foetal life. It may be found in the stomach of a new-born child, and a question will thence arise whether its presence there should be taken as a proof of entire live birth. It may be discharged from the child during delivery, in cases in which there is a difficult or protracted labor. In the act of breathing it may enter the throat with other discharges, and thus be found in the stomach. That a breathing child can thus swallow meconium cannot be disputed, but assuming that in the body of a child which has not lived to breathe this substance is THE MECOSriUM. 587 found in the air-passages and stomach, how is the conclusion af- fected ? In the following case, Dr. Fleisher was required to examine the body of a new-born child which was said to have been bom dead. He found meconium in the large intestines (the colon and rectum), and a greenish-yellow-colored liquid in the cavity of the stomach, in the larynx, windpipe, and gullet. In the air-passages it was in well-marked quantity. The lungs contained no air, but possessed all the usual foetal characters. When cut into pieces and placed on water, all the pieces sank. It appeared that a woman was present at the birth, who observed that the child did not breathe, but was born dead. It was not bathed' or washed, and no air was blown into its lungs. Prom the general appearance and properties of the liquid found in the stomach and air-passages. Dr. Fleisher had no doubt that it was meconium from the intestines of the child. It could not have been swallowed after the child was born, but must have been accidentally drawn into its throat by efforts to breathe during birth. Some of the meconium had pro- bably been discharged from the bowels of the child during labor, and as the mouth passed over this liquid a portion was drawn into the throat by aspiration. When once there, the instinctive act of swallowing would immediately convey a portion of it into the stomach. As the facts connected with the birth were well known, this appears to be the only reasonable explanation. (See report of the case in Casper's " Vierteljahrschrift," 1863, vol. 1, p. 97 ; also for another case, " Med. Times and Gazette," August 3, 1861, p. 116.) The presence of fluids therefore — such as blood, meconium^ or the watery discharges attending delivery — in the stomach and air-pas- sages of a new-born child, does not prove live birth, but merely in- dicates the existence of some living actions in the child at or about the time of its birth. In a case which occurred to Dr. iiamsbotham, a woman was suddenly delivered of a child while sitting over a slop-pail of dirty water. On examining the body, it was obvious that it had not breathed. There was no air in the lungs, but a quantity of dirty water like that in the pail was found in the stomach. This could have entered the organ only by the act of swallowing, and in Dr. liamsbotham's opinion, the child had swal- lowed the liquid under some foetal attempt to breathe. The coroner who held the inquest directed the jury that the child was born dead ; hut most physiologists will consider that the power of swal- lowing cannot be exerted by a dead child ; and as its body must have been entirely delivered in order to have fallen into the liquid, there was proof that it had been born living, and that in this in- stance it had died after it was entirely born, by the prevention of the act of breathing. The meconium may he generally recognized by its dirty-green color and general appearance, as well as by the absence of any offen- sive odor, which it does not acquire until after the third or fourth day, when it becomes mixed with feculent matter. Its microsco- pical characters are represented in the annexed engraving (Fig. 64). In the air-passages it is sometimes associated with vernix caseosa, and hairs derived from the skin. (" Med. Times and Gazette," June 588 GENERAL CONCLUSIONS ON LIVE BIRTH. Microscopical appearances of Me- conium: — a crystals of cholester- ine ; h epithelial scales ; c masses of green coloring-matter of bile (biliverdin) ; d e granules. Magnified 450 diameters. Fig. 64. 1, 1861, p. 591, and Aug. 3, 1861, p. 117; see also "Ann. d'Hyg.," 1855, vol. 2, p. 445.) But little need be said on its chemical properties ; still, as the detection of stains of meconium on clothing may occasionally form a part of the medical evidence, a few observations are here required. The stains which it produces are of a brownish-green color, very difficult to remove by washing. They stiffen the stuff, and are usually slightly raised above the surface without always penetrating it. Meconium forms with water a greenish-colored , liquid, hav- ing an acid reaction; a boiling heat does not affect the solution. Nitric acid and sulphuric acid with sugar yield with it the green and red-colored compounds which they produce with bile. Cholesterine may be separated from it by hot ether. It may be remarked, in reference to stains produced by the faeces of a child which has survived birth, that until the fifth or sixth day, they retain a dark-green or greenish- yellow color. On the seventh day after birth, they generally ac- quire a bright-yellow color, like that of the yelk of an egg ; and this color, if the child is in health, they will retain during all the time that it is suckled. The slightest consideration will show that the various signs of live birth above described are weak, and of purely accidental occur- rence. If a child is destroyed either during birth, or within a few minutes afterwards, there will be no medical evidence to indicate the period at which its destruction took place ; the external aiid internal appearances presented by the body will be the same in the two cases. It is most probable that in the greater number of in- stances of child-murder, a child is actually destroyed either during birth, or immediately afterwards ; and, therefore, the characters above described can rarely be available in practice. If any excep- tion be made, it is with respect to the nature, situation, and extent of marks of violence ; but the presence of these depends on mere accident. Hence, then, we come to the conclusion that although medical evidence can generally show, from the state of the lungs, that a child has really lived, it can rarely be in a condition to prove, in a case of infanticide, that its life certainly continued after its birth. We could only venture upon this inference when the signs of breathing were full and complete, or when some article of food was found in the stomach. Conclusions. — The general conclusions which may be drawn from the fapts contained in this chapter, on the question whether a child has or has not been born alive, are as follows : — 1. That if the lungs be fully and perfectly distended with air by the act of breathing, this affords a strong presumption that the NATURAL CAUSES OF DEATH. 589 child has been born alive, since breathing during birth is in general only partial and imperfect. 2. That the presence of marks of severe violence on various parts of the body, if possessing vital characters, renders it probable that the child v?as born alive when the violence was inflicted. 3. That certain changes in the umbilical vessels, and the separa- tion (by a vital process) and the cicatrization of the umbilical cord, as well as a general peeling or scaling-oflF of the cuticle, indicate live birth. 4. That the absence of meconium from the intestines and of urine from the bladder, are not proofs that a child has been born alive, since these liquids may be discharged during the act of birth. 5. That the open or contracted state of the foramen oval or ductus arteriosus furnishes no evidence of a child having been born alive. These parts may become closed and contracted before birth, and there- fore be found closed in a child born dead ; or they may remain open after birth in a child born living, even subsequently to the establish- ment of respiration. 6. That the presence of farinaceous or other food in the stomach proves that a child has been entirely born alive. 7. That the presence of blood, meconium, vernix caseosa, or the discharges in the stomach and aii'-passages, does not prove that a child was born alive. 8. That irrespective of the above conclusions, there is no certain medical sign which indicates that a child that has died at or about the time of birth, has been born alive. CHAPTER LI. CAUSES OF DEATH IN NEW-BORN CHILDREN. — PROPORTION OF CHILDREN BORN DEAD. NATURAL CAUSES OF DEATH. — A PROTRACTED DELIVERY. DEBILITY. BLEEDING FROM LACERATION OF THE NAVEL STRING. COMPRESSION OF THE NAVEL-STRING. — MALFORMATION. — DESTRUCTION OF MONSTROUS BIRTHS. — DEATH FROM CONGENITAL DISEASE. Causes of death in new-born children. — The next important ques- tion in a case of infanticide, and that upon which a charge of murder essentially rests, is: What was the cause of death? 1. It is admitted that a child may die during birth or afterwards. 2. In either of these cases it may die from natural or violent causes. The violent causes may have originated in accident or in criminal design. The last condition only involves the corpus delicti of child-murder. If death has clearly proceeded from natural causes, it is of no im- portance to settle whether the cause operated during or after birth. All charge of criminality is thenceforth at an end. It is well known that of children born under ordinary circum- 590 NATURAL CAUSES OF DEATH. stances, a great number die from natural causes either during birth or soon afterwards ; and in every case of child-murder, death will be presumed to have arisen from some cause of this kind until the con- trary appears from the medical evidence. This throws the onus of proof entirely on the prosecution. Many children die before per- forming the act of respiration ; and thus a large number come into the world dead, or stillborn. The proportion of stillborn among legitimate children, as it is derived from statistical tables extending over a series of years, and embracing not fewer than eight millions of births, varies from one in eighteen to one in twenty of all births. (" Brit, and For. Med. Rev.," No. 7, p. 235.) In immature and ille- gitimate children, forming the greater number of those which give rise to charges of child-murder, the proportionate mortality is much greater; probably about one in eight or ten. Stillbirths are much more frequent in first than in after-pregnancies. These facts should be borne in mind, when we are estimating the probability of the cause of death being natural. Thus, children are much more fre- quently born dead among primiparous than among non-primiparous females. According to Dr. Lawrence's observations, the proportion of deaths is 1 to 11 of the primiparous and 1 to 31.2 among the non-primiparous. ("Edin. Med. Journ.," March, 1868, p. 815.) In most cases of child-murder, the woman is primiparous. .Should breathing be established by the protrusion of the child's head from the outlet, or during the birth of the body, the chances of death from natural causes are considerably diminished. ]!Tever- theless, as Dr. Hunter long ago suggested, a child may breathe and die. Thus, according to this author, "If the child makes but one gasp and instantly dies, the lungs will swim in water as readily as if it had breathed longer and had then been strangled." In general, it would require more than one gasp to cause the lungs to swim readily in water ; but waiving this point, the real question is : If the child breathed either dui'ing or after birth, what could have caused its death ? The number of gasps which a child may make, or which may be required for the lungs to swim in water, is of no moment ; the point to be considered is, whether its death was due to causes of an accidental or criminal nature. So again observes Dr. Hunter: "We frequently see children born, who, from circum- stances in their constitution, or in the nature of the labor, are but barely alive, and after breathing a minute or two, or an hour or two, die, in spite of all our attention. And why may not this misfortune happen to a woman who is brought to bed by herself ?" (Op. cit.) The substance of this remark is, that many children may die natu- rally after having been born alive ; and in Dr. Hunter's time, these cases were not perhaps sufficiently attended to. In the present day, however, the case is difterent ; a charge of child murder is seldom raised, except in those instances where there are the most obvious marks of severe and mortal injuries on the body of a child ; and un- less it be intended to defend and justify the practice of infanticide, it must be admitted that the discovery of violence of this kind on the body of a new-born infant renders a full inquiry into the cir- NATURAL CAUSES OF DEATH. 591 cumstances necessary. Among the natural causes of the death of a child may be enumerated the following : — 1. A protracted delivery. — The death of a child maj' proceed, in this case, from injury suffered by the head during the violent con- tractions of the uterus, or from an interruption to the circulation in the umbilical cord before respiration is established. A child, espe- cially if feeble and delicate, may die from exhaustion under these circumstances. This cause of death may be suspected when a sero- sanguinolent tumor (called cephalcematoma, or caput succedaneum) is found on the head of a child, and the head itself is deformed or elongated ; internally, by the congested state of the vessels of the brain. The existence of deformity in the pelvis of the woman might corroborate this view ; but in primiparous women (among whom charges of child-murder chiefly lie) with well-formed pelves, delivery ia frequently protracted. It is presumed that there are no marks of violence on the body of the child, excepting those which may have reasonably arisen from accident in attempts at self- delivery. 2. Debility.— A child may be born either prematurely, or at the full period, and not survive its birth, owing to a natural feebleness of system. This is observed among immature children ; and it is a condition especially dwelt on by Dr. Hunter. Such children may continue in existence for several hours, breathing feebly, and may then die from mere weakness. These cases may be recognized by the immature condition of the body, and the appearance of a general want of development. 3. Bleeding from laceration of the navel-string. — A child may die from loss of blood, owing to a premature separation of the placenta, or an accidental rupture of the navel-string. In the latter case, it it said the loss of blood is not likely to prove fatal if breathing has been established ; but an instance is reported in which a child died from bleeding even under these circumstances. (Henke's " Zeits- chrift," 1839, Erg. H., p. 200 ; also 1840, vol. 1, p. 347, and vol. 2, p. 105 ; "Ann. d'Hyg.," 1831, vol. 2, p. 128.) Bleeding from the cord has in some cases taken place at various periods after birth, and has led to the death of the child. (" Edin. Month. Journ.," July, 1847, p. 70.) Death from bleeding may be commonly recog- nized, by the blanched appearance of the body, and a want of blood in the internal organs; but there are several instances on record, in which the cord was ruptured close to the abdomen without causing the death of the child. Bleeding from the vessels of the navel- string may prove fatal several days after birth, even when a child has been properly attended to, and the navel-string has separated by the natural process. Mr. Willing has reported a case of this kind, in which, in spite of every application, the child died from loss of blood six days after the cord had separated. (" Med. Times and Gaz.," March 25, 1854, p. 287.) The impossibility of arresting the bleeding in this case appeared to depend upon a great deficiency of fibrin in the blood, and a consequent want of tendency to coag- ulation. 592 NATURAL CAUSES OF DEATH. 4. Compression of the navel-siring. — When a child. i8 born by the feet or buttocks, the cord may be so compressed under strong uterine contraction that the circulation between the mother and child will be arrested, and the latter will die. The same fatal compression may follow when, during delivery, the cord becomes twisted round the neck. A child has been known to die under these' circumstances before parturition, the cord having become twisted round its neck in the uterus. ("Med. Gaz.," Oct. 1840, p. 122; also vol. 19, pp. 232, 233.) On these occasions, the child is sometimes described to have died from strangulation, but it is evident that before the establishment of respiration, such a form of expi'ession is improper. There are few, or no appearances indicative of the cause of death. There may be lividity about the head and face, with a mark or furrow on the neck, and congestion of the brain internally ; it is, however, necessary to remember that the brain of a child is always more congested than that of an adult. 5. Malformation. Monstrosity. — There may be a deficiency, or de- fect of some vital organ which would at once account for a child dying either during delivery, or soon after its birth. Two cases are reported, in one of which the child died from an absolute defi- ciency of the gullet, the pharynx terminating in a cul-de-sac ; in the other, the duodenum was obliterated for more than an inch, and this malformation had occasioned the child's death. (" Med. Gaz.," vol. 26, p. 542.) In a third, recorded by Mr. Fairbairn, a child was suffocated by a retraction of the base of the tongue, owing to defect of the frsenum. (" North Journ. Med.," March, 1849, p. 278.) The non-establishment of respiration sometimes arises from the mouth and fauces of the child being filled with mucus. An en- larged thyroid gland has occasionally led to the death of a new-born child by suffocation. (" Edin. Month Journ.," July, 1847, p. 64.) The epiglottis is sometimes fixed over the glottis so as to prevent the entrance of air. In a case which occurred to Dr. Hicks, a child was saved by the introduction of a finger ; the air suddenly rushed in, and the child was enabled to breathe. But a child may be born in this state when no person is at hand to assist the woman ; in this case it will die ; and the lungs being found in the foetal or unex- panded condition, it will be pronounced still-born. Obstruction of the air-passages is a frequent cause of death among still-born chil- dren. The varieties of malformation are very numerous, but there can be no difiaculty in determining whether they are such as to account for death. Persons are not allowed to destroy monstrous births ; and the presence of any marks of violence in such cases should be regarded with suspicion. It is the more necessary to make this statement, as there is an idea among the vulgar that it is not illegal to destroy a monstrous birth. Mr. Poole, of Cirencester, communi- cated to me a case which occurred some years since in his practice. A lady was delivered of a most hideous dicephalous (two-headed) monster. In his absence, and at the earnest solicitations of the friends, the nurse destroyed it. The question was, was this woman NATURAL CAUSES OF DEATH. 593 guilty of murder? The only case in reference to this point which is recorded by medico-legal writers, is that of two women who were tried at the York Assizes in 1812, for drowning a child which was born with some malformation of the head, in consequence of which it was likely that it could not survive many hours. It did not ap- pear that there had been any malice or concealment on the part of the prisoners, who were not aware of the illegality of the act. (Paris and Fonblanque) (" Med. Jur.," vol. 1, p. 228.) The absence of malicious intention would probably lead to an acquittal on a charge of murder; but such an act would doubtless amount to man- slaughter; the degree of monstrosity or the viability of the oifspring cannot be received as an extenuating circumstance. As to the first, if a liberty of judging what was monstrous and what not, were conceded to any ignoi'ant nurse, children simply deformed might be put to death on this pretence ; as to the second, it is held in law that whoever accelerates death causes it ; hence, the fact that the offspring is not likely to live more than a few hours does not justify the act of one who prematurely destroys it. 6. Atelectasis. — This, as it has been elsewhere explained, implies simply an unexpanded state of the lungs. In some cases it is complete, in others, partial. (See ante, p. 565.) It can scarcely be regarded as a diseased condition, as the body of the child may be otherwise healthy ; the lungs themselves are in a normal state, and they can be easily expanded by the artificial introduction of air. That they are not so expanded during birth or afterwards may arise from feebleness in the child. 7. Congenital disease. — It has been elsewhere stated that a child may be born laboring under such a degree of congenital disease as to render it incapable of living. The discovery of any of the fcetal organs merely in a morbid condition amounts to nothing, unless the disease has advanced to a degree which would be sufficient to- account for death. There are, doubtless, many obscure affections,, particularly of the brain, which are liable to destroy the life of a child without leaving any well-marked changes in the dead body- According to Dr. Burgess, apoplexy and asphyxia are common causes of death among new-born children. (" Med. Graz.," vol. 26,. p. 492 ; Henke's " Zeitschrift der S. A.," 1843, p. 67.) Probably diseases of the lungs are of the greatest importance in a medico- legal point of view, because by directly affecting the organs of respiration, they render it impossible for a child to live, or to sur- vive its birth by a long period. These diseases in the foetal state are principally congestion, hepatization, tubercle, scirrhus, and oedema ; the existence of any of which it is not difficult to discover.. They render the structure of the lungs heavier than water, and, thus prevent the organs from acquiring that buoyancy which in their healthier state they are known to possess. It is not common to find the lungs diseased throughout ; a portion may be sufficiently healthy to allow of a partial performance of respiration. Conclusions. — The following conclusions may be drawn from the preceding remarks: — as 694 VIOLENT CAUSES OF DEATH. 1. That a large number of illegitimate children, especially when immature, are born dead from natural causes. 2. That a child may die from exhaustion as the result of a pro- tracted labor. 3. That if a child be prematurely born, or if it be small and weak even at the natural period, it may die from mere debility, or want of power in the constitution either to commence, or to con- tinue the act of respiration. 4. A child may die from loss of blood, owing to accidental rup- ture of the cord during delivery ; it may even die from this cause after it has breathed. 5. That fatal bleeding is more likely to occur when the cord has been cut close to the abdomen, than when it has been lacerated or cut at a distance from the navel. 6. That the division of the cord, whether by rupture or incision, without ligature, is by no means necessarily fatal to a healthy mature child. 7. That a child may die from accidental compression of the cord during delivery — the circulation .between the mother and child being thereby arrested before respiration had commenced. 8. That death may speedily follow birth from some malformation or defect, or defective condition of important organs. 9. That a child may die from congenital disease affecting the organs of respiration, or the air passages. CHAPTER LI I. VIOLENT CAUSES OE DEATH IN NEW-BORN CHILDREN. — SUFFOCATION. — DROWNING. — DEATH OF THE CHILD FROM COLD AND EXPOSURE. — STAR- VATION. — DEATH FROM IMMATURITY. — WOUNDS IN NEW-BORN CHIL- DREN. — FRACTURES OP THE SKULL, ACCIDENTAL AND CRIMINAL. — TWISTING OF THE NECK. VIOLENCE IN SELF-DELIVERY. POWER OF LOCOMOTION AND EXERTION IN FEMALES AFTER DELIVERY. Violent causes of death. — In this chapter we have to consider those modes of death which are totally independent of the ex- istence of congenital disease, or other natural causes. In most cases of alleged child-murder, the body of the child bears about it the marks of physical injury, such as those which are indicative of strangulation, wounds, burns, and fractures. The marks of violence may be such as to leave no doubt that they were wilfully inflicted. In order to render a person criminally responsible, it must be proved that the injuries were unlawfully inflicted on a living child, and that they were the cause of death. Assuming that the altera- tions in the law regarding the destruction of new-born children DEATH FROM SUFFOCATION. 595 will be carried out (p. 576), cases of child-murder will include all those in which it is proved that the violence was wilfully inflicted during or after birth, and that it was subsequently the cause of death. If the child has died after birth, from violence carelessly or ignorantly inflicted during birth or afterwards, this will consti- tute a case of manslaughter. A question of medical responsibility may be raised under these circumstances, as where a medical man is charged with having caused the death of a child by gross ignor- ance and carelessness in the delivery of a woman. The following instance is reported by Cbitty (" Med. Jur.," p. 416 ; also Arch- bold, p. 345): A man of the name of Senior, who, it appears, was an unlicensed medical practitioner, was tried for the manslaughter of an infant, by injuries inflicted on it at its birth. The prisoner practised midwifery, and was called" to attend the prosecutrix, who was taken in labor. The evidence showed that when the head of the child presented, the prisoner, by some mismanagement, frac- tured, and otherwise so injured the cranium, that the child died immediately after it was born. It was argued, in defence, that as the child was not born {in ventre sa mere) at the time the wounds and injuries were inflicted, the prisoner could not be guilty of manslaughter. The judge, however, held that as the child was born alive and had subsequently died from the violence, the case might be one of manslaughter. This opinion was afterwards con- firmed by the other judges, and the prisoner was convicted and sentenced to imprisonment. From the decision in this case, it will be seen that if the prisoner had eftectually destroyed the child before it was entirely born, he would not have been guilty of any crime. 1. Suffocation. — This is a common cause of death in new-born children. A wet cloth may be placed over the child's mouth, or thrust into this cavity, either during birth or afterwards, and before or after the performance of respiration. To the latter case only could the term sufiibcation be strictly applied. A child may be thus destroyed by being allowed to remain closely compressed under the bed-clothes after delivery, or by its head being thrust into straw, feathers, ashes, and similar substances. The appearances in the body are seldom sufficient to excite a suspicion of the cause of death, unless undue violence has been employed. There is com- monly merely lividity about the head and face, with slight conges- tion of the lungs. A careful examination of the mouth and throat should be made, as foreign substances are sometimes found in this situation, aftbrding circumstantial evidence of the mode in which the suffocation has taken place. Thus, wood, straw, feathers, dust, tow, or a hard plug of linen may be, and in some cases have been, found blocking up the mouth and throat, drawn into these parts by aspiration when the mouth of a child has been covered with such substances. If a child has lived sufficiently long to be fed, it may be accidentally suffocated by the entrance of portions of solid ^ food, such as the curd of milk, into the windpipe and air-passages. A new-born child may be suffocated by having its head held over 596 DEATH FROM SUFFOCATION. noxious vapors, such as the exhalations of a privy or of burning sulphur; and it is here necessary to remind a medical jurist that other highly poisonous vapors, e. g., chloroform, may be used by a criminal without leaving any traces upon the body — except, pos- sibly, for a short time, that M^hich may depend upon their peculiar odoi". There are but few of these cases of suffocation in which a positive medical opinion of the causes of death could be given, unless some circumstantial evidence were produced, and the witness were allowed to say whether the alleged facts were or were not sufficient to account for death. (" Annales d'Hyg.," 1832, vol. 1, p. 621.) On the other hand, if it be even clearly proved that death has been caused by suffocation, it must be remembered that a child may be accidentally suff"ocated, and the crime of murder falsely imputed. Dr. J. M. Duncan, quoting the observations of Dr. Buhl, states that obstruction of the air-passages by mucus and other matters, is a frequent cause of death in new-born children. Among twenty-seven children dying in labor or shortly after birth, eleven died from ob- struction of the air-passages with foreign matters. Eight were born dead, and of those which were alive at birth, none survived the first day. In ten of these cases, the obstruction was produced by a greenish-brown slimy mass (meconium and mucus) filling the larynx and windpipe. In two of the cases, in which the child died during delivery, air was found in the lungs, and in only one of these the air had been derived from the act of respiration during birth. (" Edin. Monthly Med. Journ.," April, 1863, p. 924 ; also " Med. Times and Gazette," August 3, 1861, p. 117.) In Dr. Hicks' case (p. 592) the base of the tongue in a new-born child was so drawn down by spasmodic action, as to close the glottis by pressing back- wards the epiglottis. The child was saved by simply raising the epiglottis, when air rushed in, and breathing was established ; but many children must be born under similar conditions when no as- sistance is at hand. Cases of this kind, however, rarely give rise to charges of child-murder, as no air is found in the lungs. A child might be killed during delivery by pressure applied to the chest ; this might be such as not to produce any marks of violence. If the child had not breathed, there would be nothing to indicate the mode of death ; if air had entered the lungs, then the usual ap- pearances would be found in these organs (p. 557). In dealing with a case of this kind, it should be remembered that a child with its head born, but detained in the outlet by the size of its shoulders, might die from pressure exerted on the chest by the vagina. It might have breathed, but be born dead with the marks of suffo- cation about it. There is another accidental cause of the death of a new-born child during delivery: the membranes or caul may be carried forward over the head and face, and the act of breathing thus mechanically prevented. If no assistance is at hand, the child, although born living, will die soon after birth in consequence of the prevention of respiration. If, when the dead body is found, the membranes are no longer there, the cause of the prevention of DEATH FROM SUFFOCATION. 597 respiration would not be apparent. The child, although born living, would probably be pronounced to have been born dead. (" Med. Times and Gaz.," January, 1863, p. 126.) The delivery of a child with a mask or caul around its head is not an unfrequent occur- rence. In June, 1862, Mr. Blenkinsop, of Warwick, communicated to me a case in which a mature and healthy child so born was allowed to perish by those who , had access to it. The caul was simply not removed, so that breathing could not be set up. The lungs contained no air. There was congestion of the brain and lividity of the body, but no mark of violence. There was some evidence that the child had been born living, and that the cause of death was the prevention of respiration by omission to do that which was necessary. As the medical evidence showed that the child had not breathed, the Coroner held that it had never had any (legal) existence, and that there was no ground for further investi- gation. Dr, Hunter, who was well aware of the risk to which a woman might be thus exposed, observes in relation to this state of things: — " When a woman is delivered by herself, a strong child may be born perfectly alive, and die in a very few minutes for want of breath, either by being on its face in a pool formed by the natural discharges, or upon wet clothes : or by the wet things over it col- lapsing and excluding air, or drawn close to its mouth and nose by the suction of breathing. An unhappy woman delivered by herself, distracted in her mind and exhausted in her body, will not have strength or recollection enough to fly instantly to the relief of her child." (Op. cit. p. 35.) It may be added that a primiparous woman may faint, or be wholly unconscious of her situation ; or, if conscious, she may be ignorant of the necessity of removing the child, and thus it may be suffocated without her having been intentionally accessory to its death. In such cases, however, there should be no marks of violence on the body, or if present, they should be of such a nature and in such a situation, as to be readily explicable on the supposition of an accidental origin. An infant is easily destroyed by suffocation. If the mouth and nostrils are kept covered for a few minutes, by the face being closely wrapped in clothes, asphyxia may come on without this being indi- cated by convulsions or any other marked symptoms (see p. 444). A suspicion of murder may arise in such cases ; but the absence of marks of violence, with an explanation of the circumstances will rarely allow the case to be carried beyond an inquest. Sometimes the body is found maltreated, with severe fractures or contusions on the skull, and marks of strangulation on the neck, concealed in a feather-bed or privy, or cut up and burnt. This kind of violence may properly excite a suspicion of murder, and lead to the belief that the allegation of death from accidental suffocation is a mere pretence. This, however, is purely a question for a jury, and not for a medical witness. Unless the case be of a glaring nature, the violence is considered to have been employed for the purpose rather of concealing the birth of a child than of destroying it. The appearances in the body in cases of death from suffocation 598 APPEAEANCEa IN DEATH FROM DROWNING. have been elsewhere described, in reference to adults (p. 440) ; they are similar in new-born children, provided respiration has been fully performed. M. Tardieu attaches great importance to the dis- covery of subpleural ecchymoses in the lungs of children ; he has also noticed small eft'usions of blood on the surface and in the sub- stance of the thym US-gland. ("Ann. d'Hyg.," 1855, vol. ii. p. 379.) If the lungs float on water, as the result of bi'eathing, then the ap- pearances described will be met with ; but it is worthy of remark that in three instances M. Tardieu met with similar appearances in children whose lungs had not received air, and sank when placed on water. They were children prematurely born, and under con- ditions which prevented full- vital development. One born in the Hospital of Ribois^re uttered several cries, but, in spite of this, the lungs contained no air. The subpleural ecchymoses met with in children under these circumstances, are ascribed by M. Tardieu to the efforts made to breathe after birth (loc. cit.). Partial emphy- sema of the lungs is occasionally observed. At page 444 ante some remarks have been made on the suffocation of new-born children, by thrusting foreign substances into the mouth. In May, 1872, Dr. Moon, of Lancaster, consulted me on the follow- ing case. A servant girl had given birth to a healthy child. This child was found alive about a quarter of an hour afterwards, in a privy, and it lived a few minutes after the discovery. Its jaw was broken, its cheek torn, and the mouth contained ashes, some of which were found in the back part of the throat. The body was blanched, and there had evidently been a great loss of blood from the wounds and the torn umbilical cord. There was no engorge- ment of the lungs, or any subpleural ecchymoses. The lining membrane of the trachea was stained with ashes, and a small cinder was found in the left branches. In this case there was no question respecting live birth, as the child was living when found, but what was the cause of death, and was this accidental or the result of violence wilfully applied after birth ? In the opinion of Dr. Moon the mouth of the child had been forcibly torn open and filled with ashes in order to suffocate it. These ashes must have been drawn by aspiration into the air- passages, and death was caused partly by suffocation and partly by hemorrhage from the wounds, the child's body being bloodless. The condition of the lungs was not inconsistent with death from suffocation. Eor some remarks on death from suffocation in child- murder, with reports of cases, see a paper by M. S^verin Causs^, "Ann. d'Hyg.," 1869, 2, 122, 443. 2. Drowning. — The fact of drowning cannot be verified by any appearances on the body of a child which has not breathed. Thus, if a woman caused herself to be delivered in a bath, and the child was forcibly retained under water (a case which is said to have oc- curred), it would of course die ; but no evidence of the mode of death would be found in the body. After respiration, the signs of drowning will be the same as those met with in the adult. (See p. 390.) The main question for a witness to decide will be, whether APPEARANCES IN DEATH FROM DROWNING. 599 the child was -put into the water living, or dead ? Infanticide by drowning is by no means common ; the child is generally suftbcated, strangled, or destroyed in other ways, and its body is then thrown into water in order to conceal the real manner of its death. The fact of the dead body of an infant being found in water must not allow a witness to be thrown off his guard ; although a verdict of " found drowned" is so commonly returned in these cases, the body should be carefully inspected in order to determine what was really the cause of death. All marks of violence on the bodies of children that have died by drowning should be such as to have resulted from accidental causes. The throat and air-passages should be par- ticularly examined. It is not necessary that the whole of the body of a child should be submerged, in order that it may be destroyed by drowning ; the mere immersion of the head in water, or the covering of the mouth by liquid, will suffice to produce the usual effects of asphyxia. The outlets of the ears and the air-passages should be examined for foreign substances which may be deposited in them. ]!f ew-born children may be drowned or suffocated by being thrown into mud, or into the soil of a privy. Sometimes the child is de- stroyed by other means, and its body is thus disposed of for the purpose of concealment. Should there be a large quantity of liquid present, the phenomena are those of drowning. The liquid portion of the soil abounding in sulphide of ammonium may then be found, if the child was thrown in living, in the air-passages, gullet or stomach. The mere discovery of soil in the mouth would not suffice to show that the child was living when immersed; but the presence of foreign substances, such as dirt, straw, or ashes, in the air-passages, gullet, and stomach, has usually been taken as a medical proof that the child was living when immersed in the dirt, etc., and that the substances had been drawn into the passages' by aspiration, or by the act of swallowing. On these occasions the defence may be: 1. That the child was born dead, and that the body was thrown in for concealment ; but the medical evidence may show that it had breathed, and had pro- bably been born living. 2. It may be alleged that the child breathed for a few moments after birth, had then died, and that the woman had attempted to conceal the dead body. A medical witness may be here asked, whether a woman could have had power to convey the body to the place — a point which must, as a general rule, be conceded. 3. It is most commonly urged, that the woman being compelled to go to the privy, was there delivered unconsciously or unexpectedly ; that her waters had broken in the watercloset, and that she had no idea of anything more having happened; or that the child had dropped from her, and was either suftbcated or prevented from breathing. (" Med. Times and G-azette," Dec. 21, 1861, p. 646.) All these circumstances may readily occur; but on the other hand, the explanation may be inconsistent with some of the medical facts. (See a case by M. Adelon, " Ann. d'Hyg.," 1855, vol 2, p. 453 ; also Casper's " Klinische Novellen," 1868, p. 585.) 600 APPEARANCES IN DEATH FROM DROWNING. Thus, the- head or the limbs of a child may be found to have been separated or divided by some cutting instrument, or a cord or other ligature may be found tightly bound round its neck, or there may be a tightly-fitting plug in the throat. Then, again, the body may be entire, but the umbilical cord may be cleanly cut. This would tend to set aside the explanation of the child having accidentally dropped from the female ; because in such an accident the cord should always be found ruptured. The practitioner should make a careful examination of the divided ends of the cord by the aid of a lens, or a rupture may be mistaken for a section with a sharp in- strument. Mr. Higginson, of Liverpool, has published a case of some interest in this point of view. The child fell from the mother, and the cord broke spontaneously. " The torn ends were," he states, " nearly as sharp-edged and flat as if cut." (" Med. Gaz.," vol. 48, p. 985.) This case goes to prove that a careless or hasty examina- tion of the ends of the cord may lead to a serious mistake. When the cord is lacerated, this will be, cceteris paribus, in favor of the woman's statement as to the mode in which her delivery oc-' curred. Drowning may be the I'esult of accident from sudden delivery. A woman in an advanced state of pregnancy, while sitting on a chamber-vessel was suddenly delivered. The child fell into the fluids in the vessel, and before assistance could be rendered, it was dead. "Whether, in any instance, the drowning of a child was accidental or criminal, must be a question for a jury to determine from all the facts laid before them. The situation in which the body of an infant is found may plainly contradict the supposition of accident. On the other hand, a child may be accidentally drowned by its mouth falling into a pool of the discharges during delivery, al- though this would be rather a case of suftbcation. The throat, windpipe, and stomach of the child should always be examined on these occasions, as mud, sticks, straw, weeds, or other substances may be found in these parts, indicating, according to circumstances, that the child had been put into the water living, and that it had been drowned in a particular pond or vessel. The following, which is reported by Dr. Tenneson, is of some interest in this respect. ("Ann. d'llyg.," 1872,1,438): In this case, a new-born child recovered after it had remained four hours in a drain-pipe connected with a cesspool which received the soil of privies. A girl was charged with attempting child-murder. It was proved that she had been recently delivered. She stated that she had been to the privy for a natural purpose, and was there suddenly delivered. A full-grown child was found in the large drain-pipe, between the privy and the cesspool. It was alive, and was restored by the warm bath and other means. On examining it, there were no marks of violence ; the cord had been ruptured as by a fall, while there was nothing to show an attempt at murder. The appearances presented by the body of the child were consis- tent with the woman's statements. The preservation of its life was remarkable. The first part of the drain-pipe was wide enough DEATH FROM COLD AND STARVATION. 601 to admit the body, which lodged at the lower part, near a bend. It was thus saved from falling into the cesspool. The drain-pipe contained air and no sewer gases — hence the child could breathe, and before removal it was heard to cry. M. Devergie suggested that its life had been saved owing to the noxious gases being kept down by the drying of the surface of the soil. 3. Gold. — A new-born child may be easily destroyed by simply exposing it uncovered, or but slightly covered, to a cold atmosphere. In a case of this kind there may be no marks of violence on the body, or these may be slight and evidently of accidental origin. In death from cold the only appearance occasionally met with has been congestion of the brain, with or without serious effusions in the ventricles. (See Cold, p. 483.) The evidence in these cases must be purely circumstantial. The medical witness may have to consider how far the situation in which the body was found, the kind of exposure, and the temperature of the air, would suffice to account for death from the alleged cause. There is no doubt that a new-born child is easily affected by a low temperature, and that warm clothing is required for the preservation of its life. An in- spection of the body should never be omitted on these occasions, because it might turn out that there was some latent cause of natu- ral death which would at once do away with the charge of murder. Admitting that the child died from cold, it becomes necessary to inquire whether it was exposed with a malicious intention that it should thus perish. Unless wilful malice be made out, the accused cannot be convicted of murder. In general, females do not expose their children for the purpose of destroying them, but for the pur- pose of abandoning them ; hence it is rare to hear of convictions for child-murder where cold was the cause of death, although some medical jurists have called this infanticide by omission, an offence which does not appear to be recognized by the English law. ■ 4. Starvation. — A new-born child kept long without food will die, and no evidence of the fact may be derivable from an exami- nation of the body. There may be no marks of violence exter- nally, nor any pathological changes internally, to account for death. This is a rare form of murder, except as it may be accidentally combined with exposure to cold. In order to convict the mother, it is necessary to show that the child was wilfully kept without food, with the criminal design of destroying it. Mere neglect or imprudence will not make the case infanticide. The only appear- ance likely to be found on an examination of the body would be complete emptiness of the alimentary canal. Without corrobora- tive circumstantial evidence, this would not suffice to establish the cause of death ; a medical witness could only form a probable con- iecture on the point. In a suspected case of this kind, the contents of the stomach should be tested for farinaceous and other kinds of food. 5. Immaturity in cases of Abortion. — From the case of Meg. v. West (Nottingham Lent Assizes, 1848), it would appear that if by the perpetration of abortion, or the criminal inducement of pre- 602 INFANTICIDE FROM WOUNDS. mature labor, a child be born living at so early a period of uterine life that it dies merely from immaturity, the person causing the abortion, or leading to a premature birth, may be tried on a charge of murder. A midwife was alleged to have perpetrated abortion on a female who was between the fifth and sixth month of preg- nancy. The child was born living, but died five hours after its birth. There was no violence ottered to it ; and its death appeared to be due entirely to its immaturity. The prisoner was acquitted, apparently on the ground that abortion might have arisen from other causes. Among those cases of violent death which leave on the body of the child certain marks or appearances indicative of the cause, may be mentioned wounds, strangulation, and poisoning. 6. Wounds. — Probably this is one of the most frequent causes of death in cases of child-murder. Wounds may, however, be found on the body of a child which has died from some other cause. The principal questions which a medical witness has to answer are: 1. Whether the wounds were inflicted on the body of the child before or after death. 2. Whether they were sufficient to account for death; and 3, whether they resulted from accident, or criminal de- sign. The child may have been destroyed by burning, and evidence must then be sought for by an examination of the state of the skin. All these questions have been fully considered in treating the subject of Wounds, and they therefore do not require any special notice in this place. Incised wounds found on the bodies of children may be referred to the use of a knife or scissors by the prisoner in attempting to sever the navel-string, and they may therefore be due to accident. This point should not be forgotten, for a wound even of a severe kind might be thus accidentally inflicted. In such cases we should always expect to find the navel-string cut, and not lacerated. The end of it may, for the purpose of examination, be stretched out on a piece of white card. This will in general suflice to show whether it has been cut or torn. Wounds, however slight, should not be overlooked : minute punctures or incisions externally may corre- spond to deep-seated injury of vital organs. The spinal marrow is said to have been wounded by needles or stilettoes introduced between the vertebrae, th« skin having been drawn down before the wound was inflicted, in order to give it a valvular character, and to render it apparently superficial. The brain is also said to have been wounded, by similar weapons, either through the nose or the thinner parts of the skull (the fontanelles). In some instances the body of a child is found cut to pieces, and the allegation in defence may be that the child was stillborn, and the body thus treated merely for the purpose of concealment. Dr. Toulraouche has reported a case of this kind, which was the subject of a trial in France in 1852. As the woman had not destroyed the lungs, experiments on these organs gave satisfactory results of per- fect respiration. The cavities of the heart and great vessels were empty ; the body was generally drained of blood, and the skin FRACTURES OF THE SKULL. 603 throughout very pale. This led to the inference that the mutila- tions must have been inflicted while the child was living ; and as all the parts were healthy and no natural cause of death apparent, Dr. Toulmouche ascribed the death of the child to the wounds. The woman was convicted, and condemned to twenty years' confine- ment in the galleys. ("Ann. d'Hyg., 1853, vol. 2, p. 200.) In this country she would probably have escaped under a verdict of "con- cealment of birth," and have been sentenced to a year's imprison- ment. Injuries to the head. — It has been elsewhere stated that, during a protracted delivery, there was formed on the head of a child a tumor containing either serum, blood, or a mixture of the two. If a woman has been secretly delivered, non-professional persons may ascribe a tumor of this kind to violence, whereas it may really have been produced by natural causes. The tumor is generally situated on one of the parietal bones, its situation depending on that part of the head which presents during delivery. After the discharge of the waters, the scalp is firmly compressed by the mouth of the uterus, and subsequently by the os externum. This pressure interferes with the circulation through the skin, and causes the compressed portion of the scalp to swell. In the simplest form of this tumor serum only is found in the swollen part ; occasionally this is mixed with blood, and ther^ are small ecchymoses of the scalp, as well as of the pericranium and skull, but there is generally no injury to the bones, nor is there any laceration of the skin externally. In other cases, blood is found eft'used in the tumor either under the scalp, the membrane covering the skull (pericranium), or within the skull itself. The term caput succedaneum is applied to a tumor which has this natural origin (p. 591.) The sanguineous, is more likely to be confounded with the effects of violence, than the serous tumor: but it may be identified by the scalp being always unin- jured, although it may present redness and lividity. Violence from blows or fal]s which would produce bloody effusions beneath the scalp, or within the skull, would in general be indicated by injury to the skin, or by fracture of the bones. The only injuries to the head which require to be specially con- sidered in relation to infanticide, are fractures of the skull ; and here the question to which we may chiefly confine our attention is, whether the fracture arose from accident or criminal violence. The rules for determining whether these injuries were inflicted during life or after death have been elsewhere considered. (See Wounds, p. 258). Although it has been a matter of frequent observation, that great violence may be done to the head of a child during parturition without necessarily giving rise to fracture, yet it is placed beyond all doubt, that such an injury may occur by the expulsive efforts of the uterus forcing the head of a child against the bones of the pelvis. Even the violent compression which the head sometimes experiences in passing the mouth of the* uterus, may suffice for the 604 FRACTURES FROM UTERINE ACTION. production of fracture. (See " Edin. Med. and Surg. Journ.," vol. 26, p. 75.) It was formerly supposed that fractures of the skull in new-born children were always indicative of criminal violence ; but cases which have occurred in obstetric practice have established the cer- tainty of their accidental occurrence. These accidental fractures, it is to be observed, are generally slight ; they commonly amount merely to fissures in the bones, beginning at the sutures, and ex- tending downwards for about an inch or less into the body of the bone. According to Dr. Weber, the frontal and parietal bones are the only bones liable to be fissured or fractured by the action of the uterus during delivery; and in the greater number of cases re- ported, the parietal bones only have presented marks of fracture. The possible occurrence of an injury of this kind, as the result of uterine action, has been strained in several cases of child-murder, to explain the origin of fractures which could not fairly or reasonably be assigned to such an accident. A case was tried at Glasgow, in April, 1852 (case of Ann Irwin), in which there was no doubt, from the state of the lungs, that the child had fully breathed, and there was violence to the head which satisfactorily accounted for its death. The whole of the right side of the head was deeply ecchy- mosed, and there was a large quantity of coagulated blood lying beneath the scalp. In the centre of the right parietal bone there was a fracture extending across the vertex for fully lour inches, and involving a part of the parietal bone on the opposite side ; it was in a continuous even line, not radiated and not depressed. The peri- cranium, bones, and soft parts in the track of the fracture were deeply ecchymosed, while on the surface of the brain, particularly on the right side, there was a copious effusion of clotted blood. It was impossible to refer severe injuries of this kind to the action of the uterus in delivery, or to violence applied after death. The prisoner alleged that the child was stillborn. (See " Edin. Monthly Journ.," June, 1852.) Accidental fractures and effusions of blood, which are caused by uterine action, may be in general recognized by their slight extent. In cases of murder by violence to the head, the injuries are com- monly much more severe : the bones are driven in, the brain pro- trudes, and the scalp is extensively lacerated. Such severe injuries as these cannot be ascribed to the actfion of the uterus in parturi- tion. Here, however, it may be fairly urged, that the woman was unexpectedly seized with labor, that the child was expelled sud- denly by the violent efforts of the uterus, and that the injuries might have arisen from its head coming in contact with some hard surface — as a floor or pavement. It must be admitted that a woman may be thus suddenly and unexpectedly delivered while in the erect posture, although this is not common among primiparous women ; and that injuries may be thus accidentally produced on the head of a child. A woman is often unable to distinguish the sense of fulness, pro- duced by the descent of a child, from the feeling which leads her feactue.es feom uteeine action. 605 to suppose that she is about to have an- evacuation: and thus it is dangerous, when a labor has advanced, to allow a woman to yield to this feeling, for there is nothing; more probable than that the child will be suddenly born. Mr. Rankin, of Carluke, has reported two cases of this description, where there could not be the slightest suspicion of criminality. In one, a primipara, the child was actu- ally born under these circumstances, but its life was fortunately saved ; had there been no other convenience than a privy it must have been inevitably lost. In the second, although a case of third pregnancy, the female was equally deceived by her sensations. .("Edin. Month. Jour.," Jan. 1846, p. 11.) It is true that this alleged mistaken sensation forms a frequent and specious defence on charges of child-murder ; but still a medical jurist is bound to admit, that an accident which occurs to women of the middle class, may also occur to the poor, without necessarily implying guilt. The following case shows that a fracture of the skull of a child may occur when a woman is delivered in the erect posture. In this instance there was merely the appearance of a bruise on the head, and the navel-string was ruptured (not cut) three inches from the navel. The child did not suffer from the fall, and continued well until six days after its birth, when it was seized with convul- sions and died. A fissure of about an inch and a half in length was found in thp upper part of the left parietal bone. A clot of blood was found in this situation between the dura mater and bone, and there was congestion of the vessels of the membranes ; with this exception there was no morbid appearance in the body. (" As sociation Journal," Oct. 14, 1853, p. 901.) Dr. Porter Smith, of Bath, communicated to me a case, which occurred in November, 1856, in which the facts were similar to those above related. In consequence of the concealment of the body, however, the mother was charged with murder. The right parietal bone was fractured, and there was effusion of blood internally, but there was no mark of external violence. The cord had been ruptured at a distance of two-and-a-half inches from the navel. The stomach of the child contained the usual albuminous and mucous matters of the foetal state, without any appearance of food. The lungs contained air, and were highly crepitant ; the foramen ovaie and the ductus arte- riosus were in their tbetal condition. The child had probably been drowned in the discharges from want of assistance at the time of birth. The woman, who admitted that the child fell from her suddenly, was acquitted. Dr. Olshauseu has published four cases of sudden delivery, in each of which the child dropped from the woman ; and in two of them there were fissures in the parietal bones. The children recovered from the effects of the accidents. (" Med. Times and Gazette," Sept. 1860 ; " Am. Jour. Med. Sci.," Jan. 1861, p. 279.) Other cases of rapid delivery in the erect pos- ture are reported in the "Lancet" (Jan. 5, 1861, p. 13). In these there was no injury to the child, although in one case, the delivery took place on the deck of a vessel. A medical witness would find no difficulty in determining the 606 FRACTURES OF THE BONES OF HEAD PROM FALLS. probability of this explanation of the accidental origin of such fractures, if he were made acquainted with all the facts connected with the delivery. But the acquisition of this knowledge must be accidental ; and it will in general be out of his power to obtain it. "When the fractures are accompanied by cuts, punctures, or lacera- tion of the scalp or face, although their production might be ac- counted for by an alleged fall during parturition, the cause of these wounds would still remain to be explained. In fractures of the bones of the head in new-born children, the presence of eflusions of blood on the outside of the skull, or on the membranes within, is one of the most common appearances. Etfu: sions of blood beneath the skin of the scalp are by no means uncom- mon in new-born children, and are not necessarily indicative of criminal violence. Each case, however, must be decided by the circumstances attending it. Eftiisions on the membranes and in the substance of the brain are generally the results of great violence to the head. Length of the umbilical cord. — It has been recommended on these occasions, that we should observe the length of one or both por- tions of the umbilical cord, and notice whether it is cut or lacerated, as these facts may, it is presumed, throw some light on the ques- tion. But a medical witness can seldom procure the entire cord for examination, although it will generally be in his power to as- certain whether it was cut or lacerated, by examining the portion which is attached to the body of the child. The cord varies in length — the average being from eighteen to twenty inches : but it has been met with so short as six inches (" Lancet," June 13, 1846, p. 660), and even five inches (" Lancet," July 11, 1846, p. 49). In a twin-case which occurred to Mr. Stedman, of Guildford, the cord was only four inches long. (" Lancet," Aug. 28, 1841.) On the other hand, in one instance, where it was found twice twisted round the child's neck, it was fifty-three inches long. Dr. Churchill found, out of 391 cases, that the shortest cord was twelve inches, and the longest fifty-four inches in length. In January, 1850, Dr. Tyler Smith presented to the "Westminster Medical Society a cord^ fifty- nine inches and a half in length. In a case reported by Mr. "Wood it was sixty-one inch^ long, and coiled twice round the abdomen of the child. (« Med. Gaz.," vol. 45, p. 263.) As the whole of the cord can rarely be obtained, it is unnecessary to discuss the ques- tion, whether it was long enough to admit of the falling of the child without rupture. It has been remarked that, when the cord is ruptured from accidental causes during delivery, the rupture takes place either near to the placental or the navel end, more com- monly within a few inches of the navel. In twenty-one of the cases observed by Klein, it was found to have been forcibly torn out of the abdomen ; but it may be torn or lacerated at any part of its length, although the rupture is commonly observed near to one extremity. Among the cases of sudden delivery reported by Dr. Olshausen, the cord was torn through at three inches from the navel in one, and no bleeding followed. In two, the cord was torn PHYSICAL POWERS OF RECENTLY DELIVERED WOMEN. 607 through its middle, and at first there was great hleeding ; in three other cases, it was torn close to the navel, and no bleeding had occurred. In four, the cord was torn at five or six inches from the navel, and there was no bleeding, although it remained untied for ten minutes. Tioisting of the neck. — -Children are sometimes destroyed in the act of birth by the neck being forcibly twisted, whereby a displacement of the cervical vertebrae, with injury to the spinal marrow, may occur, and destroy life. Such injuries are immediately discovered by an examination of the body. It should be remembered that the neck of a child is very short, and that it always possesses consider- able mobility. Violevce in self -delivery. — When the marks of violence found on the head, neck, or body of a child cannot be easily referred to ute- rine action, or to an accidental fall, it is common to ascribe them to the eftbrts made by a woman in her attempts to deliver herself — the destruction of the child being an accidental result of these efforts. A medical opinion in such cases must depend upon the nature, situation and extent of the. injuries ; and each case must be therefore decided by the circumstances attending it. A medical witness, however, should always be prepared to allow that a woman at the time of her delivery, owing to pain and anxiety may be de- prived of all judgment, and may destroy her offspring without being conscious of what she is doing. It is therefore a sound prin- ciple of law that mere appearances of violence on a child's body are not per se sufficient, unless there is some evidence to show that the violence was knowingly and intentionally inflicted or the appearances are of such a kind as of themselves to indicate inten- tional murder. (Alison.) But, judging from cases which have hitherto occurred, it would be difficult to suggest any appearances which would be considered by a jury to indicate murderous violence. Power of exertion in recently-delivered women. — On these occasions, a witness will often find himself questioned respecting the strength or capability for exertion evinced by the lower class of women shortly after child-birth. Dr. Alison remarks that many respecta- ble medical practitioners, judging only from what they have observed among the higher ranks, are liable to be led into an erro- neous opinion, which may afifect their evidence. He mentions a case, in which a woman accused of child-murder walked a distance of twenty-eight miles in a single day, with her child on her back, two or three days after her delivery. (Case of Anderson, Aberdeen Spring Circular, 1829.) Instances have even occurred in which women have walked six and eight miles, on the very day of their delivery, without sensible inconvenience. ("Criminal Law," p. 161.) In one case (Smith, Ayr Spring Circ. 1824), the woman was engaged in reaping — she retired to a little distance, effected her delivery by herself, and went on with her work for the remainder of the day, appearing only a little thinner and paler than usual. In Beg. v. Stowler (Wells Aut. Ass. 1865), two witnesses proved that the pri- 608 PHYSICAL POWERS OF RECENTLY DELIVERED WOMEN. soner, who was tried for the murder of her child, was at work with them in a field about 800 yards from a pond, in which the body was afterwards found. They left the pi'isoner weeding, returned in about an hour, and she Avas not then in the field. After a time she returned, sat on a bank, and then resumed her work. The witnesses noticed that on her return there was a great diiference in her appearance. In the short interval she had been delivered, had disposed of the body of the child, and resumed her work, as if nothing had happened. A firm resolution, with a desire to conceal her shame, may enable a woman, immediately after her delivery, to perform acts connected with the disposal of the body of her child which, from ordinary experience, might appear to be far beyond her strength. Conclusions. — The conclusions to be derived from the contents of this chapter are: — 1. That a new-born child may die from violent causes of an ac- cidental nature. 2. That some forms of violent death are not necessarily attended with external signs indicative of violence. 3. That a child may be accidentally sufibcated during delivery. 4. That the usual marks of death from suftbcation or drowning are riot apparent except in the bodies of children which have breathed. 5. That the state of the umbilical cord may often furnish impor- tant evidence. 6. That some females recently delivered may have strength to exert themselves and walk a great distance. 7. That a new-born child may speedily die from exposure to cold or from want of food. 8. That slight fractures of the bones of the cranium may arise from the action of the uterus on the head of the child during delivery. 9. That women may be unexpectedly delivered while in aw erect posture ; the umbilical cord is under these circumstances sometimes ruptured, and the child may sustain injury by the fall. 10. That the violence found on the body of a child may be some- times referred to attempts innocently made by a female to aid her delivery. DEATH OF THE CHILD FEOM STRANGULATION. 609 CHAPTER LIII. DEATH OF THE CHILD FROM STRANGULATION. — STRANGULATION BY THE NAVEL-STRING. — ACCIDENTAL MARKS RESEMBLING THOSE OF STRANGU- LATION. — CONSTRICTION BEFORE AND AFTER DEATH. — BEFORE AND AFTER BREATHING. — BEFORE AND AFTER THE SEVERANCE OF THE NAVEL-STRING. — EXAMINATION OF THE MOTHER. Among the forms of violent death vs^hich are generally attended with appearances indicative of criminal design are the following: — 7. Strangulation. — The destruction of a new-born child by stran- gulation is not an unfrequent form of child-murder ; and here a medical jurist has to encounter the difficulty that the strangulation may have been accidentally produced by the twisting of the umbili- cal cord round the neck, during delivery. We must not hastily con- clude, from the red and swollen appearance of the head and face of a child when found dead, that it has been destroyed by strangulation. There is no doubt that errors were formerly made with respect to this appearance ; for Dr. Hunter observes: "When a child's head or face looks swollen, and is very red or black, the vulgar, because hanged people look so, are apt to conclude that it must have been strangled. But those who are in the practice of midwifery know that there is nothing more common in natural births, and that the swelling and deep color go gradually oft" if the child lives but a few days. This appearauce is particularly observable in those cases where the navel-string happens to gird the child's neck, and where its head happens to be born some time before its body. " (Op. cit. p. 27.) Strangulation by the navel-string can of course refer to those eases only in which it becomes firmly twisted round the neck after the child has breathed. This is rather a rare occurrence, because under these circumstances death more commonly takes place by compres- sion of the cord, and by the consequent arrest of circulation before the act of breathing is performed. The only internal appearance met with in death from this cause is a congested state of the cere- bral vessels. The presence of ecchymosis on the scalp, as well as of lividity of the face, is very common in new-born children when the labor has been tedious and difficult ; and therefore, unless there were some distinct marks of pressure about the neck, with a pro- trusion of the tongue, such appearances would not justify any sus- picion of death from strangulation. It has been supposed, that the strangulation produced by the wilful application of any extraneous constricting force to the neck, would be known from the accidental strangulation caused- by the 610 STRANGULATION BY THE UMBILICAL CORD. cord, by the fact that in the former case there would be a livid or ecchymosed mark or depression on the neck, while in the latter, there would not. Severe violence to the neck of a new-born child may produce in the seat of constriction not only ecchymosis, but a laceration of the skin, muscles, and windpipe; but these appear- ances are not always present in homicidal strangulation. In April, 1861, Dr. Evans, of Sunderland, communicated to me the particu- lars of the case of a new-born child which had been destroyed by strangulation. G-reat violence had been used, but there was no trace of discoloration in the course of the ligature, or of ecchymosis in the tissues beneath. The muscles compressed were very dark in color. In most cases when a ligature is applied to the neck during life, the skin above and below it becomes much swollen, and pre- sents an cedematous character. This indicates an application of violence when there is still some vital power in the body of the child. The navel-string itself may be used as a means of constric- tion, and the mark or depression may sometimes present an appear- ance of ecchymosis. Among various cases which might be quoted in support of this statement, is the following, reported by Mr. Fos- ter. In April, 1846, -he was summoned to attend a lady in labor with her first child. The labor was of a lingering kind, owing to the size of the head ; and the child came into the world dead. The navel-string was found coiled thre4 times round the neck, passing under the right armpit ; and upon removing it three parallel dis- colored depressions were distinctly evident. These extended com- pletely round the neck, and corresponded to the course taken by the coils. The child appeared as if it had been strangled. (" Med. Gaz.," vol. 37, p. 485.) Had this child been born' secretly, this state of the neck might have created a strong suspicion of homi- cidal violence. Strangulation after birth could not, however, have been alleged, because there would have been no proof of respiration. When a blue mark is found on the neck of a child whose lungs re- tain their fcetal characters, it is fair to presume, cceteris paribus, that it has been accidentally occasioned by the twisting of the um- bilical cord during delivery. Mr. .Price has communicated to' the same journal the account of a case in which the cord, which was short, was so tightly twisted around the neck of a child, that he was compelled to divide it before delivery could be accomplished. There was in this instance a deep groove formed on the neck, con- veying the impression to himself and a medical friend that, in the absence of any knowledge of the facts, they would have been pre- pared to say that the child had been wilfully strangled by a rope. (" Med. Gaz.," vol. 38, p. 40.) A diagnosis might have been formed, as in the preceding case, by examining the state of the luugs. Dr. Mutter met with a case in which a child was born dead, and the cord was tightly twisted round its neck; when removed, the neck exhibited a livid circle of a finger's breadth, smooth and shining ; but on cutting into this mark, no ecchymosis was found. (" North. Journ. Med.," Jan. 1845, p. 190.) Dr. Williamson, of Leith, has directed attention to an important STRANGULATION BY THE UMBILICAL CORD. 611 fact connected with the state of the lungs in a new-born child, and the medical opinions which may be expressed from their condition as furnishing evidence of live birth. Referring to Mr. Price's case, in which the cord was tightly twisted round the neck of the child, he states that in similar cases which have occurred to himself, the child has breathed immediately on the birth of the head ; but, owing to the shortness of the cord, the child would have been stran- gled and born dead, unless he had divided it. Thus, then, a child might die apparently strangled, and not be born alive, although it might have so breathed during birth that the lungs would present all the characters of respiration. If the circumstances were not known, a medical man might be led to say that the child had been born alive, and had been destroyed by strangulation. (" Edin. Med. Journ.," Feb. 1858, p. 714.) The proof of respiration, as it has been elsewhere stated, is, however, not necessarily a proof of live birth. From these cases, it will be perceived that ecchymosis in the depression on the neck furnishes no distinction between constriction produced by criminal means, and that which may result accidentally from the navel-string. In the following case ("Ann. d'Hyg.," 1841, vol. 1, p. 127), a woman charged with the murder of her child by strangulation appears to have been unjustly condemned. The child had fully and perfectly breathed ; the lungs weighed one thousand grains ; and when divided, every portion floated on water, even after iirm compression. There was a circular depression on the neck, which was superficially ecchymosed in some parts. From an inves- tigation of the facts, this appeared to have been a case in which a mark on the neck was accidentally produced by the umbilical cord, during attempts at self-delivery on the part of the woman ; she was nevertheless convicted and condemned to a severe punish- ment, chiefly from the opinion expressed by two medical witnesses, that a soft and yieldmg substance like the umbilical cord could not produce a depression and ecchymosis on the neck of a child during birth. They attributed the mark to the wilful application of a liga- ture like a garter ; but the experiments of Dr. If^grier clearly show that the umbilical cord has su^cient strength to produce fatal con- striction. In the same volume of the " Annales d'Hygi^ne" (at p. 428), will be found the report of another case, suggesting many import- ant reflections in regard to the medical jurisprudence of infanticide. In this instance, the navel-string a,nd the membranes were actually used by the female as a means of strangulation ; the child had not breathed, but was thereby prevented from breathing. There was superficial ecchymosis on each side over the muscles of the neck. The defence was, that the child was born with the cord around its neck, and that it was from this circumstance accidentally strangled ; but the medical evidence tended to show that the cord had been violently stretched and employed as a means of strangulation. The child had not breathed, and the medical witnesses considered that it had been born dead, owing to the violence used by the woman. The cause of death here was certainly not strangulation. 612 DEATH FROM STRANGULATION". but arrested circulation. In the mean time, the case proves that ecchymosis (a blue mark) may be the result of violent constriction produced by the navel-string. A case occurred to Mr. M'Cann in September, 1838, in vfhich the navel-string, vrhich was of its full length, had been used as the means of strangulation. It was twisted once around the neck, passed under the left arm, over the shoulder, and around the neck again, forming a noose or knot, which, pressing upon the throat, must have caused strangulation, as the tongue was protruded, and there were other clear indica- tions of the child having been strangled. The hydrostatic test applied to the lungs proved that respiration had been performed. When the mark on the neck is deep, broad, much ecchymosed, and there is extravasation of blood beneath, with injury to the mus- cles or trachea, and ruffling or laceration of the skin, it is impossi- ble to attribute these appearances to accidental compression by the navel-string. The lividity produced by it in the cases hitherto observed has been only slight and partial, and unaccompanied by laceration of the skin, or injury to deep-seated parts. On the other hand, in homicidal strangulation, as much more violence is commonly used than is necessary for destroying life, we may expect to find great ecchymosis and extensive injury to the surrounding soft parts. On some occasions, all difficulty is removed by the discovery of a rope, tape, or ligature, tied tightly round the neck; or, if this be not found, the proofs of some ligature having been used will be discovered in the indentations or irregularly-ecchymosed spots left on the skin ; the depressed portions of skin being generally white, and the raised edges livid or (Edematous. It has been doubted whether a child can be born with the navel- string so tightly round the neck as to produce great depression of the skin and ecchymosis, i. e., to simulate homicidal strangulation, and at the same time perform the act of respiration fully and com- pletely. It is important, therefore, when this hypothesis is raised in order to account for a suspicious mark on the neck, to examine closely the state of the lungs. Unless the cord be designedly put round the neck of the child after th^ head has protruded, the eft'ect of the expulsive efforts of the uterus, when a coil has become acci- dentally twisted round the neck, would be to tighten the cord, com- press the vessels, and kill the child by arresting the maternal cir- culation, at the same time that this pressure would effectually pre- vent the act of breathing. Hence the lungs usually present the appearances met with in stillborn children generally ; but the case which occurred to Dr. Williamson (p. 611) shows that this state of things may sometimes occur, and that a child may breathe, and die, strangled by the umbilical cord before its body is entirely born. Medical witnesses, however, should not be too ready to accept such a suggestion ; a careful examination of the neck will show whether a ligature has or has not been wilfully applied after birth. In Reg. V. Bohinson (Lewes Summer Assizes, 1853), there was around the neck, the mark of a ligature which had been tied very tightly. The child had fully breathed, and according to the medical evi- ■DEATH FROM STRANGULATION. 613 dence it had died from strangulation, owing to an accidental twist- ing of the cord during delivery. In examining a suspicious mark on the neck of a new-born infant, it is proper to notice whether it does not, by its form or course, present some peculiar indentations which may reader it certain that a ligature has been wilfully employed after birth. When it is found that a child has fully breathed, the presence of a deeply-ecchymosed or an (Edematous mark on the neck with injury to the skin and muscles is, cceteris paribus, presumptive of homicidal strangulation. Death from acci- dental constriction of the cord during delivery should, as a general rule, leave the lungs in their foetal condition. Marks on the neck of a child may be accidentally produced by the navel-string without necessarily destroying the child's life. Two cases of this kind are reported by Professor Busch (" Brit. and For. Med. Rev.," vol. 10, p. 579) : and a child may be destroyed without ecchymosis being a necessary consequence of the con- striction produced by it. There is much less risk of strangulation from twisting of the cord during birth, than is commonly believed. Out of 190 cases. Dr. Churchill found the cord round the neck in fifty-two children, and the shortest cord so disposed was eighteen inches long ; Dr. ]!>I^^grier found it round the neck in twenty cases out of 166 natural labors. ("Ann. d'Hyg.," 1841, vol. 1, p. 137.) The appearances met with in the body in death from strangula- tion have been elsewhere fully considered (p. 422). The facts of a case communicated to me, in March, 1865, by Mr. Gann, of Dawlish, will, however, serve to show the appearances as they may present themselves in a new-born child. A maid-servant in a family was secretly delivered of a child. When the body was found, it was observed to be full-grown, and there was a piece of tape twice round the neck, which had been tied tightly in a bow. The tongue protruded between the lips ; two deep furrows were found round the neck after the removal of the tape ; there was great oedema with swelling of the skin between and above them, and the right hand was clenched. The lungs were of a light-red color; they filled the chest, were highly crepitant, and floated readily on water, even when divided into sixteen pieces, and these had been sub- mitted to strong pressure. They weighed, however, only 626 grains. The heart was healthy ; the right side contained some co- agula of blood — the left side was empty ; the foramen ovale was open. The scalp was much congested, the congestions almost amounting to small eft'usions of blood ; the pia mater was also con- gested. The inference drawn from these facts were, that the child had been born alive, and that it had died from strangulation. The lungs were as light as they usually are in the foetal state, showing that, although they had received air, the pulmonary circulation had not been perfectly established. Accidental marks resembling those of strangulation. — In the forepart of the neck of a child, a mark or depression is sometimes accident- ally produced by forcibly bending the head forward on the chest, especially when this has been done repeatedly and recently after 614 APPEARANCES RESEMBLING STRANGULATION. death, while the body is warm. It may occur, also, as an accident during labor. Such a mark must not be mistaken for the eifect of homicidal violence. It has been a question whether, independently of the constriction produced by the umbilical cord, the neck of the uterus might not cause, during its contractions, an ecchymosed mark on the neck. I am not aware that there is any case reported which bears out this view ; and it seems highl}'^ improbable that any such result should follow. The discoloration may be in detached spots or patches — situated in the fore part of the neck, and evidently not arising from the em- ployment of any ligature. These marks may depend on the forcible application of the fingers to the fore part of the neck of the child, and the indentations have been known to correspond — a fact which has at once led to a suspicion of the cause of pressure and the mode of death. At the same time it should be borne in mind that a superficial mottling of the skin occurs after death in new-born infants, in parts where moderate pressure only may have been acci- dentally produced. This would not be attended with ecchymosis, and its true nature would be at once determined by comparing the discolored spots with the surrounding skin. It may be alleged, in defence, that such marks might have been accidentally produced : 1. By the forcible pressure produced by the child's head durinir labor. 2. They will be more commonly referred to violent attempts made by a woman at self-delivery, during a paroxysm of pain. This expla- nation is admissible, so long as it is confined to injuries which, by any reasonable construction, might be caused during labor ; but supposing the marks to have been certainly produced after the com- plete birth of the body, it will not of course apply. Among marks simulating violence, which are sometimes found on the necks of new-born children, Mr. Harvey has pointed out one of a singular kind. In February, 1846, he was present at a deliv- ery in which a child was expelled rather suddenly ; and after mak- ing two or three convulsive gasps, it died. Whilst endeavoring to restore animation, he observed a bright red mark extending com- pletely across the upper and fore part of the neck, from one angle of the lower jaw to the other, as though it had been produced by strangulation with a cord, except that the mark was not continued round to the back of the neck. It was of a vivid red color, and not like a bruise or ecchymosis, but it had very much the appear- ance of a recent excoriation. It was most clearly defined in front, where it was about a quarter of an inch in breadth, and it became diffused at the sides. The face was not swollen, and there was no fulness of the veins. (" Med. Gaz.," vol. 39, p. 379.) A distinction in this instance might have been based upon the color of the mark, the uninjured state of the cuticle, and the absence of congestion of the face and venous system. Nevertheless, the fact is of some im- portance, and should be borne in mind during the examination of the body of a new-born child alleged to have been strangled. Another case, which was the subject of a coroner's inquest, was published by Mr. Eose in the same journal (vol. 37, p. 530), in which APPEARANCES RESEMBLING STRANGULATION. 615 red marks on each side of the nose of a new-born child were mis- taken for the effects of violence applied to the nostrils during a supposed attempt at suffocation. Mr. Rose examined them closely, and considered that they were nmvi (mother's marks), and had nothing to do with the death of the infant. A medical witness may be asked on these occasions, whether he will undertake to swear that the ligature or the fingers had been applied to the neck of the child before, or after its death, or before, or after it had breathed. It is proper to observe that, so far as external marks of strangulation are concerned, there is no difference in the appearances, whether the constriction takes place during life, or immediately after death while the body is warm. Casper's ex- periments render it highly probable, that when a constricting force is applied to the neck of a dead child, at any time within an hour after death, the marks cannot with certainty be distinguished by any appearance from those made on a living body. ("Wochen- schrift," Jan., 1837 ; see also p. 344, ante.) With regard to the second point, it may be stated, that whether the child has breathed or not, provided it be living, and the blood circulating, marks of violence on the neck will present precisely the same characters. In the absence of any visible discoloration of the skin, it may be a question whether this should be taken as evidence of the means of constriction not having been applied during life. What we are entitled to say from observed facts is, that eccliymosis from the ligature is not a necessary consequence of constriction either in a living or a recently dead child ; although we might expect that there would be few cases of deliberate child-murder in which when strangulation was resorted to, there would not be some ecchymosed mark or discoloration, chiefly from the presumption that great and unnecessary force is suddenly applied. Besides, it is not improbable that a slighter force would cause ecchymosis on the skin of a new- born infant, than would be required to produce such an appearance on that of an adult. Another question has been put, which the proposed change in the statute law will hereafter exclude — namely, whether a medical wit- ness will undertake to say that the constricting force had not been applied to the neck of the child until after its body had been en- tirely born. This, of course, must be a pure matter of speculation. The appearance caused by a ligature applied to the neck of a living child would not be different whether the child was partially, or entirely born. If the child has actually breathed, the appearances in the body would be the same, and there are no medical facts by which it could be determined whether the act of strangulation proved fatal during birth or afterwards. A medical witness has also had this question put to him : Whether the strangulation oc- curred before, or after the navel-string was severed. It would appear that the severance of the cord has been sometimes regarded in law as a test of an independent circulation being established in the child ; but this is obviously an error, depending on the want of proper information respecting the phenomena which accompany 616 DEATH FROM POISON. birth. Eespiration, and therefore an independent circulation, may take place before the cord is divided ; and its severance, which is never likely to occur until after entire birth, cannot consequently be considered as a boundary between a child which is really born alive, and one which is born dead. A premature severance might possibly endanger the life of a child, instead of giving it an inde- pendent existence. A healthy and vigorous child may continue to live and breathe independently of the mother, before the division of the cord, and the time at which the severance is made depends on mere accident. Hence, the marks of strangulation on the neck of a living and breathing child must be the same whether the cord has been divided, or not. The entire birth of the body is, however, now considered to be complete, although the navel-string has not been divided. 8. Poisoning. — This is placed among the possible means of perpe- trating child-murder, but we rarely hear of nevhborn children being thus destroyed. The earliest age at which I have known a trial to take place for the murder of a child by poison was two months. {JRex V. South, N"orf. Aut. Circ, 1834.) A quantity of arsenic was given to an infant, and it died in three hours and a quarter after the administration of the poison. At this age, the case. can scarcely be called one of infanticide, in a medico-legal signification, because all that it would be necessary to prove would be the cause of death ; the question of life or live birth would not require to be entered into. If, in a case of child-murder, death from poison should be suspected, it must be sought for in the usual way. Some cases have occurred, in which children have been wilfully destroyed a week or two after birth, by the administration of opium, or excessive doses of purgative medicine. M. S^verin Causs^ refers to cases of this kind which have occurred in France. A woman was sentenced to eight years' imprisonment for the crime of poisoning her new-born child with concentrated sulphuric acid. In another case, a woman was convicted of poison- ing her infant with phosphorus scraped from lucifer matches. ("Ann. d'Hyg.," 1869, 2, 124.) There would be no difficulty in proving the presence of the poison under these circumstances. In some instances, it has been found on the napkins used for the child. {Beg. V. North, Guildford Summer Ass. 1846.) In cases in which infants are destroyed by poison, there is gene- rally great difficulty in tracing the act of administration to the guilty person. The fluid food given to them renders the admixture of poison easy, and as many persons may have access to this food, it is often impossible to fix upon the criminal. In one instance which came to my knowledge, an illegitimate child had been placed out to nurse by its mother, a woman in good social position. It was noticed that after each visit paid by the mother the child was sick, and after repeated attacks of illness, the child died. On inspection, arsenic was found in the body, and this was beyond doubt the cause of death. There was no suspicion against the nurse ; but a strong suspicion fell on the mother, from the circumstances above men- EXAMINATION OF THE MOTHER. 617 tioned. There was evidence, however, that the child was not at any time fed by the mother when she visited it, and that the mother had no access to the child's food. No poison could be traced to her possession, and she was not seen by the nurse, who was present, to give anything to the infant. The only fact that transpired was that, at each visit, she took it in her arms and was observed to rub its gums with her fingers, and soon after her visits, sickness followed. There was reason to believe that she had concealed small quantities of arsenic under her finger-nails, and that she had administered the poison while rubbing the gums of the child ! Examination of the mother. — The duties of a medical practitioner, so far as they relate to the mother of the child, generally the accused part}', are slight. He may be required to prove, by an examination made under an order from proper authority, whether a woman has, or has not been recently delivered of a child, and to state the pro- bable period at which the delivery took place. (See Delivery, p. 507.) This examination may be necessary in order to connect her delivery with the period which may have elapsed since the birth and death of the child. Unless the examination of the woman be made within twelve or fifteen days, no satisfactory evidence can in general be obtained. It has happened, on more than one occasion, that medical men have assumed to themselves the right of enforcing an examination of a suspected woman, and, by threats or otherwise, have compelled her to undergo this. Such a course of conduct is in the highest degree indecent and improper ; if a woman willingly consents to an examination, or an order be obtained from a magis- trate or other official person, the case is different. In taking this authority upon himself, a medical man is forcibly compelling an accused party to produce positive proof of her guilt — a principle which is entirely opposed to the spirit and practice of English juris- prudence. The mischievous results of such officiousness on the part of a medical practitioner are well illustrated by the case of Weir and wife v. Hodgson (Liverpool "Winter Assizes, 1861). The dead body of a child had been found near the house of the plaintiff. The defendant, a surgeon, went with the inspector of police to see Mrs. Weir ; and having informed her that she was suspected of having had a child, told her that he had come to examine her by the authority of the law, and that she must submit. She refused at first, and proposed to send for a medical man whom she knew. In the end, the defendant examined her, and there was no ground for the charge. The jury returned a verdict of 200^. damages for the assault. The police can give no legal power to a medical man to make such an examination in a suspected case, and the ultimate consent of the woman, if extorted by threats or intimidation, will be no answer to a charge of assault. In August, 1871, a case occurred near Leominster, which has placed the question of medical responsiblity in cases of alleged in- fanticide in a painful light. A young lady, the sister of a clergy- man, committed suicide rather than submit to a physical examinai tion by two medical men, under the order of a coroner. The coroner fil8 DEATH FROM POISON. held an inquest on the body of a child, a case of alleged infanticide. A suspicion arose that this young lady had been recently delivered. Two medical gentlemen, armed with a written order from the coroner, went to the rectory where this young lady w^as residing, and requested an interview with her for the purpose of ascertaining whether she had recently had a child. She refused to see them, and su.bsequently destroyed herself. All the particulars of this tragedy have not been made known, but this attempt to examine this woman for the purpose of obtaining evidence against her on a charge of child-murder, appears to have had such an efl'ect on her mind as to lead to suicide. The fragmentary particulars of this sad case will be found in the " Lancet," for 1871, 2, 333-474, and 477. The medical gentlemen, in endeavoring to justify themselves for the part which they took in the matter, rely upon the written order of a coronei", but they have not published the order. The editor of the " Lancet," in commenting on this ease, says truly enough, that no coroner, even of " twenty-eight years' standing," can order the performance of an illegal act, and should he do so, refusal is clearly justifiable. Conclusions. — The following conclusions may be drawn from the preceding remarks :— 1. That congestion of the face and head in a new-born child is not a proof of death from strangulation. 2. That strangulation can take place only in children which have breathed. 3. That a child may be strangled during birth by the accidental twisting of the navel-string round its neck, 4. That the navel-string may produce a livid or ecchymosed de- pression on the neck, like any other ligature. 5. The marks on the neck, arising from accidental causes, may resemble those which arise from strangulation. 6. That the effect of constriction on the neck, either by the navel- string or any other ligature, is the same if the child be living, whether it has or has not breathed. 7. That the effect is the same whether the child has been partially, or entirely born. 8. That the effect of a ligature on the neck of a living child is the same, whether the navel-string has, or has not been severed. 9. That a new-born child may die from strangulation, without this fact being necessarily indicated by ecchyraosis on the neck. This depends on the nature of the ligature, and the amount of force used. BIRTH — INHERITANCE. 619 BIRTH. INHERITANCE. CHAPTEE LIY. EVIDENCE OF LIVE BIRTH IN CIVIL CASES. — LEGAL RIGHTS OF THE F(ETUS IN UTERO. DATE OF BIRTH. DIFFERENCES BETWEEN ENTIRE AND PAR- TIAL BIRTH. SIGNS OF LIVE BIRTH INDEPENDENT OF BREATHING OR CRYING. — VAGITUS UTERINUS. — TENANCY BY COURTESY. — CJJISARBAN EXTRACTION OF CHILDREN. — LEGAL BIRTH. — POST-MORTEM BIRTHS. — MONSTERS. — WHAT CONSTITUTES A MONSTER IN LAW. — DEPRIVATION OF LEGAL RIGHTS. — DOUBLE MONSTERS. — MINORITY AND MAJORITY. Live birth in civil cases. — The law of England has not defined the meaning of the term Birth, in reference to civil jurisprudence ; but if we are to be guided by the numerous decisions which have been made on trials for infanticide, it must be regarded as signifying " the entire delivery of the child," with or without its separation from the body of the mother. (See Infanticide ; see also Chitty, "Med. Journ.," 412.) So long as an infant remains in the uterus it is said in law to be "en ventre sa mh-e;" but it is legally supposed to be born for many purposes. (" Blackstone's Comm.," vol. 1, p. 130.) A child in the womb may have a legacy, or an estate made over to it ; it may have a guardian assigned to it ; but none of these conditions can take eftect unless the child is born alive. So the fcetus may be made an executor ; but it is very judiciously provided that an infant cannot act as such until it has attained the age of seventeen years. The Roman and English systems of law apply the same term {venter) to the unborn child ; when born dead it is called abortus, abortion ; when alive, partus, infans, infant. In 1871 the following case affecting the venter came before the Court of Admi- ralty. A ship was damaged, in collision with another, called the " Elentheria," and a man named Ncyes, one of the crew of the dam- aged ship, was killed. The widow claimed of the proprietors of the " Elentheria," damages in respect of a child with which she was then pregnant. Sir R. Phillimore held that the child was en- titled to recover for the loss sustained of its father, although the damages could not be assessed until the child was born. The maxim of English law derived from the Roman law is that a child " en ventre sa mire" is to be considered as actually born if any question arises for its benefit. This ruling was confirmed by Lord West- bury in Blasson v. Blasson, but this fiction is applicable only for 620 PARTIAL AND ENTIRE BIRTH. enabling such child to take a benefit to which it would have been entitled if actually born. In the case decided by Sir R. Phillimore the action of the Court was suspended until the child was born, as if stillborn there would be an end to any claim. (" Med. Times and Gaz.," 1871, p. 146.) Date of birth. — Medical evidence has occasionally been demanded in courts of law respecting the actual date of birth of individuals, in cases in which a period of a few days, hours, or even minutes was required to prove the attainment of majority, and therefore a legal responsibility for the performance of civil contracts into which the parties had entered, either knowingly or ignorantly, when minors. Some cases of this kind have been decided by the evi- dence of the accoucheur himself; others, when the accoucheur was dead, by the production of his case-books ; and it is worthy of no- tice that the strictness and punctuality of some medical practi- tioners, in making written memoranda of cases attended by them, have in more than one instance led to a satisfactory settlement of such suits, and the avoidance of costly litigation. The proof of the exact date of birth is also of considerable importance in certain cases of contested legitimacy. The most important medico-legal questions connected with this subject are those which arise in contested suits relative to succes- sion, or the inheritance of property. A child that is born alive, or has come entirely into the world in a living state, may by the Eng- lish law, inherit and transmit property to its heirs, even although its death has immediately, and perhaps from morbid causes neces- sarily, followed its birth. Should the child be born dead, whether it died in the womb, or during the act of birth, it does not acquire any civil rights ; for it is not regarded legally as a life in being, unless it manifests some sign of life after it is entirely born and separated from the mother. Some have considered that partial birth, provided a child is living, should suffice to confer the same rights on the offspring as the proof of entire birth. The following case has been adduced by Sir C. Locock in support of this view, although the question here was rather in reference to the actual date of birth, than to the acquisition of civil rights therefrom : the principle is, however, the same. On a Saturday evening a lady was taken in labor with her first child. The head and one arm were born two or three minutes before a neighboring clock struck twelve. There was a cessation of pain for several minutes, during which time the child cried and breathed freely. The rest of the body was not expelled until full five minutes after the same clock had struck twelve. "Was the child born on the Saturday, or on the Sunday? Certainly the birth was not completed until the Sunday ; the child was still partly within the body of the mother — the circulation was still kept up through the umbilical vessels ; " but," continues Sir C. Locock, "I gave my opinion that the child was born on the Saturday. I considered that the child had then commenced an independent existence. The foetal life had then to all intents and purposes ceased ; and breathing — a function incompatible with the PARTIAL AKD ENTIRE BIRTH. 621 condition of a fcetus — had commenced. The navel-string will, it is true, go on pulsating for many minutes after an infant has been brought completely into the world, crying and kicking, unless it be compressed artificially ; and yet no one will say that a child in such a case is not born until we choose to take the trouble to tie the navel-string. The child would not have been damaged if it had remained for hours or even days, with merely its head and arms extruded ; it could have been fed in this situation." ("Med. Gaz.," vol. l2, p. 636.) However reasonable, medically speaking, this view may appear, a medical jurist must shape his evidence ac- cording to what the Isjw, demands. It has been elsewhere stated (Infanticide), that our judges have distinctly laid down the law that no child can be considered to be legally born until the whole of its body has come entirely into the world. This is in relation to criminal jurisprudence, in which ease, if in any the rule should be relaxed, because its relaxation would tend to punish the wilful destruction of living infants partially born. This child could not, therefore, have been born on the Saturday, becaiise the law does not regard partial birth as an entire birth ; and respiration and birth are not synonymous terms. Supposing this child to have died before its body was entirely extruded, it could not be said, even medically, that it was born alive ; and certainly it could not be considered, according to the present state of the law, to have ac- quired the rights of a child born living. The reasonableness of the opinion that partial birth should suffice for all the legal purposes of entire birth is a distinct question, and one over which a medical witness has no sort of control. Whatever apparent injustice may be done by adhering to this rule in respect to the civil rights of persons, there is no doubt that the evil is really of great magnitude in relation to criminal jurisprudence ; for it would appear, from the present state of the criminal law, that the destruction of partially- born children, although alive and healthy, is not, legally -speaking, child-murder. On the other hand, some difficulty might arise in civil cases if the bare extrusion of a -part of the body sufficed for all the legal purposes of entire birth. It might become a casuistical question as to how much of a child's body should be in the world in order to constitute legal birth ; for there is no reason why, in a medical view, the extrusion of the head and shoulders should constitute birth any more than the extrusion of a hand or foot. Admitting, then, that a child must be entirely born in order that it should acquire civil rights, it will next be necessary to examine the medical proofs required to show that it has been born alive. The question here is different from that of live birth in reference to child-murder. "We must presume that a medical man is present at a delivery in which a child is born in a doubtful state, or where its death speedily follows its birth. The civil rights of a child and its heirs will depend upon the careful observation, made by him, of the circumstances attending the delivery. It is proper that he should note when the birth is completed, by the body of the child 622 SIGNS OF LIVE-BIRTH. being entirely out of the body of the mother. Children born at or about midnight are thus liable to have the date of birth wrongly registered; and the legal difference of twenty-four hours, which a few seconds or minutes may make, may hereafter affect their own rights if they survive, or those of others if they die. The birthday of the illustrious Duke of Wellington was entered in the parish register as the 30th of April, 1769, while there is abundant evidence for fixing it on the 1st of May ; in fact, he was born just after twelve o'clock in the night between the 30th of April' and the Ist of May. ITothing can be more simple than for an accoucheur to fix the true date, not by the hour at which labor commences, but at the time at which it is completed. Signs of live birth independently of respiration, or crying. — The visi- ble respiration of a child after its birth, or as it may be manifested by its crying, is an undoubted sign ofiits having been born alive ; but as it has just been stated, a child may acquire its civil rights, although it may be neither seen to breathe, nor heard to cry. The pulsation of a child's heart, or even the spasmodic twitching of any of the muscles of the body, has been regarded as a sufficient proof of live birth. The latter sign has been judicially so pronounced — d fortiori, therefore, the motion of a limb will be considered sufficient legal evidence, in an English Court of law, of life after birth. It is to be observed that tlae length of time during M'hich these signs of life continue after a child is born is wholly immaterial : all that is required to be established is, that they were positively manifested. A child which survives entire birth for a single instant, acquires the same civil rights as if it had continued to live for a month or longer. These facts will be better understood from the following case {Fish v. Palmer), which is reported to have been tried in the Court of Exchequer in 1806. (" Beck's Med. Jur.," vol. 1, p. 354.) The wife of the plaintiff JFish was possessed of landed estate in her own right. She died in 1796, after having given birth to a child which was supposed at the time to have been born dead. In con- sequence of the plaintift''s not having had a living child (as it was assumed) during the marriage, the estate of the wife was claimed and taken by the defendant Palmer, her heir-at-law — the husband being obliged to surrender it under the circumstances. From infor- mation derived many years after the death of his wife, from some women who were present at the delivery, the plaintiff' was led to believe that the child had. not been born dead, and that the estate had therefore been surrendered to the plaintiff" under a mistake. An action was brought to decide this question in 1806, ten years after the death of the wife, and it lay with the plaintiff" to prove his allega- tion that the child had been born living. Dr. Lyon, the accoucheur, had died some time before the trial ; but it was proved that he had declared the child to have been living an hour before it was born, that he had directed a warm bath to be prepared, and when the child was born, gave it to .the nurse to place in the bath. The child neither cried, nor moved after its birth, nor did it mani- fest any sign of active existence ; but the two women who placed SIGNS OF LIVE-BIRTH. 623 the child in the bath swore that when it was immersed there appeared twice a twitching or tremulous motion of the lips. They informed the accoucheur of this, and he directed them to blow into its throat, but it did not show any further signs of life. The main question in the trial was whether this tremulous motion of the lips was a sufficient proof of the child haying been born alive. The obstetric experts who were summoned to give evidence on this occasion diftered in opinion. Drs. Babington and Haighton stated that had the child been born dead, or had the vital principle been extinct, there could have been no muscular movement in any part of its body; therefoi-e the child had, in their opinion, been born alive, and had manifested some evidence of life after its birth. Dr. Denman, who was called for the defendant, dissented from this view. He contended that from the evidence the child had not been born alive, and in explanation of this drew a distinction between uterine and extra-uterine life. He attributed the tremulous move- ments of the lips after birth to the remains of uterine life. The Jury, however, under the direction of the Court, did not adopt this view of the case. They pronounced by their verdict that the child had been born living, and the plaintiff thus recovered an estate of which he had been for ten years deprived. From the result of this case it would appear that the English law does not recognize any distinction between uterine and extra-uterin.e life, as drawn by Dr. Denman. The question is simply life or death — living or dead ? Dr. Denman did not assert that the child was born dead. On the contrary, he assigned the movements observed by the witnesses to the continuance of life — but of uterine life. The act of breathing is commonlj'- set down as the boundary ; but a child is not necessarily dead until it breathes, as the recovery of numerous children born with uterine life clearly proves. The fallacy of trusting to breathing as a criterion in the living or dead body is fully shown in the chapter on Infanticide. Breathing is justly regarded by the English law as only one sign of life ; and proof of the possession of active and vigorous life is not required. It can- not be admitted, physiologically, that any tremulous motion of the muscles can ever take place spontaneously in the body of a child really dead, and the spasmodic movement of the lip differs only in degree from the motion of a leg or arm, or of a rib by the inter- costal muscles. If a certain quantity or degree of life were required to be proved, instead of the bare fact of its actual presence or entire absence, the most subtle medical distinctions would be continually drawn. JSTon-professional persons might be easily deceived as to the act of breathing in these feeble subjects, and an examination of the dead body would not suffice to remove the doubt, since new- born infants may live for hours without any air being.found in the lungs ; but a person is not so likely to be deceived about the move- ment of an arm, a leg, or a lip. It has been objected to this view of the case that the movements described may be the mere remains of muscular irritability, and not a sign of actual life or the vital force ; but it seems to me that 624 SCOTCH LAW IN RELATION TO LIVE-BIRTH. this is practically an admission of the presence of life, or vital force under another name. Muscular irritability and spontaneous con- tractions are not manifested in bodies really dead, and their spon- taneous occurrence proves that some vital power must still remain in the body of a child. Some medical jurists have contended that there should be, in all cases, evidence not only of the breathing, but of the crying of a child, in order to justify a medical opinion that it was born alive ; but according to Blackstone (" Commentai-ies," vol. 2,ch. 8, p. 127), " Crying, indeed, is the strongest evidence, but it is not the only evidence;" and Coke says, "If it be born alive it is sufficient, though it be not heard to cry, for peradventure it may be born dumb;" he also describes ^'■motion, stirring, and the like," as proofs of a child having been born alive. So far the decision in Fish v. Palmer is borne out by good legal authority ; and we may consider that although the mere warmth of the body would not be evidence of live birth, yet the slightest trace of vital action, in its common and true physiological acceptation — such as crying, breathing, pul- sation, or motion — observed after entire birth and separation from . the mother, would be deemed, in English law, a sufficient proof of the child having come into the world alive. A late eminent Scotch judge informed me that in Scotland, the husband's right of courtesy, or life-rent in his wife's estate, depends upon there having been a child of the marriage born alive ; and for the proof of live birth it is required to be shown, not merely that it had breathed, but that the child had cried after it was born. Dr. Beck remarks that the Scotch law is more precise than the English, in thus demanding proof oi crying ; but it should be added that it is more unjust. The case of Dobie v. JRichardson (Court of Session, 1765) is sufficient to prove this. Dobie's wife brought orth a child about nine months after marriage which breathed, raised one eye-lid, and expired in convulsions about half an hour after its birth, but was not heard to cry. The mother died in child- bed, and the question was whether the jus mariti was not lost by the death of the wife within the year, without a child of the mar- riage which had been heard to cry. The decree made in the case was, that as the wife did not live a year and a day after her mar- riage, and as it was not proved that the child or foetus, of which she was delivered, was heard to cry, the husband was not entitled to any part of his deceased wife's effects (" Beck's Med. Jur.," 1 358). The learned judges in this case did not stultify themselves by affirming that the child in question was born dead. This is a physiological and not a legal point. A child which died in convul- sions half an hour after its birth could not be described as having been dead. The law of any country may assume its own standard of life at birth. The Scotch law thus assumes " audible crying," but it cannot alter the physiological fact that a child may be born living without crying. It is not merely a living but a "crying" child which conveys the right of courtesy to the husband across the PARTIAL AND ENTIRE BIRTH; 625 border. This will be further seen from the decision in the case of Blackie (Court of Session, 1833). There is some reason to believe that, in any future case, this will not be taken as a precedent. The attainment of greater knowledge on the nature and the proofs of life from the results of medical experience and observation, and the fact that these physiological questions have become more generally known and better understood, will probably lead to a different decision. That there should not be a power of proving life (when the death of a child takes place speedily after birth) except by direct evidence that the child had cried, is in truth a view of the matter wholly indefensible. From what will be hereafter stated ( Vagitus uterinus, infra) it will be seen that the crying child is not necessarily a sign of live birth, for it may cry during the act of birth, and die before its body is born ; while the fact that it breathes and moves after birth, although from accidental circumstances it may not cry, is unexceptionable evidence of its having been born alive. The case of Brock v. Kelly involved a claim by a widow to the estate of her husband, on the ground that a child born twenty years before had been born living, although it was at first supposed to have been stillborn. The case came before Yice-Chancellor Stuart in April 1861, and his decision confirmed the views here expressed. Dr. Freeman noticed at the birth of this child, and after separation from the mother, that there was a slight pulsation in the cord, showing a feeble but independent circulation. There was no other indication of breathing than an arched state of the chest. He had, it appears, made an entry in his diary of the birth being that of a live child, and believing it to be alive, he caused it to be placed in warm water to sustain its vitality ; he felt sure of its being alive for the reason above assigned. This statement was confirmed by the nurse, who had been heard to say that the child was born alive, but died the same day. This may be regarded as strong evidence that the child was really born with life, although: in a passive state of excitation. At the time when these observa- tions were made, namely, twenty years before, the legal question of live birth was not raised, and there could have been no conceivable^ motive for misstating the facts, or inventing a state of things to- ^suit a legal claim. Dr. Tyler Smith supported the opinion of Dr. Freeman in an affidavit, considering that the fact that pulsation was observed in the umbilical cord after delivery was a physiological proof that the' child in question was not born dead. On the other side, Drs. Lee and Ramsbotham gave their opinion that there was no proof in this case of breathing having taken place after birth, and that nothing less than breathing could- establish the fact of live birth L The child, therefore, in their judgment, was not born alive. In their judgments a child must breathe before it can be said to possess independent life. The Vice-Chanccllor decided the proof of breathing was not necessary, and held that there was sufficient legal evidence of life after birth in the pulsation observed by the 40 626 PARTIAL AND ENTIRE BIRTH. accoucheur. This decision is in accordance with law and common sense. Pulsations indicate an action of the heart, as much as motion of the chest indicates an action of the intercostal muscle. There is a difficulty in relying upon the suggested proof derivable from the pi-esence of air in the lungs. It is well known, and cases are described under the section of Infanticide, that a child may breathe and die before its body is born. Therefore, unless there are eye-witnesses to testify to the act of visible breathing, the test is not only valueless, but fallacious. It would mislead a court of law. On the other hand, children are born and live for many hours in a state of passive existence without visibly breathing, and after death no air is found in the lungs. These are the cases which would be truly pronounced stillborn by those who were not present at the birth, although the accoucheur and nurse may have distinctly seen movements of the arms, legs, or lips, or even a convulsed state of the body ! Many cases of this kind are described in the section on Infanticide; for such cases of life without respiration have been thought to form a serious obstacle to any inference from ex- periments on the lungs. The following case, in which all the facts were accurately ob- served in reference to the manifesfations of signs of life after birth, and the duration of life in a new-born child, clearly proves that the English Courts are correct in relying upon proofs of life, irrespective of breathing or crying. It shows, too, that the decision of Viee- Chancellor Stuart in the case of Brock v. Kelly was based on sound physiological reasons, and that any other decision would have been unjust. This case occurred to Dr. Scale, U.S. ("Amer. Journ. Med. Sci.," July 1870, p. 278.) He induced labor in a woman by ergot of rye, at about the seventh month of gestation. A large child was born after some difficulty, but it did not make the slightest effi)rt to breathe. There was distinct pulsation in the cord. "Was this child living or dead? As it had not breathed, according to some accoucheurs, it would be regarded as dead. The pulsation of the cord would be treated as of no importance, i. e., as giving no indication of life after birth. But this child was really born living, a fact proved by what followed. Flagellation and alternate sprink- ling with hot and cold water produced a violent spasmodic con- traction of the diaphragm, which caused the entire infra-mammary^ region to be very much depressed. There was no doubt that this was a case of atelectasis pulmonum, or inexpansibility of the lungs, a state which continued for Jive minutes after the birth of the child. The cord was now severed, and about half an ounce of blood was allowed to flow slowly from the foetal end. The tongue, which had fallen hack, was drawn forward. A sudden spirt of a drachm of blood flowed when the constriction was relieved, and the child began to breathe very feebly, and so continued to breathe at long intervals. The heart beat very feebly. The pupils were widely dilated, they did not respond to the influence of a bright light, and the child was suffering from all the symptoms of compression of PARTIAL AND ENTIRE BIRTH. 627 fhe brain. This condition lasted one hour, when the child ceased breathing. According to the evidence of Drs. Lee and E.amsbo.tham in the case of Brock v. Kelly (p. 625 ante) this child was born dead, and would have been so pronounced for the first five minutes after birth, the pulsation of the cord and the spasmodic movement of the dia- phragm being regarded by them onlj' as indications of uterine life. Yet it is clear that this child was born living — that it lived before the act of breathing, which after all was performed only in the most imperfect manner. To have pronounced it dead within the first five minutes of its birth, and living for an hour afterwards, would have been inconsistent ; yet if the slight indications pointed out were not signs of continued life these conclusions would neces- sarily be drawn, involving a reductio ad absurdum. The child would have had no power of inheriting or transmitting property for the first five minutes after its birth because it was dead, and would have acquired this power for the last fifty minutes because it was living ! According to the French law a child so living for five minutes, or an hour, after birth would be pronounced non-viable and incapable of acquiring or transmitting property. A health}' full-grown child recently born may make an attempt at inspiration, but the closure of the larynx from convulsions, or some irritant such as the vaginal discharges, meconium, etc., may impede the entry of air into the lungs. The chest in this case is arched, the head thrown back, and there is a convulsive rigidity of the muscular system ; the tongue is firmly retracted, especially at its base. Unless the finger of the accoucheur is passed quickly down to the base of the tongue, and the epiglottis raised by pressing it forwards, the child would never inspire, although it might have a perfect. capacity to breathe. Dr. Braxton Hicks met with a case of this kind ; the air entered the lungs immediately after the above operation, and the child breathed and lived. According to the theories propounded in reference to the cases of Fish v. Palmer- and Brock v. Kelly, this child would have been pronounced dead or stillborn up to the time at which the accoucheur removed the im- pediment to its breathing. It has been observed that a respiratory action ensues upon any stoppage of the placental supply to the child, and, moreover, that this may occur in the uterus as well as in the * vagina ; and it has been remarked that foreign substances, which had been drawn in under these circumstances, may be found in the bronchial tubes. If this be so, then the finding of the natural se- cretions in the bronchial tubes would not be an absolute proof of inspiration having been established ; it would merely show that there had been an action of the chest during birth similar to that of inspiration. Still this must be regarded as a living action, and therefore indicative of life in the child. There is no doubt that the best test to apply to such-cases for the determination of physiological life is auscultation. The beating of the heart, as determined by the ear or the stethoscope, applied even for five consecutive minutes, is an undoubted sign of life, in a phy- 628 PARTIAL AND ENTIRE BIRTH. Biological sense, whether the child breathes, cries, or moves. M. Bouchut noticed, on one occasion, that this kind of passive life continued iji an infant for twenty-three hours after its birth. Feeble but distinct pulsations were heard at long intervals, but there was no motion of the ribs. Attempts at resuscitation were made, but the motions of the heart became more and more feeble, until they entirely ceased. An examination showed that the lungs had not received air. As we take the cessation of the heart's action to be the only certain evidence of death, so the existence of pulsa- tion in the heart or arteries, when clearly perceived by the ear, stethoscope, or finger, is positive evidence of life in a physiological sense. Is this legal life ? Would the wilful destruction of such a child constitute murder ? "Would this proof of pulsation without muscular motion, breathing, crying, or any other sign of active life, confer tenancy by courtesy, or transfer an estate by inheritance or survivorship? M. Bouchut justly observes that apparent death succeeding to birth, and characterized by the presence of a beating of the heart and an absence of respiration, is only a diseased condi- tion of the new-born child (see " Atelectasis," Infanticide) ; and, whether it is cured of this or dies, it is living, although it has not breathed ; or, as a G-erman j urist remarks, " Scheintod ist Scheinleben." By taking away its right of succession, the law punishes the child and its heirs for a malady with which it is born (" Gaz. des H6p.," 1855, ISo. 124; and "Med. Times and Gaz.," August 19,1856). They who contend that crying or breathing alone should be taken as a sign of life after birth, would of course pronounce such a child to have been born dead,'eveii at the time that they might be listen- ing to the pulsations of its heart ! (Casper, " Klinische Novellen," 1863, p. 564.) Such pulsations would probably be referred by them to the remains of uterine life. « Vagitus uterinus. — Let us suppose that the evidence of a child having been born alive is stated to be that it was heard to cry — it may be a question for a medical, witness, in cross-examination, whether this is to be taken as an absolute proof of live birth. The answer must be in the negative, because a child may cry before its body is entirely born ; or there may have been what is called vagitus uterinus — a uterine cry after the rupture of the niembranes. (See Infanticide.) It is quite certain that a child may breathe with- out crying, but it cannot cry without breathing ; yet neither the crying nor the breathing is an absolute proof that the child was actually born alive. As in all cases of this description there must be eye-witnesses, either professional or not ; the evidence will not rest solely upon a mere medical possibility of the occurrence of such a cry before birth ; and proof will be required of the crying of the child after it was born. The determination of the momentary ex- istence of children after birth is of importance in a legal point of view, in reference to the following subject. PARTIAL AND ENTIRE BIRTH. 629 of Fish V. Palmer, p. 622, and Brock v. Kelly, p. 625.) If a married woman possessed of estate die, the estate passes from the husband to her heir-at-law, unless there has been a child born living of the marriage, in which case the husband acquires a life-interest in the property. The only defence of this singular custom is that it is of great antiquity. An unsuccessful attempt was made a few years since to substitute for it the reasonable provision that the marriage alone should entitle the husband to a right which he can now only acquire by the fulfilment of certain accidental conditions. Incura- ble sterility, a protracted labor, deformity in the pelvis of the wife, orthe necessary performance of craniotomy on a healthy well- formed child, may, under this custom, lead to an aversion of the inheri- tance. The tenancy, in contested cases, is generally established or disproved by medical evidence; and the following are the condi- tions which the law requires in order that the right should exist : — 1. The child must be born alive. — Cases have been already related, wherein the motion of a lip and a pulsation of the umbilical cord were held^to be sufficient proofs of live birth. Some physiologists have objected to these as inadequate proofs of life ; and if the ques- tion were one of physiology, and not of law, there might be some ground for the objection. In truth, however, the law does not require proof of active life in a child, but merely some evidence, however slight, that it has been born living ; and the amount of proof to satisfy the purposes of justice must of course rest with those who are expounders of the law. Rare as these cases are, one has been the subject of two trials {Llewellyn v. Gardiner and others, Stafford Lent Assizes, 1854 ; and Gardiner v. Llewellyn, Stafford Summer Assizes, 1856). This was an action of ejectment brought to try the plaintiff's right to a life-interest in the property of his deceased wife. The plaintiff claimed as tenant by the courtesy of England, and his right depended upon whether his deceased wife had had a child bore alive. According to the plaintiff's evidence, his wife had taken a long walk, she being at the time in about the seventh month of her pregnancy (S^ovember, 1851) ; and, having been taken ill during the night, she was suddenly delivered of a child, which lived for about a quarter of an hour. He stated that he heard the child cry. The plaintiff immediately fetched his sister, and returned with her to his wife in a few minutes, and she deposed that she heard the child cry twice. This evidence was relied upon as conclusive that the child had been born alive, although it appears on the same evidence to have died before anything could be done towards dressing it. The case for the defendants at the first trial was that the wife was a girl of delicate health and liable to epileptic fits ; that when little more than 16, she had been mai-- ried to the plaintiff" without the consent of her mother ; and evi- dence was given to show the improbability of the child having been born alive, there being reason to believe, from the conduct of the plaintiff" and other circumstances, that it never could have had more than a foetal existence. There had been no medical exami- nation ; the body was buried the same day, and, as in the case of 630 PARTIAL AND ENTIEE BIRTH. stillborn children, neither the birth nor the burial was registered. "Wightman, J., left it to the jury to say whether the positive evi- dence given by the plaintiff and his sister had been rebutted by the evidence given for the defendant, and the other circumstances of the case. The jury found a verdict in favor of the husband's claim. At the second trial, ordered by the Court of Chancery (Stafford Summer Assizes, 1866), the plaintiff" Llewellyn was made defendant ; and medical and other evidence was adduced to show that the child could not have reached an age at which it could either breathe or cry. The age was variously assigned at the fourth or fifth month of gestation. The body of the child was not seen by any medical man, and the non-professional witnesses who saw it differed entirely regarding its size and appearance; so that, in fact, the case rested mainly on the credibility of the statements of Llewellyn and his sister. There were no medical facts to guide the jury. The late Baron Alderson, in summing up, said the question simply was whether Eliza Bennett, afterwards Eliza Llewellyn, was delivered of a living child during the time she was a wife. If they had a doubt on the subject, and could not tell whether it was born alive or not, they must find a verdict for the plaintiff's (Gardi- ner) ; they could not find for the defendant Llewellyn unless they were satisfied that the child was in a state of life in the world, during the time the husband was married to the wife. The verdict of the jury was to the effect that they did not believe the child was born alive : it was, therefore, a reversal of the former verdict. It has been usually considered that the crying of a child, properly attested by disinterested witnesses, is sufficient evidence of live birth. This is, in fact, one of the tests given by Lord Coke. In the section on Infanticide, some cases are related in which new- born children survived birth several hours, but manifested no sign of active life either by crying, or in any other mode, and after death there was no air in the lungs. As in cases of infanticide, if the evidence of live birth rests entirely on an examination after death, the absence of air from the lungs will not necessarily show that a child has come into the world dead, nor will the presence of air in these organs prove that it has been born alive, because it may have breathed and died before birth. The child must be heard to cry, or be seen to breathe, or move after birth. The fact that the lungs are not distended with air, and that they immediately sink in water, either when entire or when divided into small pieces, is no proof that a child has not breathed and cried during birth and afterwards. (See cases by Dr. Vernon and Dr. Davies. Infanticide.) Although in Dr. Vernon's case the child had only reached the sixth month, it was strong enough to cry; and yet probably, had its history been unknown, some medical experts would have been prepared to swear, from an examination of the lungs, that it must have been boTn dead, and certainly could not have had the power of uttering a cry ! A child born at the fifth month has been known to cry (see Legitimacy) ; but the state of its lungs is not recorded. In the case of Gardiner v. Llewellyn, a medical witness who ap- PARTIAL AND ENTISE BIRTH. 631 peared for the plaintiff stated as his belief that a child born at the fifth month could not breathe, and if it could not breathe (so as to fill the lungs) it could not cry! This may have been consistent with his experience, but it is not consistent with facts observed by others. One of the greatest difficulties that lawyers have to con- tend with in getting at medical truth, is this strong disposition on . the part of witnesses to act upon a foregone conclusion, and to ' fix' all natural events by an exclusive reference to their individual experience. In Llewellyn's case, the only evidence of the child being born alive rested on the testimony of strongly-interested persons, Llewellyn and his sister. The alleged fact on which they based their case was that they had heard the child cry; but taking the other evidence in the case, the jury placed no confidence in their statement. It would be indeed most unsafe as a rule to receive evidence on points of this nature, i. e. of breathing, crying, or movements of the limbs of new-born children, except from medical men present at the time, or from persons not interested in the results of the case. In general, medical opinions have been received on these occasions. Jfothing would be more easy than to assert that a child at birth cried or moved, and it would be utterly impossible, from an inspection of the body, to disprove these statements. 2. The child must be born while the mother is living. Ccesarean ex- traction. — From this it appears that if a living child were removed from the outlet, or extracted from the uterus by the Csesarean ope- ration, after the death of the mother, the husband would not be entitled to enjoy his wife's estate, although the child might survive its removal or extraction, and succeed to the estate on attaining its majority. How such a case would be decided in the present day it is difficult to determine ; but one instance is quoted by most medico-legal writers from Lord Coke, in which, about three centu- ries ago, the decision went against the husband, in consequence of the child having been removed from the uterus by the Csesarean section after the death of the wife. In the case of Llewellyn {supra), the late Baron Alderson ruled that the husband could not take the estate unless the child was proved to have been born during the marriage, i. e, while the wife was living. Although there is no recent English case in which this question has arisen in reference to the performance of the Csesarean operation, a case which occurred in France in 1834 will show the points to which medical evidence must be directed on these occasions. In April, 1834, a woman named L'Hotellier, about eight months pregnant, was seized with convulsions and died. A quarter of an hour after her death. Dr. Cabaret extracted the child by the Csesarean operation. The ques- tion was, "Was this child a living or a dead child at the time of its removal ? Dr. Cabaret, the operator, deposed that he saw its chest and ribs move, that there was pulsation in the umbilical cord, and also at its base after it was cut off, and that on laying his hand on the region of the heart, he felt this organ beating. The body was placed in a warm bath, and immediately on immersion the right 632 PARTIAL AND ENTIRE BIRTH. hand was raised towards the head, and there was a slight respiration. After this the child was motionless. Dr. Cabaret considered that it had breathed, though feebly, and for the space of about five minutes. This testimony was confirmed by several women who were present at the delivery. On the other hand, a physician swore that the child must have been born dead, since he had been for eleven hours in attendance on the woman previous to her decease, and had felt no motion in the uterus. This witness, however, was not present at the operation for the removal of the child. Thirty-three days after the extraction of the child, the body was exhumed and examined. The lungs were compact, of a reddish-brown color, and the left was emphyse- matous. This portion of the lungs, cut into pieces, floated on water. There was meconium in the intestines, but the stomach and urinary bladder were empty. On this state of facts Velpeau gave his opinion that the child had been born alive ; but Oi'fila, Dubois, and Pelleton said that in their judgments it had not been born alive. Orfila assigned the condition of the lungs to putrefaction, and Dubois considered the pulsation in the cord to prove that extra-uterine life was not esta- blished ; in other words, that the child had not breathed. The Court submitted these conflicting opinions to three experts — Drs. Marjolin, Roux, and Marc. According to them, the movements of the arm observed by Dr. Cabaret was mechanical (not vital), owing to the stimulus of immersion acting on the remains of fcetal life. As to respiration, if a child breathed ever so feebly for five minutes, it is remarkable that it raised no cry, not even those feeble sounds produced when the air penetrates no further than the trachea. Finally, the pulsations of the cord cease as soon as respiration com- mences. The post-mortem inspection proved nothing in favor of the child having been born alive. The arched state of the chest and the condition of the lungs were due to putrefaction, and not to the act of breathing. From these considerations, and believing that all the indications might be referred to the remains of fcetal life, they gave it as their opinion that this child had not breathed, and consequently (?) had not lived. ("Ann. d'Hyg.," 1838, 1, 98 ; and Beck's " Med. Journ.," vol. 1. p. 360.) Upon the strict rules of English law such a case would not have given rise to any question in reference to the jus mariti. The proofs of life in the child were much stronger than in the case of ^ish V. Palmer (p. 622, ante.) The evidence of the physician and of the women present at the extraction of the child shows that there was a pulsation of the cord — a visible act of breathing, pulsation of the heart, and the spontaneous movement of an arm when the child was placed in a warm bath. The fact that another physician, who did not see the child extracted, had not perceived any movements in the uterus for some hours before, amounts to nothing. The suggestion of the experts that the movement of the arm was mechanical was an evasion of the true question. A really dead PAETIAL AND ENTIRE BIRTH. 633 body might be put into a warm bath without such a mechanical force being exerted. The stimulus of warm water has no effect on a dead body ; but it is quite consistent with the fact of this child being living, that when put into a warm bath, there was a move- ment of a limb and an act of respiration. But under any circumstances, unless the alleged facts were dis- proved by eye-witnesses, the theoretical opinions of experts should not be allowed to set aside the direct and independent evidence of the operating physician and of the other persons in attendance. Ac- cording to English law, this child would have been pronounced living. Even the referee-experts did not positively say that it was " born dead." They somewhat evasively say, " This child has not lived," implying by this that it has not breathed perfectly, and has not manifested what they call active extra-uterine life. Further, if it had lived, it was a viable child, i. e., there was nothing in its conformation to prevent it from continuing to live. The husband or representative of the deceased parturient woman may object to the performance of this operation, even although the child may be living in the womb, and there may be a reasonable hope, by an immediate operation, of extracting it living. The late Dr. Lever informed me that on two occasions, in 1858, the husbands thus refused to allow him to operate on the dead body of the wife. I apprehend that no medical man would proceed to operate by force, or against the will of the husband ; at the same time, in refusing his permission, the husband is not guilty of any legal offence. The practice on the Continent has been to undertake it while the woman was living, and the result has shown that, in a large number of cases, it may thus be performed successfully, both with regard to mother and child. Important legal consequences may hereafter ensue from a more general adoption of this practice in England in respect to deformed females. Thus, supposing in any case a child were removed alive while the mother was living, both of them dying shortly after- wards, Would the husband become a tenant by courtesy ? The law says that the child must be horn ; and some lawyers would find ground for arguing whether extraction by the Csesarean operation should be regarded as " legal birth." " lUud autem vald^ con- troversum est inter jurisconsultos, an is qui editus est, exsecto matris ventre, reputetur partus naturalis et legitimus et successi- onis capax." (Caranza.) According to Fonblanque, the question is settled in the affirmative — a child extracted is a child born. (" Med Journ.," vol. 1, p. 236.) Our ancient law authorities do not appear to have contemplated that such an operation would ever be undertaken on a living female. The words of Lord Coke, which are considered to express the state of the English law, are, " If a woman seised of lands in fee taketh husband, and by him is bigge with child, and in her travell dyeth, and the child is ripped out of her body alive, yet shall he not be tenant by the curtesie, because the child was not born during the marriage, nor in the life of the wife, but in the mean time her land descended." According to other 634 MONSTROSITT. authorities, the Csesarean operation does not divert the course of descent, or divest the hushand of the life-estate, provided the child be born alive, and the mother was living when the child was born. (" Obstetric Record," vol. 3, p. 6Q.) Birth and extraction by the Ceesarean operation are, therefore, treated as similar conditions. Medical jurists have differed respecting the period of gestation at which the^operation should be performed. This would, of course, depend on the earliest period at which a child might be born capa- ble of living. In reference to tenancy by courtesy, a child might be extracted alive as early as the fifth month, but it would not be likely to survive unless it was at or about the seventh month. When a woman dies undelivered, it is difficult to say for how long a period the child may survive in the uterus. It has been stated that a child might thus continue to live for many hours, but this is not borne out by any facts, and the physician who makes the suggestion says that no time should be lost in removing the fcetus. In the French case above quoted, p. 631, the child was removed alive a quarter of an hour after the death of the woman. Dr. Madge operated in a case of convulsions twenty minutes after the death of the woman, but the child was then dead. There were no signs of uterine action after the mother's death. ("Amer. Journ. Med. Sci.," July, 1872, p. 585.) Some have alleged, that unless the ope- ration is performed immediately after the death of the woman, the child would not be extracted living. The condition of the foetus in utero is, however, peculiar, and quite distinct from that of a child living by the act of respiration. It is possible, therefore, that there may be a limited survivorship, and that the operation may be performed so late as an hour after the death of the woman, with the possibility of extracting a living child. JBirth of the child after the death of the woman. — The post-mortem birth of a dead child can give rise to no question in connection with tenancy by courtesy. This part of the subject has been elsewhere further considered. (See under Delivery, ante p. 514.) But it may happen that the child is born after the death of the woman, and survives its birth, as in the following case. A woman died during labor. The accoucheur who was summoned found the head of the child presenting, but too high up in the pelvis to allow of the application of the forceps to aid delivery. He immediately introduced his hand into the uterus, and a quarter of an hour after the death of the mother, and twenty hours after the rupture of the membranes, he extracted a male infant in a state of apparent death. The child, which was well formed, was speedily resuscitated by the application of the ordinary means. (" Berlin Medicin. Zeit.," July, 1836.) Had this case occurred in England, it would probably have been decided, according to the old precedent, that the husband could not become a tenant by courtesy, because by the death of the mother the marriage was dissolved, and the land had descended befoi'e the child was born ! 3. The child must be born capable of inheriting. Monstrosity. — If the woman is delivered of a monster, which cannot inherit, the MONSTROSITY. 6?5 husband does not acquire a right of tenancy. The connection of teratology or monstrosity with medical jurisprudence has been most ably investigated by M. St.-Hilaire. Although legal questions con- nected with monstrous bii'ths do not often occur, yet it is proper that a medical witness should be acquainted with certain facts re- pecting them. The law of England has given no precise definition of what is intended by a monster. According to Lord Coke, it is a being " which hath not the shape of mankind ; such a being cannot be heir to or inherit land, although brought forth within marriage." A mere deformity in any part of the body, such as supernumerary fingers or toes, twisted or deformed limbs, will not constitute a monster in law% so far as the succession to property is considered, provided the being still have " human shape." Even a supernu- merary leg would not probably be allowed to avert an inheritance! Various classifications of monsters have been made, but these are of no assistance whatever to a medical jurist, because each case must be decided by the peculiarities attending it ; and his duty will not be to state the class and order of the monster, but simply in what respect it differs from a normal human being. In consequence of the want of a sufficient number of precedents on this subject, it is difficult to say what degree of monstrosity would be required in law in order to cut off the civil rights of a being. Monsters may be acephalous (headless), dicephalous (two heads with one body), or disomatous (two bodies with one head). Others again, like the Siamese twins, have two distinct bodies united by a broad band of skin. Would an acephalous monster be considered as devoid of human shape? Would a disomatous monster be allowed to inherit as one? — to marry as one? — or how would legal punishment be in- flicted in the event of one of the bodies infringing the laws? Such are the singular questions which have been propounded by medical casuists in relation to these beings ; and there is obviously ample room for the exercise of much legal ingenuity in respect to these questions. According to St.-Hilaire, the rule which has been fol- lowed in all countries respecting these monstrosities is to consider every monster, with two equally developed heads, whether it be disomatous or not, as two beings ; and every monster with a single head, under the same circumstances, as a single being. He ascribes the origin of this rule to the performance of the rite of baptism in all Christian countries upon each head, when the monster is dice- phalous. This view appears rational when we consider that with two heads there are two moral individualities ; while with a single head, there is one will and one moral individuality. But it is doubtful how far this doctrine would be accepted by jurists and legislators. The Siamese twins, Chang and Eng, may be regarded as forming the most remarkable duplex monster of modern times. They \Yer& born in 1811, and appeared first in England in 1830, and after- wards in 1869. They are united by a broad thick band, extending from the lower part of the chest-bone to the other (cartilage ensi- formis). The band is four inches in length, and seven inches in cir- 636 MINOETTT AND MAJORITY. cumference. The nerves and bloodvessels of each meet in the centre of it, but there is no direct blood-communication between the two. There are two distinct hearts, the pulses having been observed to differ in frequency and character. The respiration is wholly independent of each other. Their mental operations are entirely distitict, and they have been known to difler in opinion on the question of bathing, etc. In short, they are really two distinct men, with the misfortune of having this connecting band between them. Under the circumstances mentioned, it would have been impos- sible in relation to civil and criminal jurisprudence to make both responsible for the acts of one. Living for forty years in America, they exercised the rights of citizenship as independent persons, and had married two sisters, entering into the contract as separate beings. No charge of bigamy was raised against them for this double union. It is clear, from this independence of will and action, that one might kill a person under circumstances which would constitute murder or manslaughter, the other not being an assenting party, and endeavoring to prevent the perpetration of the crime. The application of the criminal law would, as in the Pari- sian case related by St.-Hilaire, become a subject of great difficulty. No punishment could be inflicted on the guilty without necessarily involving the innocent (undivided) moiety. Such cases of mon- strosity must be regarded as setting at defiance all the ordinary rules of law, whether civil, criminal, or canonical. Another duplex monster, Mellie and Christine, was exhibited in London in 1871. (See " Lancet," 1871, 1, 725.) Like the Siamese twins, they were two independent beings, females, united by a band extending from one OS coccygis to the other. They were in all respects independent in thought and action. Malpositions, transpositions, or defects of the internal organs of any of the cavities, do not form monstrous births within the mean- ing of the English law. The legal question relates only to external shape, not to internal conformation. It is proper to state that no person is justified in destroying a monster at birth. Minority and majority. — The word minor is synonymous with that of infant {infans) and is applied in law to any one under the age of twenty-one years. The age of a person may render him incompe- tent to the performance of civil duties. Minors are frequently called upon to act as witnesses in civil and crimi^nal cases. In rapes com- mitted upon children, it is especially important to notice whether the prosecutrix is or is not competent to give evidence. The law has fixed no age for testimonial competency, and I have never heard of the question being referred to a medical practitioner. The child is always orally examined by the court, and it is soon rendered ap- parent by the answers whether the witness possesses a proper knowl- edge of the nature and obligations of an oath. If not, his or her testimony is not received, or, in a case of rape, the trial is postponed, and the child is placed under instruction, to appear again at the following sessions or assizes. The competency of a child as a wit- MINORITY AND MAJORITY. 637 ness, therefore, does not depend on age, but upon its degree of un- derstanding. In respect to criminal responsibility as aftected by- age, it was held by Keating, J., in a recent case {Beg. v. Cowley, 1860), in which the prisoner, a boy aged eight years, was charged with felony, that up to seven years of age the law presumed that a child could not distinguish right from wrong, so as to be capable of crime ; and evidence was not admissible to prove that he pos- sessed that capacity. After the age of seven, and up to fourteen years, although the law presumed a child to be primd facie inca- pable of crime, this " presumption might be rebutted by evidence which showed that he had what was called a mischievous dis- cretion. [The maxim in this case is " malitia supplet cetatum." — P.] In the case referred to, there was no evidence of that sort, and therefore his lordship directed the jury to acquit the prisoner. In another case, tried before the same learned judge in May, 1863 ( Whitby V. Hodgson), an action for trespass and false imprisonment was brought against a man for giving into custody on a charge of stealing, a boy under six years of age. It appeared that the child had stolen some wood ; but it was held that at this age, and under seven years, a child was in point of law doli ineapax, hence the de- fendant was not justified in giving the boy into custody. The jury returned a verdict with damages against him. According to the principles of our law, a male at fourteen is con- sidered to be at years of discretion, and he then becomes responsible for his actions ; at twenty-one he attains majority, and is at his own disposal, and may alienate his lands, goods and chattels by deed or will. It is only when this age has been attained that an individual can be sworn to serve on a jury. The period at which a male is considered to have attained full age varies in different countries : thus, in the kingdom of ITaples it was formerly fixed at eighteen years ; in Holland at twenty-five ; but generally throughout the States of Europe the law prescribes twenty-one years, — the same as the common-law of England. A child under fourteen indicted for murder must be proved to have been conscious of the nature of the act. In the case of Reg. v. Vamplew (Lincoln Summer Assizes, 1862), a girl under fourteen years of age was convicted of destroying the life of a child by strychnia. It was shown that she was competent to understand the nature of the act. Under fourteen, a male infant is presumed to be incapable on the ground of incapacity, of committing a rape as a principal in the first degree, or even of committing an assault with intent to perpetrate this crime ; but if the boy have a mischievous discretion, he may be convicted as a principal in the second degree. The patient may be convicted of an unnatural crime, although the agent be under fourteen. A female under the age of ten years is presumed to be incapable of consenting to sexual intercourse. (" Taylor on Evidence," vol. 1, p. 117.) A person attains his legal majority, or is completely of age the first instant of the day before the twenty-first anniversary of his birth- day, although forty-seven hours and fifty-nine minutes short of the 638 MINORITY AND MAJOBITY. complete number of days counting by hours ; and this mode of cal- culating age and time is applicable to all other ages before and after twenty-one. This is on the principle that a part of a day is, in a legal point of view, equal to the whole of a day. A few minutes or hours may thus determine the attainment of majority, and with this, the responsibility of minors for civil contracts, or the validity of their wills. By 1 Vic. c. 26, no will made by any person under the age of twenty-one years shall be valid ; and as the day of a per- son's birth is included in the computation of his age, and there being in law no fraction of a day, a valid will may be made at any time on the day before that which is usually considered the twenty-first an- niversary of birth. [The law (in general) " does not recognize frac- tions of a day ;" that is, it does not consider the hour at which an event takes place, and looks upon it as the same thing whether a birth occurs upon the last or upon the first minute of the day. At the last moment, therefore, of the day preceding a person's twenty- first birthday, he actually completes his twenty-first year ; but upon the same principle, the law looking upon the day as a unit, regards the first moment of it as a completion of the year, just as much as the last moment ; and hence, though his birth may not have occurred until the last hour of the day on which he was born, the law re- gards him as of age on the first hour of the day preceding, or 48 hours earlier than in point of fact he completes his twenty-first year. — P.] There is another aspect in which this question of age may be viewed — namely, in reference to the responsibility of accused per- sons for debts, or alleged criminal acts. In Reg. v. Thornhill (Staf- ford, Lent Assizes, 1865), the prisoner was indicted for a misdemeanor' in carnally knowing and abusing one Mary Sambrook, being a girl above the age of 10 and under the age of 12 years. It appeared in evidence that the girl's birthday was on the fifth of December 1852, and the offence was alleged to have been committed on the 4th of December, 1864. The question then arose whether the girl was under the age of 12 years, so as to bring the offence within the statute. It was objected by the prisoner's counsel, that as on the 5th of December the girl would enter on her 13th year, she had therefore completed her 12th year on the 4th of December, and that the law did not recognize a fraction of a day in such a case, so that she was 12 years old as much on the first hour of that day as on the last — and his lordship (Pigott, B.) so held. The indictment con- tained counts alleging rape and assault, but, after the cross-exami- nation of the girl, his lordship stopped the case, and the prisoner was acquitted. It is obvious that this principle would equally apply to charges of felony for the carnal knowledge of children under 10 years of age, as well as to the misdemeanor of taking girls under the age of 16 years from the custody of their parents, or of stealing children under the age of 14 years from their parents or guardians. (24 and 25 Vict. c. 100, ss. 50, 51, 55, 66.) The proof of the exact date of birth sometimes rests with the medical man. PRESUMPTION OF LEGITIMACY. 639 The subject of -plural births has been regarded as appertaining to medical jurisprudence ; but I am not aware that there is any case on record in which the evidence of a medical man has been re- quired respecting it. It is a simple question of primogeniture, which has been generally settled by the aid of depositions or dedla- rations of old relations, or servants present at the birth. Of course, in the absence of eye-witnesses the question of priority of birth must be a matter of conjecture. It cannot be determined by the size or weight of the child, but it might be determined by the observation of certain marks or deformities in one, or more of the children. LEGITIMACY. CHAPTER LY. PRESUMPTION OP LEGITIMACY. — NATURAL PERIOD OF GESTATION. — DURA- TION OF PREGNANCY FROM ONE INTERCOURSE. — PREMATURE BIRTBS. — SHORT PERIODS OF GESTATION. VIABILITY. EARLIEST PERIOD AT WHICH A CHILD MAY BE BORN LIVING. — EVIDENCE PROM THE STATE OF THE CHILD. — PROTRACTED BIRTHS. — A PERIOD OF GESTATION NOT FIXED BY LAW. Legal 'presumption of legitimacy. — Every child born^ either in law- ful matrimony, or within a period after the death of the husband, in accordance with the natural duration of gestation, is considered by the English law to be the child of the husband, unless the con- trary be made clearly to appear by medical or moral evidence, or by both combined. [In a recent case in Pennsylvania, Dennison v. Page (5 Casey, 420), where a child was born three months after marriage, which the husband instantly disclaimed, and never, during his life, recognized, it was held, that where a child is born during wedlock, of which the mother was visibly pregnant at the marriage, it is presumed, Jwrjs et de jure, to be the offspring of the husband, and that its illegitimacy cannot be proved by the mother after the husband's death. But see the very able dissenting opinion of Lowrie, J., 1 Grant, 377. — P.] It is only in reference to medi- cal evidence that the subject of Legitimacy can here be considered ; but it is extremely rare to find a case of this kind determined by medical evidence alone. There are generally circumstances which show that a child whose legitimacy is disputed is the offspring of adultery, while the medical facts may be perfectly reconcilable with the supposition that the claimant is the child of the husband. These cases, therefore, have been repeatedly decided from moral 640 PRESUMPTION OF LEGITIMACY. evidence alone — the medical evidence respecting the period of ges- tation, or physical capacity in the parties leaving the matter in doubt. The present state of the English law on this subject ap- pears to be this: A child born during marriage is deemed illegiti- mate, when, by good medical or other evidence, it was proved that it was impossible for the husband to be the father — whether from his being under the age of puberty, from his laboring under physi- cal incapacity as a result of age or natural infirmity, or from the length of time which may have elapsed since he could have had intercourse, whether by reason of absence, or death. "When the question turns upon any of these conditions, medical science is re- quired for its solution, and on these occasions skilled experts are usually selected by the litigants. "With proof of non-access of the husband, or immorality on the part of the mother, so important on these occasions, a medical witness is not in the least concerned. In cases of contested legitimacy, the English law does not regard the d^te of conception, which cannot be fixed, but the date of birth, which can be fixed. Medical evidence may relate — 1st, to the actual length of the period of gestation; this may be in a given case so short or so long, as to render it medically impossible that the husband could be the father. 2dly, there may be physical in- capacity in the husband to procreate : he may be too old or too young — or he may labor under some physical defect rendering it impossible that he should be the father. 3dly, there may be ste- rility or incapacity in the wife, rendering it impossible that the child should be the offspring of a particular woman ; in other words, the claimant may be a supposititious child. In some instances, the law assumes without medical evidence that the offspring is illegitimate, as where the husband and wife have been legally divorced " a vinculo matrimonii." When children are born where the divorce is " a mensd et thoro," they are presumed to be illegitimate until the contrary appear. There is a peculiar difference in relation to legitimacy between the laws of England and Scotland. A chjld born of parents in Scotland before marriage, is rendered legitimate by their subse- quent marriage. In England the offspring is illegitimate, whether the parents marry or not after its birth. Children born after the death of the wife or husband. — It appears that a child born after the death of the wife, provided she has been lawfully married, is legitimate, although the marriage is dissolved by the death. This is not a mere hypothetical question. Two cases have already been quoted {ante, pp. 631-4), in which living children were born after the death of the women ; these facts are of special interest in relation to tenancy by courtesy. Whether the birth takes place by the aid of art through the outlet, or by even- tration, as in the Csesarean section, the husband, if the wife be at the time dead, cannot legally claim the estate ; but the child thus born out of marriage is legitimate, and if it live may, on attaining its majority, take the estate of which the mother was seised. (See ante, Ccesarean extraction, p. 631.) The fact that the English law NATUEAL PERIOD OF GESTATION. 6il disregards the time, place, or date of conception might therefore give rise to a singular question. A child may have been conceived beibre the marriage of the parents, and be brought into the world by the Csesarean operation after the death of the mother; hence it would neither be begotten nor born in wedlock ; and yet, accoi'ding to the principles of the English law, it would be the legitimate offspring of the marriage. It sometimes happens that a child is born after the death of the husband. Conception is assumed to have taken place during wed- lock ; and although the child is not born in wedlock, the presump- tion is in favor of ligitimacy, unless non-access or physical inca- pacity be distinctly proved. The legal questions which may arise under such circumstances are elsewhere considered. Natural period of gestation. Duration from one intercourse. — The first point to be considered is — -What is the natural period of ges- tation, and whether this is fixed or variable. According to the testimony of experienced accoucheurs, the average duration of ges- tation in the human female is comprised between the thirty-eighth arid fortieth weeks after conception. N"umerous facts show that the greater number of children are naturally born between these two periods. Out of 186 cases reported by Dr. Murphy, the greater number of deliveries took place on the 285th day (" Obstetric Re- ports," 1844); but his opinion is that 301 days may be taken as the average limit of gestation. (" Lancet," 'Eoy. 11, 1844, p. 284.) Dr. Blundell considered that the average period was 274 days ; Sir J. Simpson {Broriiwick v. Waters, Chester Lent Assizes, 1863, p. 825) 277 days, i. e. nine calendar months and a week ; and other accoucheurs of repute have fixed upon 280 days. Among 500 cases observed by the late Dr. Eeid, there were 283 in which the period of gestation was within 280 days, and 217 cases in which it went beyond this period. Dr. Duncan found, in a group of forty- six cases, that 275 days is the average interval between that which he terms " insemination " (intercourse) and parturition. The largest number of cases on any particular day was seven on the 274th day. (" Edin. Monthly Journal," 1854, vol. 9, p. 230.) The most common cause of this variation in time is, that the usual mode of calcula- tion, by reference to the suppression of the menstrual discharge, even in a healthy female, may lead to a possible error of two, three or even four weeks, since there is no sign whereby, in the majority of women, the actual time of conception can be determined. Some females have been able to determine, by peculiar sensations, the time at which they have conceived ; but as a general rule, this must be a matter of pure conjecture, when they are living in connubial intercourse. On the other hand, accidental and isolated cases have clearly proved that a great difference naturally exists among women with, respect to the period of gestation ; and it is probable that in no two is it necessarily the same. When there has been only one intercourse, the duration of pregnancy may be certainly calculated without reference to any changes in the female constitution : for 41 • 642 AVERAGE DURATION OF GESTATION. the date of conception, within certain limits to be presently men- tioned, would be fixed. Observations of this kind have shown that women have difiPered from each other; and in several instances the time has exceeded or fallen short of the period of forty weeks, which has been usually set down as the legal limit of natural gestation. In three cases of one intercourse known to the late Dr. Rigby, labor came on in 260, 264, and 276 days, making a differ- ence of sixteen days. (" Med. Times," March 14, 1(S46, p. 471.) In three other instances which were privately communicated to me by Dr. S. W. J. Merriman, labor commenced at 281, 283, and 286 days respectively after one intercourse ; and in a case which occurred to Dr. Eeid, the labor did not commence until after the lapse of 293 days from a single intercourse. (" Lancet," July 20, 1850, p. 79.) In another case accurately' observed, communicated to me in March, 1865, the gestation lasted 281 days. Menstruation had ceased on the 16th Sept., intercourse took jilace on the 20th, quickening occurred on the 23d Jamiary following, and a full- grown male child was born on the 28th June following. In two cases, for which I am indebted to the late Mr. Carrington, the females were delivered respectively in 249 and 260 days after a single intercourse. In a third, in which pregnancy was the result of a rape, there was an interval of 261 days between intercourse and delivery. Hence it will be perceived that in well-observed cases, where there could be no motive for misstatement, and in which the characters of the women, some of whom were married and had already borne children, were beyond the reach of suspicion, a diflference of not less than thirty-three days has been observed to occur — i. e., between the earliest case recorded by Dr. liigby, and the latest reported by Dr. lieid. This is wortliy of remark, because in one case {Luscombe v. Pettyjohn), it was held that 299 days, only six days longer than in Dr. Reicl's observation, was an impossible period for human gestation ! In addition to the above facts, show- ing the variability of the period after a single intercourse, the following may be cited. Dr. Macilwain, U. S., has reported a case of gestation, which he thinks nmst have extended to 296 or at least 293 days. ("Amer. Journ. Med. Sci." July, 1848.) I am indebted to my collea,gue. Dr. Oldham, for nine cases, which have fallen under his observation, in which the duration of pregnancy from a single intercourse was accurately observed : — Days. . 3ai . 283 . 384 . 285 It is to be observed of these cases that I^os. 4, 5, and 6 represent the periods of gestation in the same woman at diit'erent times. Dr. Lockwood has published the following as the result of his experi- ence. The actual duration of the term of gestation in the human subject, i. e., the interval between intercourse and delivery, was Case. Days. Case 1 . . 2GG 3 . . 268 7 3 . . 271 8 4 . . 280 9 5 . . 280 CAUSE OF THE VARIATIONfi. 643 ascertained by him in four cases : No. 1, aged 19, duration 272 days (first confinement) ; l^o. 2, aged 30 (first confinement), dura- tion 276 days ; ISTo. 3, aged 17, duration 270 days ; ISTo. 4, aged 44 (seventh confinement), duration 284 days, the child weighing four- teen pounds. (" Brit. Amer. Jour." i)ec. 1847, p. 214.) M. Devil- liers has also published the particulars of nine cases, in which the interval from a single intercourse -was accurately determined. Delivery took place at the following periods: 229, 246, 257, 267, 301, 276-281, 278-283, 270, and 266-272 days, making an extreme difterence of 49 days in the earliest and the latest periods between intercourse and delivery. (" Gaz. M<^d." Mars 4, 1848.) Out of thirty cases of single or well-defined coitus, collected by Ahlfeld, gestation varied from 233 days to one case of 313 days. The average of all was 269.17, which corresporids closely with the period obtained by other modes of observation. (" Amer. Jour. Med. Sei." Oct. 1870, p. 566.) Cause of the variations. — It appears probable from recent researches, that the duration of the pregnant state may be dependent on the relative excitability of the uterine system at the menstrual periods. Ifumerous facts tend to show that, notwithstanding the general suppression of the menses, there is great excitement of the uterine system at what would have been, in the unimpregnated state, the regular menstrual periods. There is also great reason to believe that abortion takes place more readily at these, than at other periods. Hence, some accoucheurs are inclined to consider that the duration of pregnancy is really a multiple of the menstrual period ; and that in the majority of women it will occur at what would have been the tenth menstrual period, or forty weeks from the date of intercourse and supposed conception (" Gaz. Mddicale, 4 D^eembre, 1847, p. 968) ; and, according to the degree of excite- ment of the uterine system, the child may be expelled at a period earlier, or a period later than that which is assigned as the more usual natural term. It has been supposed that cases of lengthened gestation were nothing more than instances of protracted parturition : the pains indicative of delivery commencing at the usual time, but continu- ing more or less at intervals over a much longer period than usual. In an instance mentioned by Dr. Jorg, a woman went her full time, but parturition lasted a fortnight longer, the symptoms appearing and then disappearing. Admitting that this occasionally happens, still it shows that gestation from a particular pregnancy may be protracted considerably beyond the ordinary period. There is no reason to believe that the sex of the child has any direct infiuence on the length of the pregnancy. It has been stated that gestation was longer with male than female children ; and evidence of this kind was actually tendered in the Gardner Peerage case. As an answer to this singular hypothesis, it may be ob- served that of Dr. Murphy's two protracted cases, the one was a female, and the other a male child. There is reason to believe that the date of conception after a single 644: DATE OF CONCEPTION. intercourse varies in different women, and in the same woman. It is customary for physiologists to date conception from intercourse : but the researches of Bischoff and Raciborski have shown that a variable interval may elapse, according to the situation of the ovum at the time. It has also been supposed that women conceive more readily at some periods than at others, and that intercourse had within eight to twelve days from the cessation of the menstrual discharge, is more favorable to conception than at any other period. Dr. Oldham met with a case in which impregnation took place twelve days after menstruation ; and he states that he has known it to occur at the respective times of ten days, twelve days, and even twenty-one days after the monthly period ; and he knows of no fact to disprove the opinion that the human female is suscepti- ble of impregnation at any time between her monthly periods. According to Dr. Duncan, a single insemination at any period of - the interval between two menstrual periods may result in fecunda- tion. (" Edin. Monthly Journal," 1854, vol. 9, p. 233.) The experience of Dr. Oldham is confirmed by that of the late Dr. Reid. This gentlenian admits that impregnation is more likely to occur immediately after the termination of a menstrual period than at any time during the interval. The next most likely period is immediately previous to the occurrence of menstruation, and the probability of conception becomes slighter as the time is more dis- tant from this epoch ; but there is no period in the menstrual inter- val at which impregnation may not occur. ("Lancet," Sept. 3, 1853.) According to Raciborski, from observations made in Paris on one hundred women, no more than six or seven had become impregnated at the mid-term from the menstrual periods. In several cases of single intercourse, the dates being certain, concep- tion took place twelve and fourteen days after menstruation. It may be therefore fairly taken as a fact, irrespective of any modern theories of ovulation, that a woman may conceive from intercourse had at the inter-menstrual period (mid-period), although, in a given number of instances, it is probable that the conceptions would be more numerous within six or seven days after the cessa- tion of the menses than at any other time. In these cases it is assumed that intercourse and conception are synchronous, but recent physiological researches have proved that the date of conception is not fixed by the date of intercourse. The time occupied by the descent of the ovum along the Fallopian tube varies, while the time required for the passage of the male fluid to meet the ovum is also subject to variation. The investigations of Bischoff and Valentin show that the spermatozoa may retain their movements, and probably their fecundating power, for so long a period as seven days within the body of a female. Fecundation cannot result unless the matured ovum meets these bodies in a living condition ; and conception may be regarded, in the language of Dr. Meigs, as the fixation of a fecundated ovum upon the living surface of the woman. Conception may, therefore take place either in a few hours, or, according to Valentin's observations, at so long a period PREMATURE BIRTHS. 645 as seven days, after intercourse. But they do not satisfactorily ex- plain such extreme differences as were observed in the cases of Dr. Rigby and Dr. Reid (thirty-three days), or in those of M. Devilliers (forty-nine days) — ante p. 643. We must therefore be prepared to admit, either that conception may in some cases be delayed for so long a period as from five to seven weeks after intercourse, or that there may be a dift'ereuce of from five to seven weeks in the dura- tion of pregnancy. "Whatever may be the explanation adopted, it is obvious that, in a medico-legal view, the only conclusion at which we can arrive is, that the period of gestation in woman is not, as it was formerly supposed to be, a fixed and invariable terra. Great mistakes have arisen in the calculation of the period by the use of the word " month" — some intending by this a lunar and others a calendar month. Nine lunar months would be equal to 252 days, while the average of nine calendar months would be 270 days — the latter period varying according to the particular months of the year over which the pregnancy might extend. To prevent mistakes, or that misunderstanding of evidence which has so frequently arisen, it would be advisable that medical witnesses should always express the period of gestation in weeks or days, concerning which there can be no misunderstanding : it would be also proper to adopt the plan of always commencing the calculation from the period of the last cessation of the menses, rather than from two weeks later. The latter rule is often followed, and this discrepancy is another cause of confusion. Premature births. Short periods of gestation. — From the preceding remarks, we may regard all births before the thirty-eighth week as premature, and all those which occur after the fortieth week as protracted cases ; and one great point for a medical witness to de- termine is, whether the external characters presented by a child correspond to those which it should present, supposing it to be legitimately born. When the birth is premature, this sort of cor- roborative evidence may be sometimes obtained ; because, assuming that there has been no access between the parties before marriage, children born at the fifth or sixth month after marriage cannot, if the offspring of the husband, present the characters of those born at the full period. It is not so with protracted births, for children are not more developed in protracted cases than they are in those which occur at the usual period. This would lead to the infer- ence that when a child has reached a certain stage of develop- ment it ceases to grow ; a view which is borne out by the observa- tions of Dr. Riitteh (Henke's " Zeitschrift," 1844, p. 247.) This gentleman observed that the size of a child did not increase in pro- portion to the length of gestation. In protracted human and ani- mal gestation, the offspring is not rennarkable for size and weight. Thus robust mothers have had small children, and small mothers strong, and sometimes unusually large children. Dr. Murphy states that he met with a fully-developed child which was born after a gestation of only 251 days. (" Lancet," Nov. 30, 1844, p. 284.) For 646 SHORT PERIODS OF GESTATION. an account of the characters presented by children at different uterine ages, see Infanticide (p. 550). Development of the child. — In judging from marks of development on the body of a child, as a test of uterine age, we must make full allowance for the exceptions to which they are liable. The nearer the supposed premature delivery approaches to the full period of gestation, the more difficult will be the formation of an opinion. Although the characters of a seven-months' child as a general rule, are usually well marked, and may be known by common observa- tion, it is not possible to distinguish with absolute certainty a child born at the eighth from one born at the ninth month. Burns ob- serves that gestation may be completed, and the child perfected to its natural size, a week or two sooner than the end of the ninth month ; and other accoucheurs corroborate this view. (Dr. Murphy, in " Lancet," 'Soy. 30, 1844, p. 284.) When, however, the facts are such that to be the offspring of the hiisband it must be a six-months' child, and it is born matui'e, there can be no reason to doubt that it is illegitimate. {Eager v. Grim- wood, Exchequer Sittings, Jan. 7, 1847.) But the fact that a child born at nine months is small and resembles in size and weight a seven or eight-months' child, cannot be taken as a medical proof of illegitimacy. Children born at the full period vary considerably in size and weight ; yet, although small, there is commonly about them an appearance of development, which is especially apparent in the features. If there be a general want of development in the body, and if certain foetal peculiarities remain ; as, for example, the mem- branse pupillares, or, in the male, the testes do not occupy the scro- tum ; these facts lead to a strong presumption that the child has not reached the full period. On the other hand, when a child is born with the full signs of maturity about it, at or under seven months from possible access of the husband, there is an equally strong presumption that it is illegitimate. The great progressive stage of development is considered to be during the last two months of gestation ; the changes which the foetus undergoes are greater and more marked at this than at any other time. The general opinion is that an eight-months' child is not with any certainty to be dis- tinguished from one born at the ninth month. If the body of a child is large and fully developed, it would be considered to have been born at the full period of gestation, and any opinion which had led to the supposition that it was a seven-months' child, would be attributed to some mistake in the calculation. Dr. Beck states it as barely possible that a child born at seven months may occasion- ally be of such a size as to be considered mature, yet he qualifies this statement by the remark, that the assertion is most frequently made by those whose character is in danger of being destroyed. The important medical question is, however, has a really seven- months' child ever been born so developed as to be mistaken by an experienced person for one that was mature ? He adduces no case of this kind in support of his opinion. There can be no doubt of the correctness of his statement that a mature child, born before seven EARLIEST VIABILITY OF CHILDREN. 647 full months after intercourse, ought to be considered illegitimate ; but it would be difficult to maintain this proposition consistently with the above admission, for there is no obvious reason why a child should not acquire premature development during the latter half of the sixth, as well as at the seventh month. Viability. — The fact that a child has had the strength to survive its birth for a certain period has been supposed to furnish addi- tional evidence of maturity; for it is well known that under a certain age children are not born living, or, if living, they speedily die. Therefore it has been argued, if a child born at the fifth or sixth month after the first cohabitation, be born living, or survive, this should, ipso facto, be taken as a proof of its illegitimacy. Ac- cording to the English law, it is not necessary that a child, when born, should be capable of living, or viable, in order that it should take its civil rights. Thus, it may be born at an early period of gestation: it may be immature, and not likely to survive: or, again, it may be born at the full period of gestation, but it may be ob- viously laboring under some defective organization, or some mortal disease, which must necessarily cause its death within a short time after its birth. Fortunately, these points are of no importance in relation to the right of inheritance ; an English medical jurist has only to prove that there was some well-marked physiological sign of life after birth — whether the child was mature or immature, diseased or healthy, is a matter which does not at all enter into the investigation. In this respect our law appears to be more simple and just than that which prevails in France. By Art. 725 of the Code Ifapol^on, no child that is born alive can inherit, unless it is born, as the law terms it, viable. The meaning of this word is not defined by the law itself, and there are probably no two law- yers or physicians in that country who place upon it the same interpretation. The French law seems to intend (Devergie, vol. 1, p. 700 ; Briand, p. 173) by viability in a new-born child, that it should have breathed and be capable of living out of the womb of its mother and independently of her ; also, that it should be capable of living for a longer or shorter period after its birth. It would be difficult for any system of jurisprudence to lay down a more vague or incorrect principle than this ; and medical witnesses may con- sider themselves fortunate that in this country they have not to take part in the unsatisfactory litigation to which such a principle must necessarily give rise. The question, therefore, to be considered is — What is the earliest period of uterine life at which a healthily-formed child can be born living, and with a capacity to live after its birth and to attain ma- turity? It is now universally admitted that children born at the seventh month of gestation are capable of living, although they are more delicate, and in general require greater care and attention to preserve them than children born at the ninth month ; the chances, are, however, very much against their surviving. It was the opinion of Dr. William Hunter, and it is one in which most modern authori- ties concur, that few children born before seven calendar months (or 648 EARLY VIABILITY. 210 days) are capable of living to manhood. They may be born alive at any period between the sixth and seventh months ; or even, in some instances, earlier than the sixth ; but this is rare, and, if born living, they commonly die soon after birth. There is one case on record, of a child having been born living so early as tliiQ fourth month of gestation (" Brit, and For. Med. Rev.," vol. 2, p. 236) ; and another in which a woman aborted at the fourth-and-a-half month of pregnancy. M. Maisonneuve saw the woman two hours after delivery : he then found the foetus in its membranes, and on laying these open, to his surprise it was still moving. He applied warmth, and succeeded in partially restoring it ; for in a few minutes the respiratory movements were performed with regularity, but in spite of the establishment of respiration, the child died about six hours after its birth. (" Journal de Mddecine," and Med. Gaz.," vol. 39, p. 97.). In, two instances of abortion about the fifth month, Dr. Davies, of Hertford, noticed that the fcetus showed signs of life after its birth, by moving its limbs (" Med. Gaz.," vol. 40, p. 1022) ; and the following case, in which a child born at thfe fifth month survived upwards of twelve hours, occurred to Mr. Smythe. A female in her second pregnancy, and in the 147th day of gestation, had severe flooding with rupture of the membranes. Labor oc- curred on the following night, when a small but well-formed foetus was expelled, giving no other indication of life than a feeble action of the heart, and a strong pulsation in the umbilical cord. It was resuscitated, afld cried as strongly as a child born at the full period of pregnancy. It weighed less than two pounds, and measured ex- actly twelve inches. It swallowed some nourishment, but died about twelve hours after birth. The membranse pupillares were entire — the testicles had not descended — the head was well covered with hair. The length and weight, as well as the presence of hair, indicated a foetus between the sixth and seventh months ; but, as it is asserted that the period of gestation is accurately given, this must be regarded as an extraordinai'y instance of premature devel- opment. There was clearly nothing in the organization of this child to have prevented its growing to the age of maturity — in other words, it was viable. ("Med. Ohir. Eev.," July, 1844, p. 266.) In JSTovember, 1865, Mr. Carter communicated to me the partic- ulars of a case in which a child was born living at the fifth month of gestation. It cried slightly when it was born, and during the half hour that it was kept unsevered from its mother it made fre- quent efforts to breathe. It was perfectly formed. It was about one foot in length, and its weight was fully one pound and a quar- ter. It died soon after it was born. A case is reported, in which a child born at five-and-a-half months survived its birth between three and four hours ("Med. Gaz.," vol. 19, p. 165); and on a trial for child-murder- (i?e^. v. West, ISTottingham Lent Assizes, 1848), a midwife was indicted for causing the death of a child by bringing about the premature delivery of the mother, when she was between the fifth and sixth months of pregnancy. The child in this instance EARLY VIABILITY. 6i9 lived five hours after its birth. Capuron mentions an instance in which a child was born at the sixth-and-a-half month of pregnancy, and at the time he reported the case it was two years old, and en- joyed excellent health. In another instance a child was born at the same period, and lived to the age of ten years. (" Med. L^g. des Ace," pp. 162, 208.) In a case which fell under my own knowledge, a child was born at the sixth-and-a-half month of ges- tation, and lived a fortnight. (See another case, " Med. Gaz.," vol. 32, p. 623.) Capuron considers that a child born at the 180th day, or at the sixth month after conception, may be sufficiently mature to live, I. e., that there would be no reason to presume it was illegiti- mate, merely because it survived its premature birth. On the other hand, if born before the sixth month, with sufficient maturity to live, this fact, although by no means a proof, affords, in his opinion, a strong presumption of its illegitimacy. Of eight cases of children born living (by abortion) at the sixth month, Mr. Whitehead states that seven perished within six hours after birth, and one only attained to the age of ten days. ('' On Abortion," p. 249.) Dr. E.uJ;tel, who has examined the subject with great care, states, as the result of his experience, that he attended a married woman, who was afterwards delivered of a living child in the fifth month of her pregnancy ; the child survived its birth for twenty-four hours. He delivered another woman of twins, in the sixth month of her preg- nancy ; one was dead, and the other continued alive for three hours, its life being indicated only by the visible pulsation of the heart, but there was no perceptible respiration. This fact corroborates the remarks made elsewhere, as to life without active respiration (In- fanticide, p. 554) ; it has also an immediate bearing on the proof of life in reference to tenancy by courtesy (p. 628). In another in- stance of the birth of male twins, at the sixt^ month, each weighed three pounds. Dr. E-uttel saw them a year after their birth, and they were then two healthy strong children. (Henke's " Zeitschrift der S. A.," 1844, p. 241.) Dr. Barker, of Dumfries, met with a case, in which a female child was born at the 158th day of gestation, or twenty-two weeks and four days after intercourse. The size and weight of the child corresponded with the period at which it was born : it weighed one pound, and measured eleven inches. It had only rudimentary nails, and very little hair on the back of the head ; the eyelids were closed, and remained closed, until the second day ; the nails were hardly visible ; the skin was shrivelled. The child did not suck properly until after the lapse of a month, and she did not walk until she was nineteen months old. When born, the child was wrapped up and placed in a box before the fire. Three and a half years afterwards, this child was in a thriving state and healthy, but of small make ; she weighed twenty-nine pounds and a half. ("Med. Times," Sept. 1850, p. 259 ; also Oct. 12, p. 392.) Mr. Annan, surgeon, of Kinross, has recorded a case in which a child was born between the end of the sixth and the middle of the seventh month, and lived for a period of four months and eight days ; it weighed a pound and a half when seven days old. ("Med. Times," Sept. 9, 650 PROTRACTED BIRTHS. 1848, p. 304.) In a case which occurred to Dr. Outrepont of Bam- berg (reported in Henke's " Zeitschrift," vol. 6), there was the strongest reason to believe that gestation could not have exceeded twenty-seven weeks. The child (a male) weighed, when born, one pound and a half, and measured thirteen and a half inches. The skin was covered with down and much wrinkled — the limbs were small — the nails appeared like white folds of skin, and the testicles had not descended. It breathed as soon as it was born, and by great care its life was preserved. It is singular that its develop- ment was very slow until it had reached a period which would have corresponded to the forty-second week of gestation. Dr. Outrepont saw the child when he had attained the age of eleven years, and then he appeared to be of the size of a boy of eight years. The only remarkable point about the case is the length of time which the child lived. In a case quoted in the " Lancet," Aug. 23, 1851, p. 177), a child born at six months and ten days was thriving satisfactorily when four months old. (See also "Med. Times," Feb. 16, 1850, p. 129.) Hence it may be considered as established that children born at the seventh, and even at or about the sixth month, may be reared, and that the fact of their surviving for months or years cannot be taken as evidence of illegitimacy. In forming our judgment on these occasions, we are bound to look less at the period at which a child is born, than at the marks of development about the body. The case reported by Mr. Smythe, p. 648, is corroborative of this view. Dr. Bonnar has recently published a tabulated view of 112 cases of premature births of living children — the dates of gestation extending from the 120th to the 210th day. Among these cases 35 children died within the first twenty-four hours ; l3 more before the completion of one week ; 1 in six weeks ; 4 in four months. The following lived, or were living at the date of the report ; 1, seven and a half months ; 8, from one to two years ; 1, three and a half years ; 5, from ten to fifteen years ; 6, to adult age ; 5 lived not stated how long. ("Critical Inquiry regarding Superfoetation," 1865, p. 13.) Protracted births. Long periods of gestation. — The questions con- nected with retarded gestation have given rise to considerable dis- cussion in legal medicine. That gestation may be retarded or pro- tracted beyond the fortieth week is now, I believe, not disputed by any obstetric writer of reputation. Some accoucheurs have denied it, because they have not met with such cases; but the medico-legal relations of such questions do not depend upon the solitary expe- rience of practitioners. It is only by the accumulation of well- ascertained facts from all authentic sources that medical knowledge can be made available for the purposes of the law ; otherwise, owing to the mere accident of a witness not having met with any excep- tional instance, a court may be entirely misled in its judgment by trusting to his opinion. It is the more important to attend to this, because most of the cases involving questions either of contested legitimacy, or the chastity of females, turn upon protracted rather than upon premature delivery. LONG PERIODS OF GESTATION. 651 In standard works on Midwifery will be found authentic reports of cases m which gestation continued to the forty-first, forty-secoud, forty-third, and even to the forty-fourth week. Dr. Murphy regards 301 days, or forty-three weeks, as the average limit of gestation. (" Obstetric Report," p. 4.) Dr. Lee met with a case in which he had no doubt that the pregnancy lasted 287 days ; the labor did not take place until forty-one weeks after the departure of the husband to the West Indies. ("Med. Gaz.," vol. 31, p. 917.) Dr. William Hunter met with two instances in which gestation was protracted until the forty-second week. Dr. Montgomery met with a case in which delivery did not ensue until between the forty-second and forty-fourth weeks. (" Med. Gaz.," vol. 19, p. 646.) Dr. Merriman has published a valuable table on the subject of protracted gestation, on which the most experienced accoucheurs have been in the habit of relying. Of 114 pregnancies, calculated by him from the last day at which the females menstruated, and in which children ap- peared to be mature, the following were the periods : — In tlie 37tli week . . . . 3 ' In the 41st week . . . .22 " 38tli " . . . . 13 : " 43d " . . . 15 " 39th " . . . . 14 1 " 43d " . . . .10 " 40th " . . . . 33; " 44th " .... 4 Another well-marked case, occurring forty-four weeks precisely after the cessation of the menses, has been communicated to me by Dr. S. W. J. Merriman. From these results, Dr. Merriman considers that in the greater number of women gestation is completed in the fortieth week from the cessation of the menses, and next to this period, in the forty-first. In the evidence given by this gentleman in the Gardner Peerage case before the House of Lords in 1825, the case of longest protraction -on which he was able to rely was that of a married woman, who was in the habit of calculating from the last day on which her monthly period ceased. This lady was delivered 309 days, or forty- four weeks and one day, from the time at which she supposed that she had conceived. In another case mentioned by the witness the period was 303 days, or forty-three weeks and two days from the termination of the last monthly period. It was objected to this evidence, by the Attorney-G-eneral, that it was impossible to -fix the exact date of conception, and, as the female might have really conceived only a day or two before the expected return of men- struation, twenty-eight days (or four weeks) should be deducted from the periods assigned by the witness. Admitting the validity of this objection — and the fact upon which it is based is indispu- table — it followed that the longest protracted case observed by Dr. Merriman might have really been only a case of ordinary gestation extending to forty weeks and one day. An objection of this kind may of course be successfully urged in law to any inference from a calculation so made, and it was thus in the Gardner Peerage case, the medical evidence failed to render it certain that gestation might be BO protracted as to support the legitimacy of the claimant : namely 652 CASES OP PROTRACTED GESTATION". to 311 days, or forty-four weeks and three days. Hence, in consi- dering this question, it is necessary to make full allowance for such a cause of error; and, in calculating the pregnancy from the last day of the last menstrual period, we should deduct the interval of menstruation, if known, and at least twenty-eight days if unknown. In these cases of contested legitimacy, the offspring is commonly the result of a single intercourse, hence the date of conception is fixed within limits already described (p. 641): and a comparison can be instituted only between the period of gestation thence deduced, and the periods taken in other cases which are equally free from error. A well-marked case of gestation passing beyond what is com- monly set down as the average period was communicated to me by Mr. Howell, of "Walton-on-JSTaze. This occurred in a healthy woman, aged 30, who had borne three children, the youngest being 4 years old. She had menstruated with regularity up to the third week in June: the menses then stopped without any apparent cause. Her delivery took place 323 days after their last appearance. Allowing that impregnation occurred at the intermenstrual period, this would make the gestation 309 days ; or assuming that impreg- nation did not occur until twenty-eight days from the date of the last menstruation, this would make the period 295 days, or forty- two weeks and one day. A case is reported by Dr. Power in his work on " Human Preg- nancy," in which gestation is said to have extended to 325 days. Mr. Chattaway of Knighton, a former pupil, communicated to me the following instance of protracted gestation. A healthy woman, set. 36, the wife of a farmer, applied to him to attend her in her confinement, which she expected to take place in September, 1856. The menses appeared for the last time in December, 1855, and she quickened in the beginning of April, 1856. About the middle of September {i. e. on the 283d day, dating from the last menstrua- tion), Mr. Chattaway was summoned to attend her, and he found her laboring under severe false pains ; there was also a discharge of mucus tinged with blood. The case went on until the 19th Ifovember, 1856, when the patient was delivered of a female child of the average size. It would thus appear, according to the ordi- nary mode of calculation, that deducting twenty-eight days from the last appearance of the menses, gestation was protracted in this instance to 330 days, or forty-seven weeks and one day. Protracted cases of gestation are always open to the objection that the menstrual function may have been suspended from some hidden morbid cause, one or two months before the actual date of concep- tion, and that there may have been some error in the calculation by which the period has been determined. If, however, the objection is admitted under these circumstances, it would be only equally just to admit that in any given case the ordinary and so-called fixed period, also calculated from the cessation of menstruation, is based on a fallacy. The menstrual function may have accidentally ceased, or continued for several intervals after conception, and thus a cor- CASES OF PROTRACTED GESTATION. 653 responding change should be made in fixing the ordinary period of gestation. This view of the question implies that no reliance can be placed on the date of the cessation of the menses as evidence of the actual duration of pregnancy, vrhether natural, premature, or protracted. My colleague Dr. Hicks informs me that he met with a case in which the pregnancy of a woman appeared to be protracted to between twelve and thirteen months. There was every reason to believe that this woman became pregnant during the absence of the menses, and that these had been suspended some time before the intercourse took place. This is no doubt the explanation of a large number of cases of alleged protracted gestation. It is, however, difficult to admit that all the protracted cases re- corded by diflerent observers have depended upon mistakes being made in the calculation of the period, since this calculation is based on the same principles as those adopted in cases of ordinary preg- nancy. Hence, if there is a mistake in the one case, there would be in the other ; if an error in the exception, there would be an error in the rule. Either the average term of pregnancy is wrongly calculated by most accoucheurs at the thirty-eighth or fortieth week, or it is rightly calculated to extend occasionally to the foi-ty- fourth, or, admitting these protracted cases, to th& forty-sixth week. But, even setting aside the obvious answer to an objection of this nature, some of the protracted cases observed were instances of impregnation from a single intercourse ; and, making due allow- ance for the interval for conception, the general inference would not be affected, and no fallacy could have arisen in these cases of protraction, from mistakes dependent on the cessation of menstrua- tion. The late Dr. Reid's conclusions, derived from numerous facts and cases, represent the views of an experienced observer on this much- disputed question. They are — " 1. The duration of pregnancy is not altogether a fixed period ; it varies somewhat in the human female, as it does in the lower orders of animals. 2. This devia- tion, however, is not to any great extent ; the only certain data of calculation are those dependent on the known time of conception (of intercourse ?). 3. The average duration of the pregnant state, when calculated from this event, is about 275 days, or it may have a range of from 270 to 280 days. 4. There is no full or satisfactory evidence of gestation having been prolonged beyond 293 days. 5. The Code Napoleon, which allows 300 days, may be regarded as liberal. 6. The menstrual period must generally serve as our guide in default of some exact knowledge ; it is, however, often fallacious, and is only a means of approximation to the probable time of parturition. 7. The fortieth week after the last appearance of the menses is the most-likely period, and the forty-first week the next." Dr. Duncan ("Edin. Monthly Journal," 1854, vol. 9, p. 230) draws the following conclusions regarding the duration of preg- nancy: 1. That the interval between conception and parturition (the real duration of pregnancy) has not been exactly ascertained in any case. 2. That the average interval between insemination 651 DURATION OF GESTATION. (intercourse) and parturition (commonly called the duration of pregnancj') is 275 days. 3. That the average intervals between the end of menstruation and parturition have no standard length, but vary within certain limits. 4. That while absolute proof of the prolongation of real pregnancy beyond its usual limits is still deficient, there is evidence to establish the probability that it may be protracted beyond such limits to the extent of three, or even four weeks. It will be perceived from the conclusions drawn by Dr. Reid, that he admits a variation of 23 days, i. e., from 270 days (the shortest period) to 293 days, the longest known to himself from a single intercourse. There appears to be no valid reason why the variation should not be even greater than that which is here assigned, and why the duration of pregnancy might not extend occasionally to 296 and even 301 days. It is merely a question of individual experience. An accoucheur who admitted a variation of 23 days, and who had known gestation to be protracted to the 293d after intercourse, would hesitate to pronounce a child illegiti- mate merely because it had been born on the 296th or the 300th day after possible access of the husband. There is no doubt a limit to gestation, but it is not in our power to fix it ; hence we find obstetric writers of repute adopting periods which have no point of agreement among themselves. Some stop short at 280 days ; others, like Dr. Eeid, fix the maximum yet known at 293 days ; Dr. Murphy allows from his experience at least 324 days ; and Dr. Meigs considers that gestation may be continued to twelve months, or 365 days. (" Obstetrics, the Science and the Art," 1849, p. 194.) The fact is, the term has not yet been fixed even approximately by medical science ; hence, it is a disputed case, other circumstances must be looked to in order to lead a court of law to a safe decision. It is at present hopeless to reconcile the conflicting medical opin- ions which exist on the subject of the duration of pregnancy in the human female. There is, indeed, only one point on which all modern observers agree — namely, that the period cannot be limited to a fixed and invariable number of days or weeks but that it is liable to variation according to circumstances not fully understood. It has been elsewhere observed that the date of intercourse does not furnish us with the date of conception ; and according to some authorities all evidence connected with the function of menstruation is untrustworthy. In spite of these objections, the menstrual period must generally serve as a guide in default of more certain criteria. It is, however, a curious fact, and one which the mind of an acute lawyer will not fail to appreciate, that the date of the cessation of the menses is taken by some physicians as a guide (in married life with constant intercourse), so long as gestation does not extend beyond 280 days ; while, supposing it to extend to 300 days, they will assume that some other cause than pregnancy must have led to an earlier suppression, and thus to an error in the calculation ! There may be no more evidence of suppression from a morbid cause in the one case than in the other, and the period of 280 days may PERIOD OF GESTATION NOT FIXED BY LAW. 655 be as much based on error, as the period of 300 days. It is strange that clover \\'riters, who adopt this mode of making facts square with a foregone conclusion, do not perceive that they must, in fairness, either reject altogether the evidence derivable from a cessation of the menses, or admit it adversely to their own views, in cases in which the facts connected with the cessation have been as carefully observed and recorded by others, as by themselves. Period of gestation not fixed by law. — In all cases of contested legitimacy, the question respecting the duration of gestation, when it arises, is left entirely open by the English law. The Fi-ench law, under the " Code E"apoldon," allows 300 days, and the Prussian law 301 days ; but no period has been fixed by English jurists within which, or beyond which, a child, if born in wedlock, will be pre- sumed to be illegitimate. The decision of a court of law would be founded, quoad the duration of pregnancy, on the opinions of ex- perts selected for the occasion, and each case would be decided on its own merits. Precedents can have but little influence on these occasions, because a court may think fit to pronounce illegitimate, on non-medical grounds, a child born in the thirty-eight- week of gestation, while it may decide that another was legitimate that had been born in the forty-third week. By some law-authorities forty weeks (or 280 days), and by others forty-three weeks (or 291 days), have been taken as the " ultinmm tempus pai'iendi ;" but as the period of human gestation is wholly independent of legal dicta, it is not the custom (jf courts to act upon any definite rule, l^ever- thelcss, it is clear in some extreme cases tliat the law may fairly interpose, and pronounce for a reasonable limit. In the case of Gotterall v. Cotterall (decided in the Consistory Court, July, 1847), a child was born during the marriage, and the husband proceeded against the wife for a divorce on the ground of ailultery. The main proof was based on the fact that in order to have been the cliild of the husl.iand it must have been born after twelve months' gestation. Dr. Lushington, without entering into the question of protracted gestation, upon proof of this allegation, at once pronounced for the divorce. Such a duration of pregnancy is not supported by any known facts, and is altogether opposed to medical probaljility. In suits of contested legitimacy the general practice consists in estab- lishing possibility of access on the part of the husband : when this is proved, the medical question arises, whether the term of gestation falls within the limits assigned by the best medical experience. In two instances, children have been pronounced legitimate, which were born, the one in forty-one weeks and throe days, and the other in forty-one weeks and four days, after tlie death of the husband. Legitimacy has been allowed where gestation was probal^ly pro- tracted to the forty-third week {Anderton v. Gibbs, 1854). In the United States, a decision in favor of paternity has been made in a case in which gestation extended to forty five weeks ami two days {Commonwealth v. Porter). Legitimacy has been disallowed in the English Courts, although probably on non-medical grounds, where it was protracted to forty four weeks and three days {Gardner Peerage 656 THE 6AEDNER PEERAGE CASE. case, 1825); in one case, paternity was denied (judicially) because festation had extended to forty-two weeks and five days (Luscombe v. ^rettyjohn), and in another (Dyson), because it had extended to forty- eight weeks. Few trials in relation to legitimacy have excited more attention among jurists than the Gardner Peerage case, which came before the House of Lords in 1825. A full account of the medical evidence has been published by Dr. Lyall. (" Med. Evid. in Gardner Peer- age case," 1827.) Alan Legge Gardner, the son of Lord Gardner by his second wife, petitioned to have his name inscribed as a peer on the Parliament Eoll. The peerage was, however, claimed by another person, Henry Fenton Jadis alias Gardner, who alleged that he was the son of Lord Gardner by his first and subsequently divorced wife. It was contended that the latter was illegitimate ; and in order to establish this point, the evidence adduced was partly medical and partly moral. The child whose legitimacy was dis- puted, was born on the 8th of December of that year. Therefore the plain medical question, taking the extreme view, was whether a child born 311 days (forty-four weeks and three days, from January to Decembei"), or 150 days (twenty-one iveeks and three days — from July to December) after possible intercourse, could be the child of the husband. Lord Gardner. If these questions were answered in the affirmative, then it followed that this must have been either a premature, or protracted birth. There was no pretence that it was a premature case, the child having been mature when born. The question then was reduced to this — Was this alleged protracted gestation of 311 days consistent with medical experience ? Many medical witnesses, comprising the principal obstetric practitioners in the kingdom, were examined on this point. Their evidence was conflicting, but a majority concurred in the opinion that natural gestation might be protracted to a period which would certainly cover the birth of the alleged illegitimate child. On the moral side of the question, it was clearly proved that Lady Gardner, after the departure of her husband, was living in open adulterous intercourse with a Mr. Jadis ; and on this ground Lord Gardner obtained a divorce from her, after his return. He subsequently married a second wife, by whom he had the claimant, Alan Legge Gardner. It was contended that the other claimant was really the son of Lady Gard- ner by Mr. Jadis. The decision of the House was that this claimant was illegitimate, and that the title should descend to the son of the second Lady Gardner. The decision appears to have been chiefly based on moral circum- stances : for had not the first Lady Gardner been living in adultery at the time of her husband's departure, it is highly probable, from the medical evidence bearing strongly that way, that the legitimacy of the child would have been admitted. Morally speaking, the decision could not be impunged, but medically speaking it assumed that gestation could never be protracted to the 311th day after probable intercourse. Considering that conception is not necessarily the immediate result of intercourse (p. 644), and that we have no DISPUTED PATERNITY. 657 data for fixing the precise time of its occurrence, this decision could hardly be supported on medical grounds. We should not be justi- fied in affirming that every child born forty-four weeks and three days after the opportunity of intercourse with the husband was ex necessitate rei an illegitimate child, and that the wife was an adulteress. It is true that their lordships did not decide directly that the one claimant was illegitimate, because he could not have been born only after 311 days' gestation ; but their decision practi- cally led to this result, as the other claimant was pronounced to be the only son and rightful heir of Lord Gardner. Of the seventeen medical experts examined on this occasion, five supported the opin- ion that the duration of human pregnancy was limited to about nine calendar months, i e. from thirty-nine to fo^'ty weeks, or from 273 to 280 days — or, strictly speaking, from 270 to 280 days ; one of the witnesses, indeed, said from 265 to 280 days. These witnesses, of course, gave a negative to the possibility, unless by miracle, that Henry Fenton Jadis alias Gardner could have been the product of 311 days' gestation. On the other side, of twelve medical gentle- men, who seemed to agree with respect to the above-mentioned period as the natural term of gestation, the greater number main- tained the ^possibility of pregnancy being protracted to nine-and-a- half, ten, or even eleven calendar months, and of course to 311 days — the alleged term of gestation, at which the counter claimant was born — and thej"^ thus admitted the possibility that Mr. H. F. Jadis alias Gardner might be a ten-and-a-half months' child. (Lyall's "Med. Evid. on the Duration of Pregnancy," etc., p. 8.) PATERNITY. CHAPTER LVI. DISPUTED PATERNITY. — PARENTAL LIKENESS. — AFFILIATION. — POST- HUMOUS CHILDREN. — SUPERFffiTATION IN RELATION TO LEGITI- MACY. — SUPPOSITITIOUS CHILDREN. — SEXUAL MALFORMATIONS. Disputed paternity. Parental likeness. — It has been stated that the law does not pretend to determine who begat a child when it has been born during wedlock, and from circumstances it might be the child either of the husband, or of an adulterer. But medical jurists have recommended that family-likeness should be looked to on these occasions — not merely a likeness m feature and figure, but in gesture and other personal peculiarities which may have cha- racterized the alleged parent. These are called o^uestions oi pater- nity ; they seldom occur except in reference to cases of bastardy, and 42 658 DISPUTED PATERNITY. when they do present themselves, the evidence thus produced, even if affirmative, is properly regarded as only corroborative. In the Townshend Peerage case (House of Lords, May, 1843), a presump- tion based on family-likeness was admitted by their lordships. The person whose legitimacy was in question was sworn by one of the witnesses to bear so strong a likeness as a child to the alleged adulterer, that he should have known him among five hundred children. The proceedings in the Douglas Peerage case (1767-9) show that evidence of this kind is occasionally of some importance. The peerage was claimed by Archibald Douglas — the survivor of two brothers after the death of the alleged parents. Sir John and Lady Douglas. The claim was disputed, on the ground that the appel- lant and his deceased brother were supposititious children. Evi- dence for and against the legitimacy of the claimant had been collected from every quarter, and after it had been most minutely sifted and criticized, the case came on for judgment, in the Court of Session in Scotland, on the 7th of July, 1767. So important was the cause deemed, that the fifteen judges took eight days to deliver their opinions. The result was that seven of the judges voted in favor of the identity or legitimacy of Mr. Stewart, and seven against it ; the Lord President, who had the casting vote, agreed with the latter, by which Archibald Douglas, alias Stewart, was cast on the world without either name or estate — thus furnishing one among numerous instances that learned judges as well as doc- tors can differ, with precisely the same facts before them. An appeal from this decision was taken to the House of Lords, by which the judgment in the Court of Session was reversed in 1769, and Archibald Stewart (or Douglas) declared to be the undoubted son of Lady Jane, the sister of the previous holder of the title. Much stress was laid, in favor of the legitimacy of these children, on the fact that they closely resembled — the one Sir John, and the other Lady Douglas. The resemblance was said to be general ; it was evident in their features, gesture and habits. Lord Mansfield, in delivering judgment, make the following remarks, which com- prise all that can be said on this subject : " I have always con- sidered likeness as an argument of a child being the son of a parent, and the rather as the distinction between individuals in the human species is more discernible than between other animals. A man may survey ten thousand people before he sees two faces exactly alike ; and in an army of a hundred thousand men, every man may be known from another. If there should be a likeness of feature, there may be a difference in the voice, gesture, or other characters, whereas a family likeness runs generally through all these ; for in everything there is a resemblance, as of feature, voice, attitude, and action." This kind of evidence has been strongly objected to from its uncertainty ; and I am informed, on good authority, that it was in this instance much disputed whether one of the children did resemble Lady Douglas, but it seemes to have been generally admitted that the other child resembled the bus- PATERNITY FROM PERSONAL PECULIARITIES. 659 band, Sir John. From this account it will be seen that evidence from family likeness is not strictly medico-legal ; it can be furnished only by friends and relatives virho have known the parties well, and are competent to speak of the facts from personal acquaintance with them. It will also be apparent that the arffimative evidence in such cases will be stronger than that which is negative, for it could hardly be inferred that a person was illegitimate because he did not resemble his parent. Parental likeness may be occasionally indicated by color or pecu- liarities belonging to the varieties of mankind, as of the intermix- ture of the E^egro, or Mongolian, with one of the Caucasian variety. In such a case the evidence afforded becomes much stronger ; and supposing that two men of different varieties have intercourse about the same time with the same woman, the color of the skin of the offspring might enable a court to determine the question of paternity. It is stated to have happened, on more than one occasion, that a black woman has given birth at the same, time to a black child and a mulatto ; Dr. Cunningham refers to a case in which a negress gave birth to twins, one a black and the other a white child. (" Lancet," May 9, 1846, p. 525.) This was probably a case of superconception. In Stothard v. Aldridge (Bail Court, January, 1856), the plaintiff' sued the defendant for damages for the seduction of his wife. The defendant was a man of color, and the child born of the alleged adulterous intercourse was proved by the medical witness to have been born colored and with woolly hair. The husband and wife were both light. This peculiarity fixed the paternity of the child on the black defendant. Personal deformities are not necessarily transmitted from parent to child ; yet it would appear from the subjoined case, that a dis- puted question of affiliation has been settled on this principle. A woman alleged that a gentleman in whose service she had lived, was the father of a child of which she had been recently delivered. The solicitor who appeared to support the affiliation, rested his case chiefly on the fact that the child had been born with five fingers and a thumb on the right hand, the defendant himself having been born with a similar malformation on both of his hands. It was argued, on the other side, that the deformity might have arisen from the mother's imagination, as, while pregnant, she was constantly in the habit of seeing the defendant. The magis- trates decided that he was the father of the child, and condemned him to pay the necessary expenses for its support. (" Med. Times," March 6, 1847, p. 47.) It is very likely that the decision was here influenced by moral circumstances, for otherwise the defendant might have been the victim of a coincidence. Six-fingered chil- dren are, it is well known, born occasionally of five-fingered parents; and as the deformity existed only on one hand in the child, while it was on both hands in the parent, the medical proof that it was actually transmitted by generation was certainly not clearly made out. In some instances, attempts have been made to fix the paternity of a child by the color of the hair, but this evi- 660 EVIDENCE IN CASES OF AFFILIATION.' dence is far less conclusive than that afforded by the color of the skin. In the case of Frazer v. Bagley (Feb. 1844) it was alleged that the wife of the plaintiff had had criminal intercourse with the defendant; and the last two children were stated to be the off- spring of the latter. The plaintiff and his wife had dark hair, as well as all the children, with the exception of the last two; these had red hair; and it was further proved that the defendant had red whiskers and sandy hair. ~Eo particular stress was laid upon this evidence, but it was received as a kind of indirect proof. E"ot much confidence can be placed in facts of this description, since red-haired children are often born to parents who have dark hair ; and in one case, the children born in wedlock were observed to have dark and red hair alternately. Affiliation. — Questions of paternity are involved in those relating to affiliation. A man may allege that he is not the father of a par- ticular child, by reason of certain circumstances upon which a medical operation may be required. The necessary transmission of gonorrhcea or syphilis by intercourse may thus become a medical question. In September, 1844, a man was required, under the law of bastardy, to support two children alleged by a female to be his ; the time of gestation was within nine months. The accused denied that he had had intercourse with the deceased, or that he could have been the father, since he was at the time under medical treat- ment for venereal disease. The medical questions may therefore assume this shape : 1. Are these diseases invariably transmitted by intercoi^rse ? 2. Do they interfere with the act of procreation ? Under common circumstances they must both be answered in the negative. A singular case of bastardy is reported to have occurred in Appenzell, Switzerland. The question was, which of two persons, who had had intercourse with the same woman within a period of seventeen days., was the father of an illegitimate child borne by the woman ? The council, to which the case was referred, gravely re- solved to postpone their decision until the features of the child were so far developed as to enable them to decide from paternal likeness. The equity of this difficult case would have been met by compelling each man to contribute to the support of the child ! (Schneider's "Annalen der Staatsarzneikuude," 1836, 1 B. s. 470.) The following, which is a more doubtful case, was the subject of a communication to the "Lancet" (March 13, 1847, 336): Two men, A and B, had intercourse, unknown to each other, with a young woman of deli- cate health ; and after this had continued for some years, she was delivered of a female child — nine calendar months and three days after sexual intercourse with A, and nine calendar months, less five days, after similar intercourse with B ; or at the end of 279 days after intercourse with A, and at the end of 271 days after intercourse with B : that is, a period of eight days elapsed between the periods of intercourse with the two men. The woman had no menstrual discharge in the mean time, and it is not believed that she knew any EVIDENCE IN CASES OF AFFILIATION. 661 other man ; she went her full time, had a good labor, and produced a fine healthy girl ; she had a plentiful supply of milk, and enjoyed better health during her pregnancy and suckling than at any other time. The woman died, and the circumstances of the mixed inter- course having become known to A and B, they both refused to maintain the child. A contended that, as the woman was not de- livered until nine months and three days after the connection with him, it was physically impossible the child could be his. B con- tended, on the other hand, that 280 days, and not nine months, is the period of gestation ; and that the child having been bom 279 days after connection with A, and only 271 days after connection with B, it was therefore probable that the child was begotten by A. There was no perceptible likeness to either of the men in the child, but a marked likeness to the mother. It is obvious from the remarks else- where made (ante, p. 642), that the periods of 271 and 279 days are comprised within the ordinary range of gestation : hence there would be no medical ground for affiliating the child to one more than the other. When two men have intercourse with the same female on the same day, it is impossible to settle the paternity except by the accident of likeness; as in the former case, justice to the oftspring and to each possible father requires that each should be bound to support the child. In cases of affiliation under the law of bastardy, the evidence of the mother, if corroborated, is received in support of a question of disputed paternity ; but sometimes these cases are decided by the length of the period of gestation. A man ' may prove, or a woman may state, that the intercourse took place at such a remote period as to be inconsistent with the ordinary duration of pregnancy. On this point some remarks have been made elsewhere (ante, p. 655). In the United States it appears that very long dates are allowed in bastardy cases ; while in this country the tendency is to reject medical evidence altogether. In a case at Cheltenham (July, 1853), the date of intercourse was proved to have been 319 days before the birth of the child. The medical evidence on the whole was in favor of this protraction — one of the witnesses having met with two cases in which gestation was protracted, as he believed, to 310 days from intercourse — but the case was sum- marily dismissed. These questions of affiliation, when the interval is less than six or eight weeks, can rarely be determined by medical evidence ; in a twin-case, it would be only just that one child should be affiliated to each individual. In a recent case of affiliation, an attempt was made to set aside the order of a magistrate fixing the paternity on the putative father, on the ground that, as the intercourse was had and the child conceived in France, although born in England, it was removed from the jurisdiction of an English magistrate, and should be left to the French courts. The objection was properly overruled, and the 'alleged father was ordered to pay the usual sura for maintenance. The place of birth should properly fix the lia- bility, as any other rule would be too vague. From what has been elsewhere stated, it will be perceived that intercourse might take 662 POSTHUMOUS CHILDEEJSr. place in Scotland, followed by conception in England, and birth in Ireland. So that there is a due relation between the date of inter- course and the date of birth, no other proof is requii'ed. Posthumous children. — It has been supposed that a case involving a question of paternity might present itself on the marriage of a widow soon after the death of her first husband. If a child were born after the lapse of ten months, it might be a question whether it was a child of the first or second marriage — of the dead or the living husband ; and although there might be no dispute concern- ing its legitimacy, yet it would be difficult to settle its ■paternity. Such a case appears hypothetical. [Lord Hale, however, mentions the two following cases: " 18 R. 2, where a woman in such a case, immediately after the death of the first husband, took a second husband, and had issue born forty weeks and eleven days after the death of the first husband, it was held to be the issue of the second husband. M. 4 Car. in Cur. Ward, and afterwards, P. 5 Car. B. R. Thecar marries a lewd woman, but she doth not cohabit with him and is suspected of incontinency with Duncomb : Thecar dies : Dun- comb within three weeks after the death of Thecar marries her ; 281 days and 16 hours after his death she is delivered of a son. Here it was agreed, 1. If she had not married Duncomb, without question the issue should not be a bastard, but should be adjudged the son of Thecar. 2. ISTo averment shall be received that Thecar did not cohabit with his wife. 3. Though it is possible that the son might be begotten after the husband's death, yet being a ques- tion of fact, it was to be tried by a jury, and the son was found to be the issue of Thecar." Hale MSS. — P.] In order that any doubt should exist, a woman must marry within, at the furthest, six weeks after the death of her first husband, or the birth of the child, would fall beyond the furthest limit of gestation, so far as he was concerned. The customs of society are, however, a bar to such marriages ; and admitting that a child was so born, and that it might be the offspring of either husband, then the fact of its having been born during the marriage of the second husband would pre- sumptively fix the oftspring upon him, unless it could be shown that there was no possibility of access on his part. If there was a supposed greater likeness to the first than the second husband, still this would not be allowed to defeat the legal presumption of the real parentage of the child. It appears to me that evidence much stronger than this would be required for such a purpose. (See Henke's " Zeitschrift," 1838, vol. 2, p. 432.) Superfcetation in relation to legitimacy. — Most medico-legal writers, in treating legitimacy, have considered it necessary to introduce the subject of superfoetation. By this we are to understand that a second conception may at any time follow the first, and that gesta- tion may go on to its full period in each instance, independently of the other: so that if a woman were impregnated when in the third month of gestation, she would bear the first child mature in nine months, and the second child, also mature, at the end of twelve months after the first conception. This subject has been said to SUPERF(BTATION IN BELATION TO LEGITIMACY. 6t)3 involve "not only the conjugal fidelity of a wife, but the disposi- tion of property, and much of the comfort and happiness of society." Its importance to a medical jurist appears to me to have been here considerably exaggerated. So far as I have been able to ascertain, not only is there no legal case involving this question to be met with in the judicial records of this country, but none in reference to this state is ever likely to occur, which would create the least practical difficulty. If we admit that a woman may, during mar- riage, present such a deviation from the common course of nature, as to produce two perfectly mature and fully-developed children, the one three or four months after the other, how can such an event be any imputation on her fidelity ? Superfoetation, if it occur at all, may occur as readily in married life, duriiig connubial inter- course, as among unmarried women. The following appears to be the only possible case wherein a medical opinion might be re- quired respecting this alleged phenomenon. A married woman, six months after the absence or death of her first husband, gives birth to an apparently mature child, that dies; three months after- wards, and nine months after the absence or death of her husband, she may allege that she has given birth to another child, also ma- ture. A medical question may arise, whether two mature children could be so born, that the birth of one should follow three months after the birth of the other ; or whether this might not be a case, by no means uncommon, of twin-children — the one being born pre- maturely, and the other at the full period. (For a case of this kind, .at two months' interval, see "Med. Graz.," vol. 37, p. 27; and for another at eight days' interval, see the same journal, vol. 47, p. 227 ; for a third, at thirty-two days' interval, "Am. Journ. Med. Sci.," April, 1845, p. 503.) In one case the abortion of one foetus occur- red at the third month, while the other attained the full period. ("Assoc. Medical Journal," ISTovember 11, 1853, p. 997.) Admitting that each child when born was mature and fully de- veloped, and therefore that the second child presented a case of superfoetation, the first delivery must have taken place in the presence of witnesses, and it would then have been known whether another child remained in the uterus or not. If the two children were born within the usual period of gestation after the absence or death of the husband, then their legitimacy would be presumed, until the fact of non-access had been clearly established. The mere circumstance of their being apparently mature, and born at differ- ent periods, would ^er se furnish no evidence of their illegitimacy. On the other hand, if one or both of them were born out of the ordinary period, then, according to the evidence given, they might, or might not be pronounced illegitimate. The law, therefore, ap- pears to have no sort of cognizance of the subject of superfoetation, as such ; it is generally merged in the question of protracted gesta- tion, which has already been fully considered. Until the mouth of the uterus is completely closed as a result of the development of an embryo, it is possible that conception may take place from intercourse subsequently to a previous conception. 664 SUPEKFCETATION IN EELATIOJST TO LEGITIMACY. The exact period at which this closure occurs has not been deter- mined : but according to Dr. Duncan, the menstrual secretion may find its way through the mouth of the uterus for at least two months, and probably three months after conception. If this be the case, a second conception might occur two or three months after a first conception ; but I am not aware of any facts to support this statement. It cannot be denied that superconception may occur in cases in which two separate intercourses have been had within a few days of each other ; and, according to some, twins may be generally re- garded as the result of this double conception at different periods. (Ramsbotham's '' Obstet. Med.," p. 500.) Dr. Carter has reported the following case in the " Philadelphia Medical Examiner" : A negro woman, quite black, set. 23, and of good constitution, had borne three children previously to her last labor. She stated that in April, 1848, she had had connection with a white man, and on the following day with a black man. • This was about a week or ten days before the cessation of the menses. In the middle of Feb- ruary, 1849, she was delivered of twins, one of the children (the firstborn) being as dark as negro children generally are, while the other was a mulatto. The woman believed that they were begotten by different fathers ; and this was rendered highly probable by the difference in the color of the skin. (" Edin. Month. Journ.," May, 1850, p. 485.) The reader will find several cases of a similar kind reported by Dr. Ramsbothan. (Op. cit. p. 501.) Many of the old cases of superfcetation are explicable on the sup- position that a woman was pregnant with twins, and that one of thes.e was born prematurely, and the other at the full time or later. Cases of abortion or delivery of one twin, the other remaining in utero, are by no means uncommon. In addition to those already quoted, two are referred to in the " Edinburgh Medical and Sur- gical Journal" (1839, p. 289). In one, abortion took place at three ■■ months, while the woman went to her full time and was delivered of a healthy child at nine months. In the second, one foetus was expelled at about four and a half months, while four months after- wards a full-grown child was born. In a third case, reported by Dr. E"evins, a woman was delivered of a foetus, prematurely ; and six weeks afterwards she was delivered of a full-grown cbild. (" Med. Gaz.," vol. 46, p. 983 ; see also " Med. Times and Gaz.," May 2, 1857.) Even under a malformation which might be sup- posed to be favorable to its occurrence, namely, the presence of a bilocular uterus, it has been found that impregnation has taken place in one cornu only. (See " Med. Gaz." vol. 19, p. 507.) A singular instance is, however, recorded in the same journal (vol. 20, p. 508), where a woman six months after marriage, bore a four- months' child, and forty weeks after marriage gave birth to mature twins. On examination, the uterus and vagina were both found double, and each vagina had a separate orifice. Dr. Horlbeck, U. S., states that he met with a case in which a well-grown foetus of six months was simultaneously expelled with an embryo about six SCPERFCBTATION IN RELATION TO LEGITIMACY. 665 weeks old ! ("Med. Gaz.," vol. 44, p. 87.) In the "Medical Times" (Jan. 31, 1852, p. 104), Dr. Foley has published the account of a case in which a mole was expelled from the uterus at an early period of pregnancy, while the woman was delivered, about the usual period, of a living and well-formed although weakly child, which survived its birth three days. (See also "Dublin Quarterly Journal," Feb. 1859, p. 221; and "Lancet," August 2, 1862.) M. Garimond has contributed a case of the ordinary kind, in which a woman was delivered of one child fully developed, and of another at seven months, dating from the last menstruation. (" Ann. d'Hyg." 1867, 1, 456.) This may have been simply a case of twins, impreg- nation taking place at the same time, but one twin less developed than the other. Dr. Paxton, of Kilmarnock, met with a case in which a question of infanticide arose out of the supposed condition of superfoetation. (" Glasgow Medical Journal," Jan. 1866.) Dr. Bonnar has lately examined the subject of superfoetation in another aspect, and some of the facts which he has brought for- ward are not consistent with the theory of the birth of twins at different intervals (" A Critical Inquiry regarding Superfcetation, with Cases," 1865). The first question to which his researches were directed was — at what period after parturition are the female pro- creative organs capable of again exercising their functions? It has been supposed that a period of thirty days must elapse in order to enable the organs to reacquire procreative power ; but according to Dr. Bonnar, the earliest period may be taken at the fourteenth day after delivery. Impregnation is not likely to take place until the organs have resumed their natural condition, and this will de- pend on the disappearance of the signs of recent delivery — such as the tender and swollen state of the vagina, the enlargement of the uterus with its relaxed mouth, and lochial discharge. The persis- tence of the lochial discharge, the average duration of which after delivery Dr. Bonnar considers to be from one to three or four weeks, is of the greatest importance, as it is most likely to interfere with impregnation. The time for the restoration of the sexual organs to their natural state varies in different women, so that the date for re-impregnation must be more or less conjectural. It has been usually consideced that after the second or third' month of pregnancy the cavity of the uterus is so sealed up in the development of the embryo as a result of impregnation, that it is im- possible that any fruitful intercourse can take place. In two instances, however, according to Dr. Bonnar, viable children were born of the same woman at five and a half and four months respectively after the first delivery. On the theory of superconception the uterine organs must have been susceptible of a second impregnation up to the fourth month of gestation. But if the children w6re not born mature, the power of re-impregnation must have existed for one or two months longer than the period usually assigned— i. e., up to the fifth or sixth months of a pregnancy already existing. These researches may help to explain some legal difficulties which have occurred in reference to gestation. They furnish a curious comment SUPPOSITITIOUS CHILDREN, upon the suggestion made by some medical jurists, that superfoeta- tion involves the conjugal fidelity of a wife, for no suspicion of ille- gitimacy could be for a moment entertained simply on account of the shortness of the interval between the two deliveries of the same married woman. Supposititious children. — Another medico-legal case, in relation to legitimacy, occurs when a woman feigns delivery, and represents the child of another person to be her offspring. She may substitute the living child of another woman for a dead child of which she herself has been delivered, or for a mole which may have passed from her. So, again, a male may be substituted for a female child, and vice versa. The practising of a fraud of this nature may se- riously affect the rights of inheritance of parties ; but it cannot be accomplished without great dexterity and cunning, or without the co-operation of several accomplices. Frauds of this kind have, in general, been committed by the aid of a low class of widwives. One instance occurred at Chelsea, in July, 1842, where the fraud was brought to light by the death Of the supposititious child. The calling-iu of a professional man would infallibly lead to discovery, when the question was simply whether delivery had, or had not taken place; but if it be alleged that one living child has been substituted for another, the proof of this can depend on medical evidence only when the age of the supposititious child does not happen to corre- spond to the date of the pretended delivery. (See "Ann. d'Hyg.," 1829, vol. 2, p. 227.) The legitimacy of the claimant of the Douglas Peerage was disputed on this ground, but apparently without foun- dation. A remarkable case of this description will be found in Heuke's " Zeitschrift der S. A." (1845, vol. 2, p. 172) ; and a trial took place some years since in England, involving the alleged substitu- tion of a child, but requiring no medical evidence for its elucida- tion. {Da.y V. Day, Leicester Lent Ass. 1845.) In another case it was proved that a woman had substituted a doll for the dead body of a child of which she pretended she had been delivered. In a case mentioned by Dr. Cheevers, one Mussamat Janoo, a midwife of Hisar, being employed to attend a woman in her confinement, per- suaded her that the child of which she had been delivered was a "monster with two heads, not fit to be looked at ; she afterwards said that it was dead, and she would take it away and bury it. She accordingly went away, itfext morning, the midwife's services being required, she was sent for. She excused herself from going under the pretence that she (the midwife) had just been delivered of a child. This improbable story excited suspicion, and the police were called in ; she declared that the child was her own. This she also maintained at the trial. It appeared, however, from the evi- dence of midwives who examined her shortly after the discovery of the child in her house, and also by the deposition of the civil surgeon, that she exhibited no signs of recent confinement. Several of the neighbors, who were constantly in the habit of seeing her, deposed that she had not exhibited any outward signs of pregnancy. She did not attempt to prove how she had disposed of the body of SUBSTITUTION OP CHILDEEN. 6(i7 the child which she alleged had died immediately after its birth. She was convicted, and sentenced to imprisonment for seven years. ("Med. Jur. for India," p. 512, from the " Nizamut Adawlut Re- ports," 26th April, 1853.) Cases involving a question of substitution are not very common. One of these {Hutchins v. Hutchins) was heard in the Vice Chancel- lor's Court in May, 1851 ; and in this the amount of ingenuity re- quired to perpetrate the fraud was only equalled by the skill with which the facts were exposed, and justice ultimately done, to the rightful claimant. In another {Qedney v. Smith, Rolls Court, ITov. 1864) the fraud was nearly successful, and but for the dying declara- tion of the woman herself, would probably have escaped detection and exposure. A more daring attempt of this kind came before the House of Lords in 1870, in reference to a claim for the earldom of "Wicklow {The Wicklow Peerage case. Committee for Privileges, April 1, 1870). The title and estate of the Earl of Wicklow passed at his death to his brother's issue. The first in succession was G-eorge Howard, who, after a career of dissipation, had died in October, 1864. He had been married in February, 1863, to Ellen Richardson, the daughter of a gentleman's coachman. In default of issue, the estate devolved on his brother Charles, the second in succession. Ellen Howard produced a male child who, she alleged, was born on the 16th May, 1864, and who, if such were the case, would be the rightful Earl. "Eo medical man and no nurse attended Mrs. Howai'd, although it was her first confinement, and the infant was a seven months' child. It was never registered, and never baptized. There was further strong evidence that she had not borne a child, and that the child which she had produced as her own was obtained by her in August, 1864, from a girl who had been recently delivered in the Liverpool workhouse. Mrs. Howard was clearly identified as the person who had taken away a child at this time. Her story wsEs thus proved to be false. The House of Lords decided against the claim, and came to the conclusion that the witnesses had been guilty of perjury. The cases that have hitherto been tried, illustrate the importance of accurate observation on the part of medical men in their practice as accoucheurs. ]!fotes of all cases should be made and preserved, including dates of attendance, etc., daily symptoms, and treatment. This should be an invariable rule when a medical man is suddenly called upon to attend in her confinement a woman who may not have previously consulted him. If he has had no previous knowledge of the pregnancy of a woman, and if when he arrives, the child is said to have been born and in the hands of a nurse, he should most distinctly satisfy himself, by a personal examination, that the woman has been actually delivered. He should also observe whether the child presents the appearance of a new-born child in reference to the state of its skin, the appearance of the cut navel-string, and other circumstances. It is an awkward thing for a medical man to hear at a trial many years afterwards, that his patient was not de- SEXUAL MALFORMATIONS. livered of a child, that a post-mortem examination of her body- had shown that she had never borne a child, and that the supposed new-born babe was, at the date of his first visit, several days old — in short, to find that he himself has been cleverly made to give support to a fraud. Hermaphroditism. Sexual malformation. — The legitimacy of a child is open to be contested under other circumstances than those connected with the duration of gestation. The alleged parent may have labored under physical incapacity: if a male, he may have been affected with impotency; if a female, she may have labored under sterility; and if either of these conditions be proved, the illegitimacy of a child will be established, although the alleged period of gestation may be comprised within the ordinary limits. The sexual conditions now about to be considered have also impor- tant bearings in relation to divorce, and occasionally to the civil rights of a child that may be the subject of the malformation. One of the most common and obvious causes of impotency, or ste- rility is malformation of the sexual organs, to which species of monstrosity the term hermaphroditism is commonly applied. Owing to arrested development, during the growth of the foetus, the sexual organs, which can scarcely be distinguished at the fourth month, occasionally assume an abnormal arrangement. These organs appear to be at that time more or less mixed ; and sometimes the male, and at others the female characters predominate. "With this defective sexual development, the other peculiarities of the sexes are either wanting, or we find them more or less blended. When, therefore, the being has the characters of a male with malformation of the generative organs it is called androgynous — when the charac- ters are those of a female with a like malformation, androgyna. There can be no difficulty in identifying such cases; and, according to the degree of malformation, a medical jurist can have no hesita- tion in pronouncing these persons to be incurably impotent. The organs are commonly so defective as to be wholly unfitted for the functions of either sex. It is not intended to be said that it is in all cases easy to assign the sex, but this is of minor importance ; the main question is, whether the malformation is or is not such as to justify divorce, or the imputation of illegitimacy upon chil- dren claiming to be the offspring of these beings. Diistinction of sex. — The determination of sex in these cases of de- formity has been considered to be necessary under certain circum- stances ; as when, for instance, a title of entailed inheritance of lands is in question. Lord Coke has stated that, according to the law of England, an hermaphrodite may be either male or female, and it shall succeed according to the kind of sex which doth pre- vail. Thus it is obvious, that the law will decide each case accord- ing to the special circumstances attending it : but it must not be supposed that the decision is so easy as Lord Coke's doctrine would imply. There are many cases in which neither sex can be said to prevail. The beings are positively neuter. The chief character of DISTINCTION OF SEX. 669 the male would donsist in the presence of testicles, and of the female in the presence of a uterus and ovaries. But in a case which occurred to Mr. Grigor, both the testicles and the ovaries were wanting ; there were no essential characters of either sex, and during life it would have been impossible to say whether this being was male or female. (" Cormack's Monthly Journal," July, 1845, p. 492.) In the same journal (p. 531) is reported another case, in which, notwithstanding the external resemblance to a female, the presence of one testicle in a scrotum showed that this individual was of the male sex. Yet this person passed for a woman until he had reached his 26th year ! It is rare that there is external mal- formation without interna] defect, and even when the female character preponderates in the person, it is not improbable that the uterus or the ovaries may be absent, or the former may be mal- formed. Such beings are not known to menstruate; and even if there be capacity for intercourse, they are permanently sterile. Sexual desires are, however, commonly absent. When the person is young, mistakes respecting the sex are more common than at an advanced period of life. So soon as the age of puberty is passed, certain changes take place in the configuration of the body, which may aid a medical practitioner in forming an opinion. Thus, a grave tone of voice, the presence of a beard, the width of the shoulders, and narrowness of the pelvis will indicate, cceteris paiibus, the male sex: while when these conditions are absent, and there is a rotundity of the members, with want ol prominence in the muscles, and a development of the mammse, we may pronounce upon the female sex predominating. Although no testicles are apparent, still the being may be of the male sex, since it is well known that in persons otherwise well formed these organs occasionally do not descend to occupy the scrotjim. Dr. Harris, of Clarksville, has related a singular case, in which, although no testi- cles could be found, there was a short but naturally-formed penis, through which the being regularly menstruated ! The female char- acter predominated in the'corporeal development, and there was the rudiment of a vagina (" Med. G-az.," vol. xl. p. 562). The fact that the being menstruated was here sufficient to assign it to the female sex. How easily mistakes may be made in the sex of young chil- dren is shown by a case which occurred to Mr. -Terry, and is quoted in "Cormack's Journal" (April, 1845, p. 307). The child was christened as a female, and was so considered by the parents for two months, when, owing to some defect in the passage of the urine, it was brought to Mr. Terry, and he found there was a mal- formation of the penis — no vagina, a scrotum with one testicle down and the other descending. He therefore pronounced it to be a male, and its costume was altered accordingly. Another ease occurred within -raj knowledge in 1872, in which a boy had been christened and brought up as a girl up to the age of 13, when, in consequence of a change in the voice a,nd certain masculine habits, some doubts arose about the sex. On consultation with Sir "W. Ferguson, he pronounced the child to be of the male sex, and its 670 DISTINCTION OF SEX. name and dress were altered accordingly. The testicles were re- tained in the abdomen, and this probably deceived the accoucheur and the nurse at the time of the birth. A case of doubtful sex occurred to Dr. Flume. The bodily formation was that of a male, and the external organs presented chiefly the male characters ; but on an inspection, there were found a uterus with ovaries and Fallopian tubes. This being had never menstruated. This writer thinks that the shape of the pelvis fur- nishes the best criterion of the sex. (" American Journal Med. Sci.," 1872, p. 512.) In a paper published in the " Guy's Hospital Reports," 1867 (p. 419), Mr. Bryant has described various malformations of the sexual organs. In one of these there was an entire absence of vagina, and in another a great development of the clitoris, causing it to re- semble the male organ. There were a glans and prepuce, the latter being very large. There was a depression, but no urethra, in the usual situation of the urethral organ. The presence of a beard and whiskers is usually considered to characterize a male, but the growth of hair on the chin and face is sometimes as profuse in women as in men. Dr. Chowne examined a female named Joseph Boisdechine, on behalf of a man who was about to marry her, but who required a certificate as to the real sex of his intended wife before he entered into a matrimonial engage- ment ! Dr. Chowne found nothing in her external conformation indicative of doubtful sex. The breasts were large and full, and the only resemblance to a male was in the abundance of beard and pro- fuse whiskers. The upper lip was free from hair. (See " Lancet," Oct. 11, 1851, p. 335 ; Jan. 15, 1853, p. 66 ; " Med. Times and Gaz.," Jan. 15, 1853, p. 71.) Dr. Chowne has published a full account of this case in the " Lancet" for May 1, 1852 (p. 421). He has appended an .'engraving, which displays the female beard and whiskers. It is stated that tliis female was born with a quantity of hair on her chin, and that at eight years of age the beard was two inches long ! In some instances this growth of hair in women is connected with sexual malformation. I have known an instance in which a Russian countess had so much hair upon her chin that she was obliged to shave like a man. The following case of hairy development in a woman has been reported by Dr. Hills: M. C, set. 42, dressmaker, suif'ering from mania, was admitted into the Norfolk Asylum, 1865. She had a vigorous growth of hair on the lips and chin, for which depilatories had been used, but these made matters worse. The upper part of the body is masculine in form, and the breasts are undeveloped, as in the male sex. The lower part of the body is feminine in outline, and the voice has the femi- nine tone and character. The clitoris was largely developed, having a distinct prepuce. There were no testicles in the labia, or in the inguinal canals. There was a distinct vagina, and the finger ap- peared to touch an os uteri. At an early age she had the slightest possible signs of menstruation on three consecutive occasions. In her girlhood she would not associate with other children. While MIXED CASES OF HERMAPHRODITISM. 671 in the asylum she evinced strong sexual passions, and behaved in- decently to the attendants. She had thick mustaches, and a full beard. (" Lancet," June 25, 1873, p. 129.) An -engraving accom- panies this paper, in which the hair" and beard appear as much de- veloped as in the male sex. In some cases, an external examination will entirely fail in indi- cating the sex, and even the opportunity of an examination of the dead body may leave the case in doubt. An ingenious writer has laid it dov^n that there are analogous organs in the two sexes which are never found in the same subject, and the separate existence of which would enable us to determine the sex. These analogous parts are the penis and the clitoris — the scrotum and the labia — -the testi- cles and the ovaries — the prostate gland and the uterus. This, how- ever, is an artificial and, as facts show, an incorrect means of dis- tinction. (See report of a case, in which a body resembling the prostate gland and a uterus existed in the same being, "Med. Times and Gaz.," Feb. 18, 1860, p. 177.) If a penis could always be clearly distinguished from a clitoris, and a scrotum from the labia, the rule might be serviceable ; but it fails where it is most required, i. e., in the mixed conditions. As to the other means of distinction, even if correct, they will only enable an examiner to form an opin- ion of sex in the dead, whereas it is during the life of one of these beings that the law requires the aid of medical science in the solu- tion of these questions. The reader will find, in the " Med. Times and Gaz.," an account of some remarkable cases of sexual malfor- mation by Mr. Curling (Jan. 24, 1852, p. 84) ; by Mr. Fletcher (Feb. 7, 1852, p. 136); by Mr. Broadhurst (Feb. 21, 1852, p. 187); and by Mr. Waters (May 21, 1853, p. 538.) Other cases, reported by Mr. Mann and Mr. Churchill, will be found in the "Association Journal," 1853 (Aug. 19, p. 720, and Sept. 9, p. 799). Mixed cases. — A case has been already mentioned in which neither testicles nor ovaries were found after death, and more than one in- stance has occurred in which both have been found — a case of inter- mixture of the sexes or real hermaphroditism, physically speaking, but of course without the functional power of self-impregnation. The following case is mentioned by Briand : The subject was about eighteen years of age when he died. The body was partly that of a male in configuration, and partly that of a female. An examina- tion of the sexual organs, externally, led to no satisfactory distinc- tion ; and on inspection after death a testicle was found in what was supposed to be the left labium, with an epididymis and a spermatic cord attached to it as usual ; while on the other side were an ovary. Fallopian tube, and the rudiments of a uterus. The authenticity of this case was for some time a matter of dispute ; but another, equally singular in its features, occurred to Prof. Mayer, of Bonn. This case clearly shows that such extraordinary deviations may be met with in nature. The person examined by Mayer died in 1835, at the age of 55. Diflerent opinions had been formed during the lifetime of the being respecting the sex, by the first anatomists in Europe: some afiarming that it was a male, while others contended 672 HERMAPHRODITISM — CAUSES. that it was a female. This difference of opinion is sufficient to prove that external examination does not always enable even a good anatomist to pronounce an opinion on the probable sex of the being. In the dead body was found, on the right side, a withered testicle, with a penis and prostate gland, as male peculiarities ; while on the left side was an ovary, with a uterus, vagina, and Fallopian tube. ("Med. Gaz.," vol. xix. p. 135.) It should be stated that the gen- eral configuration of the body in this case was that of a female ; but there was a duality of sex. The right half of the body was male, and the left half female. But cases may present themselves in which there is really no sex; the person cannot be assigned either to the male or female variety. M. Tardieu has given a report of a case apparently of this kind, in the "Annales d'llygiene" (1872, 2, 149). In these beings it is probable that there may be rudimentary organs of one or the other sex. This being was married as a woman at the age of 25. 'Her husband lived with her for more than two years before he took steps for a separation. It then turned out that the physical confor- mation of this person rendered a consummation of the marriage im- possible. The wife was found to have no organs essential to the female sex. There were neither breasts, vagina, uterus, nor ovaries. The pelvis was more like that of the male than of the female, and although then 27 years of age, the being had not menstruated and had not suffered from any periodical lucular or abdominal pains. On the other hand, with the exception of the conformation of the pelvis and the absence of breasts, there was no male development. When, on the one hand, there is an absence of vagina and uterus, and on the other of penis and testicles, it may be fairly said that this being had no sex. Causes. — The causes of malformation of the sexual organs, as of all other kinds of monstrosity, are involved in mystery. We know that in the early part of utero-gestation, the sex of a fcetus cannot be distinguished; while, even when it has reached the fourth month, the genital organs are so similar that the sex can seldom be deter- mined on inspection. Some organs or parts appear to be formed by equal and symmetrical portions, which gradually approximate and unite in the median line of the body. We observe this mode of union in the bones of the head, chest, and spine, as also in the vari- ous fissures (raphes) of the skin, which are the remains of a union between two equal and symmetrical parts of an organ, now become one. In regard to defects in organization, it may be remarked that they almost invariably occur in or about some part of the median line ; and they appear to proceed from a mere arrest of growth or development of those particular parts, either on one side or both, during the early stage of uterine existence. In this respect, the fissures sometimes observed in the palatine bones, in the palate itself, or in the lip — the openings occasionally noticed in the chest, diaphragm, anterior parietes of the bladder, as well as in the spinal canal, are precisely analogous in origin to the defective development of the sexual organs. There is nothing absolutely removed or lost, LEGAL RELATIONS OF HERMAPHRODITES. 673 but there is an arrest of development ; an opening, or fissure, which nature intended to be only temporary, becomes permanent by reason of an arrest of growth. In the evolution of the male genital organs, the part corresponding to the scrotum is at first always divided by a considerable fissure: and the penis and clitoris having, at this period of life, much the same kind of physical exterior, the sexual organs cannot be well defined. Should this fissure in the male not be after- wards filled up, then we shall have the most common variety of sexual malformation — the hermaphroditic form, with the male pre- dominating. These observations are not, of course, applicable to those cases in which the sexes are positively mixed. In these instances there appears to be a separate sexual organization on the two sides of the body, with an imperfect development of each set of sexual organs. According to Weber, there is in the prostate gland a rudimentary uterus in every male. (" Baly and Kirke's SeCent Advances in Physiology," 1848, p. 112. Also papers by Dr. Knox, "Med. Gaz.," ISTov. and Dec. 1843.) One circumstance is worthy of note, namely, that sexual mon- strosity appears occasionally to occur in the successive pregnancies of a well-formed female. The late Dr. Lever met with a singular instance of this in a female aged 28. She had given birth to four children in the three confinements, the first being a twin labor ; both the children males ; and in both there was an arrest of develop- ment of the sexual organs. On the third delivery, the child was a male, and its sexual organs presented the same deformity as those of the twins. (" Med. Gaz.," vol. xxxviii. p. 946.) Legal relations. — These beings, owing to defective development, are impotent and sterile. Questions connected with the legitimacy of offspring, divorce and affiliation may, therefore, be raised with respect to them. Sexual monstrosity is not a ground for depriving a being of the rights of inheritance, except under peculiar legal conditions. Thus, a right of succession or inheritance to lauded estate may depend upon the sex of the offspring — as where, for instance, two children are born, the first hermaphrodite, the second a well-formed male child. The parents die, and a title of nobility or lands may fall to the first-born male. Here, the sex of the first- born must be determined before possession can be had. In a case of this kind, if medical evidence should establish that male pecu- liarities predominate in the first-born, the second child would be cut off. Again, if an estate were limited by entailment, as where it is settled upon heirs male and female of a particular family, the birth of an hermaphrodite, an only child, would create the legal necessity for a positive determination of the predominance of sex. So, if the hermaphrodite live but a few minutes after birth, and then die, the rights of persons may be subsequently much afl'ected by the medical attendant having come to an opinion respecting its sex. Since we cannot determine under what circumstances litiga- tion may ensue, it is always right in a doubtful case to observe the sex, and make notes on the spot when a child thus malformed sur- vives its birth but for a short period. The question of tenancy by 43 674 LEGAL RELATIONS OF HERMAPHRODITES. courtesy, or the right of the husband to landed estate of which the wife was seized, will depend entirely upon the attention of the accoucheur to this point. (See " Tenancy by Courtesy," ante, page 628.) When these beings have reached adult age, other questions may arise with respect to them. According to an old law of France, an hermaphrodite was permitted to choose one sex, and thereafter compelled to keep it ! Hermaphrodites, or sexual monsters, were formerly ranked with infamous persons : and it has been a grave question in our courts, whether the calling a man an hermaphro- dite was not such a libel or slander upon him as to render it a ground for a civil action. In a case reported by Chitty (" Med. Jour.," 374), the use of this term was held not to be actionable unless it was proved that it had been attended with special damage. A dancing-master brought an action against a party for calling him an hermaphrodite, and it was decided that it was not 8ustainal)le : 1. Because such a union of the sexes cannot exist in fact, and every one must be supposed to know it ; consequently the assertion could not be supposed to prejudice. 2. Because, admitting the possibility of such a double function, the party would be just as good, and perhaps even a safer dancing-master, than if only one perfect sex had been discoverable; consequently the words would not, in legal presumption, injure him in his profession or occupation ! I am indebted to a learned member of the bar for a note on the remarkable case of the Chevalier d'JEon. There was a great dispute concerning the sex of the Chevalier, and it came before a court of law on an action to recover a wager under the following circum- stances {Da Costa v. Jones, " Cowper's Reports," vol. ii. p. 729). The plaintiff claimed of the defendant a sum of three hundred pounds. On the 4th of October, 1771, plaintiff paid to the defend- ant seventy-five guineas, on the condition that he, the plaintiff, should receive from the defendant a sum of three hundred pounds in case the Chevalier d'Eon should at any time prove to be a female. The cause was tried before Lord Mansfield, at Guildhall, and the jury found a verdict for the plaintiff, damages three hun- dred pounds, thereby affirming that the Chevalier was a female. A motion was subsequently made on behalf of the defendant to arrest the judgment, or at least to stay the proceedings, on the ground that the action could not be supported, as being upon a wager tending to introduceindecent evidence, and also as being one which materially affected the interests of a third person. The question thus raised on the motion was argued before the Court of King's Bench, and the judges unanimously agreed that the judgment must be arrested ; the law not allowing wagers upon subjects leading to the introduction of indecent evidence (this being contra bonos mores), nor upon such subjects as are calculated to have an injurious effect upon the interests or character of a third person. Irrespec- tive of this decision, the verdict was based upon what subsequently turned out to be untrue. The Chevalier was really a male, and not a female. He was carefully examined by Sir Anthony Carlisle, ELECTORAL BIGHTS OF HERMAPHRODITES. 675 who satisfied all present of the perfect condition of the testicles. (See Paris and Fonblanque, vol. i. p. 229.)^ It would appear, from a singular case reported by Dr. Barry, that, in the United States, the rights of citizenship and the privilege of voting for members of Congress have depended on the determina- tion of sex. In March, IS-iS, he was requested to examine the case of Levi Suydam, aged 23 years, a native of Salisbury, Conn. At the exciting and warmly contested election of the spring of that year, almost everything bearing the semblance of the human form, of the male sex, is stated to have been brought to the ballot-box. It was at this time, and under these circumstances, that the above- mentioned person was presented by the whigs to be made a free?7ian. He was challenged by the opposite party, on the ground that he was more a female than a male, and that, in his physical organization, he partook of l)oth sexes. The following was the result of theirs;; examination by Dr. Barry. There was a mons veneris covered with hair in the usual way; an imperforate penis, subject to erections, and about two inches and a half in length, with corresponding di- mensions ; the dorsum of the penis was connected by the cuticle and cellular membrane to the pubis, leaving about an inch and a half free, or not bound up, and towards the pubic, region. This penis had a well-formed glans ; a depression in the usual place of the mea- tus urinarius, with a well-defined prepuce and foramen. The scrotum was not fully developed, inasmuch as it was but half the usual size, and not pendulous. In the scrotum, and on the right side of the penis, there was one testicle of the size of a common filbert, with a spermatic cord attached. In the pernineum, at the root of the cor- pora cavernosa, an opening existed through which micturition was performed; this opening was large enough to admit the introduction of an ordinary-sized catheter. Having found a penis and one testicle, though imperfectly developed. Dr. Barry, without further examination, gave it as his opinion, that the person in question was a male citizen, and consequently entitled to vote and enjoy all the privileges of a iveeman ! On the morning of the first Monday in April (election day), Dr. ' [The Chevalier D'Bon had served as a military officer, had acted as a di- plomatist, and had fought duels, hut his appearance was very effeminate ; and after he had resided some years in England, frequenting race-courses and gaming-houses- in male attire, Mr. DaCosta wagered a large sum with Mr. Jones that the supposed Chevalier was a woman, and brought the action mentioned in the text, which re- sulted as there stated. Lord Campbell, speaking of this case, says: "Although the verdict was set aside on legal grounds, it was allowed to settle many other bets which had been laid on the same question. The Annual Register for 1766, p. 167, says, ' By this decision, no less a sum than £75,000 will remain in this country, which would otherwise have been transmitted to Paris. The Chevalier has left England, declaring that she has no interest whatever in the policies opened on her sex. ' The Chevalier, then assuming female attire, remained in France, supported by a pension from the French Government, for having long been a spy of Louis XV., till the breaking out of the Revolution in 1790. He then came to England, and, being in great distress, lived with a lady of reputation aa her companion ; but dying in the year 1810, was found on a post-mortem examination, to be indeed of the sex which he had originally claimed, and in all respects perfectly formed." — Lives of the Chief Justices, vol. 3, 334 (Life of Lord Mansfield.)— P.] 676 DESTRUCTION OF SEX BY OPERATION. Barry was informed that Dr. Ticknor would oppose Suydam's ad- mipsion on medical grounds. Suydam came forward, and Dr. Tick- nor objected to him as a female^ and therefore not entitled to vote. Dr. Barry then stated to the meeting, that, from an examination he had made, he considered the person in question to be a male, and re- quested that Dr. Ticknor might, with the consent of Suydam, retire into an adjoining room, and examine for himself. This was done, when Dr. Ticknor ultimately came to the conclusion that Suydam was a male. Suydam accordingly was admitted a freeman ; and his vote was received and registered. A few days after the election. Dr. Barry heard that Suydam had regularly menstruated. The sister of Suydam informed him that she had washed for him for years, and that he menstruated as regularly, but not so profusely, as most women. Suydam, when questioned, very unwillingly confessed that such was the fact. He was again examined by two physicians, when the following addi- tional particulars were elicited : Said Suj'dam is five feet two inches in height, light-colored hair, fair complexion, with a beardless chin, and decidedly a sanguineous temperament, narrow shoulders and broad hips ; in short, every wBij of a feminine figure. There were well-developed breasts with nipples and areolse. On passing a female catheter into the opening through which micturition was performed, and through which, he again stated, he had a periodically bloody discharge monthly, instead of traversing a canal and drawing oif urine, the catheter appeared to enter immediately a passage similar to the vagina, three or four inches in depth, and in which there was a considerable play of the instrument. He stated that he had amorous desires, and that, at such times, his inclination was for the male sex ; his feminine propensities, such as a fondness for gay colors, for pieces of calico, comparing and placing them together, and an aversion for bodily labor, and an inability to perform the same, were remarked by many. Dr. Bany further learned from an old lady, who was present at the birth of Suydam, that on the second day after his birth. Dr. Delamater, who attended as accou- cheur, made with an instrument the opening through which he had ever since performed micturition. (" American Journ. of the Med. Sciences," July, 1847.) This was certainly an embarrassing case — one to which Lord Coke's rule for a decision, i. e., the prevalence of either sex, is hardly applicable. The presence of a penis and one testicle referred the being to the male, while the bodily configuration, and still more strongly the periodical menstrual discharge, referred him to the female sex. The right of voting might have been fairly objected to, because, while the female characters wgre decided, the organs indicative of the male sex are described as having been imperfectly developed. Dr. Hartshorne, an American physician, quotes a case in which an attempt was made by Dr. Gross, a surgeon in the United States, to destroy all sexuality, and thereby all rights of citizenship, in the case of an infant whose sexual organs were imperfect. (A report DESTRUCTION OF SEX BY OPERATION. 677 of this case will be found in the " American Journal of Med. Sci." for Oct. 1852, and the "Ed. Monthly Journ." for Jan. 1853.) The child, when seen by Dr. G-ross, was three years of age, and had always up to that period been regarded as a girl, and in fact had been so pronounced at her birth by the accoucheur. At the age of two years she began to evince the taste, disposition, and feelings of the male sex ; she rejected dolls and similar articles of amusement, and be- came fond of boyish sports. She was well grown, perfectly healthy, and quite fleshy. Her hair was dark and long, the eyes black, and the whole expression most agreeable. A careful examination of the external genitals disclosed the following circumstances. There was neither a penis nor a vagina ; but instead of the former there was a small clitoris, and instead of the latter a superficial depression or cul-de-sac covered with mucous membrane, and devoid of everything like an aperture or inlet. The urethra occupied the usual situation (in the female ?) and appeared to be natural ; the nymphse were re- markably diminutive, but the labia were well developed, and con- tained each a well-formed testicle quite as large, and as firm as this organ generally is in boys at the same age. The hips, chest, thighs, and upper extremities were perfect. From this description it is pretty clear that the child was an androgynus, or there was imper- fect development of the sexual organs, with predominance of those of the male. There was no indication of uterus or ovaries, nor any external peculiarity, except that which is frequently met with in hermaphrodites, in which there is an arrest of male development, but no intermixture of the sexes. Dr. Gross considered that for the child's future welfare and happiness, it would be better that it should have no testicles at all, than that it should retain them under such an imperfect development of the other organs. He therefore removed them by operation from the labia or divided scrotum, and had the dissatisfaction to find that they were perfectly formed in every respect, and that the spermatic cords were quite natural. The operation was performed in July, 1849, and three years subsequently (in 1852) it was found that emasculation was complete, for the disposition and habits of the being had materially changed, and were those of a girl ; she was found to take great delight in sewing and housework, and she no longer indulged in riding sticks, and other boyish exercises. The reasons assigned for the performance of this operation — namely, the entire deprivation of sex, and thereby of any sexual feelings in after-life — appear to me to be unsatisfactory. It is clear, from Dr. G-ross's description, that this being was deprived of the rights and privileges of a male by the removal of the testicles. (See the case of Levi Suydam, ante, p. 675.) Dr. Gross appears to have contemplated the case only in a matrimonial point of view; but in a country where the rights of citizenship and power of voting for members of Congress are much valued, where they depend on direct proofs of sex, and ai'e so strongly contested by opposing parties — it is a serious question whether he has not here struck a severe blow 678 CASES OF CONCEALED SEX. at the political rights of these beings, in thus wilfully destroying the physical evidence of the male sex ! In this country, it might have been a question whether he had not rendered himself liable in damages for thus tampering with the laws of nature. Concealed sex. — -It is almost superfluous to say that in some cases sex cannot be determined by the dress, appearance, or even voice of the individual. Cases in which males have passed for many years unsuspectedly as females, and vice versa., have been numerous. In some instances the secret has been disclosed only by death. Facts of this kind belong rather to the annals of imposture than to those of medical jurisprudence. A somewhat singular case of this de- scription, that of Eliza Edwards, occurred to me in 1833. An un- claimed body was sent to Guy's Hospital, by the Inspector of ana- tomy, as a female. On removing the dress, however, it was'found to be that of a male ! From some suspicion respecting the cause of death, and the habits of this person, a coroner's inquest was held. It turned out that the deceased, whose age was twenty-four, had assumed the dress of a female at the age of fourteen, and had per- formed in many parts of England as an actress. The features had a somewhat feminine character ; the hair was very long, and parted in the centre ; the beard had been plucked out, and the remains of this under the chin had been concealed by a peculiar style of dress. It was remarked during life that the voice was hoarse. The breasts were like tho?e of a male, and the male sexual organs were per- fectly developed. They had evidently been subjected to great traction, and appeared to have been drawn forward to the lower part of the abdomen. The state of the rectum left no doubt of the abominable practices to which this individual had been addicted. It was found that death had taken place from natural causes. The most remarkable circumstance in the case is, that the deceased had been attended in his last illness by an eminent physician (now de- ceased) for disease of the lungs ; and so well was the imposition maintained, that his medical attendant did not entertain a sus- picion of the real sex of his patient! ("Med. and Phys. Jour.," Feb. 1833, p. 168.) A more remarkable case, in which a female had successfully per- sonated a male for many years, occurred in 1865. I refer to the case of Dr. James Barry, who was well known as Staff Assistant- Surgeon and Inspector of Hospitals. She died in 1865, at the age of 80 ; and although suspicions had existed among those who had. personally known her, that she labored under some sexual defect, it was only proved after her death that she was really a woman. She is reported to have been the illegitimate child of a nobleman. When, where, and how she passed through her medical studies no one knows, but she contrived to obtain a diploma as Doctor of Me- dicine from Edinburgh when only fifteen years of age. The learned examiners of the Edinburgh College may at this time have been easily deceived respecting the sex of the candidate. The young physician entered the army, and served at the Cape of Good Hope, CASES OP CONCEALED SEX. 679 St. Helena, the Ionian Islands, Malta, and the West Indies. Al- though eccentric, she is said to have displayed on various occasions great professional skill. She was noted for being very quarrelsome, and on one occasion at the Cape she challenged and fought a duel with a brother ofl&cer. In due course she retired from the service, received a pension, and was made Inspector of Hospitals. In 1857-8, and subsequently, I saw Dr. Barry, and had the opportunity of ob- serving her for several days. Her appearance and manners were effeminate. Her face and hands were smooth and white, like those of a woman ; she had no beard or whiskers. She was irritable and vain ; she was well informed and able to talk on most professional subjects in a manner which showed that she had studied them with care. Her habits were peculiar ; she was a vegetarian in diet, and at dinner ate fruit or vegetables, which she first soaked thoroughly in water in order to remove, as she informed her friends, the ani- malcula upon them. She was thin, and in stature resembled a woman, her limbs being small, but in good proportion. Her voice was shrill and squeaking, quite unlike that a man. The impres- sion left upon the mind of all those who saw her was that she labored under some sexual malformation. After her death, how- ever, it was found that she had the sexual organs of a woman. She had specially desired that no post-mortem examination of her body should be made, but this oi'der was disobeyed, a special report having been ordered by the authorities. It is difficult to compre- hend how, in assuming the attributes and duties of an army medical officer, she could have so successfully maintained the deception through a long life. Whether she menstruated or not does not appear ; although always accompanied by a black man as a valet, I, she was very secret with him, and would not allow him to be pre- sent while she was dressing. She is said to have always worn a peculiar and tight-fitting dress. Her military companions and as- sociates may have rested content with the belief that she was laboring under some sexual defect ; but the army Medical Board t appears to have been easily deceived, as it did not hesitate to grant li titles, privileges, and pensions to a woman wearing the attire of a man. 680 CAUSES OF IMPOTENCY. IMPOTENCY. STERILITY. CHAPTER LVII. IMPOTENCY. — CAUSES. — PROCEEATIVB POWER IN THE MALE. — PUBERTY. — AGE FOR VIRILITY. — VIRILITY OP CRYPSORCHIDES AND MONORCHIDES. — STERILITY. — PROCRBATIVB POWER IN THE FEMALE. — EARLIEST AND LATEST PERIODS FOR CHILD-BEARING. — LEGAL RELATIONS. Definition. — Impotency is defined to be an incapacity for sexual intercourse. It may depend — 1st, upon -physical, 2dly, upon moral causes. With regard to the moral causes of impotency they do not concern a medical jurist. Such causes are not recognized by law, and he has no duty to perform beyond the application of the prin- ciples of medicine to the purposes of the law. Causes. — Impotency may arise from age, from certain physical causes, e. g., disease, or from congenital malformation or defied. With regard to physical causes, a distinction must be made between those which are remediable, and those which are noti The presence of a disease of the testicle, such as atrophy or fungous tumor, may give rise to incapacity ; but this incapacity may be sometimes removed by an operation or by medical treatment, and therefore the physical cause may be removed ; in other words, it is remediable. To such cases as these the law does not extend ; but it is always expected, in alleged incapacity, that the practitioner examined on the subject should be able to say whether there is or is not a prospect of cure. In forming a judgment upon this point a good knowledge of his profession can alone assist him ; no rules can be laid down for his guidance, for there may not be two cases that will precisely resem- ble each other in their features. Hence, it will be necessary in this place, to point out the chief causes of impotency which are of an irremediable nature, or those in which the incapacity is absolute and permanent, — a point upon which a medical opinion is chiefly required. In strictness of laoiguage, the definition of impotency, as above given, may be applied to a female as well as to a male ; and un- doubtedly, a physical incapacity for sexual intercourse may exist in either sex. As an instance of this incapacity in the female, may be mentioned occlusion of the vagina— a condition not necessarily indicative of sterility. The mere occlusion of the vagina may be a remediable form of the malady ; but its entire obliteration would PEOCREATIVE POWER IN THE MALE. 681 be absolute and irremediable. This latter condition, however, is the only instance of complete impotency in a female. A protru- sion of the uterus or of the bladder into the vagina is mentioned by some writers as a cause of physical incapacity for intercourse ; but these forms of disease may be commonly remedied by art, and therefore require no further notice in this place. In professional language, the term impotency has been hitherto applied exclusively to a defect in the male sex ; and the term ste- rility is usually confined to all those conditions in the female which not only render intercourse impossible, but which render it unfruit- ful. A male may, however, be sterile without being impotent — a condition observed in some crypsorchides ; or he may be impotent without being sterile, as where proper intercourse is prevented by reason of physical defect in the virile member, although the testi- cles may be in a normal condition. See on this subject. Curling on " Sterility in Man" (1864). This author points out that sterility in the male, apart from impotency, may depend on three causes — Ist, malposition of the testicles ; 2dly, obstructions in the excretory' ducts ; and 3dly, impediments to the escape of the seminal fluid. A man may not be impotent, i. e., incapable of intercourse ; but, by reason of one of the conditions above mentioned, such intercourse would be unfruitful. In reference to the male, the English law does not appear to go' beyond the establishment of impotency from some clear and demon- strable cause ; and, unless the alleged sterility were accompanied by impotency, it would take no cognizance of that condition. Further, sterility from such causes could hardly be demonstrated during the life of a person — it would rest chiefly on presumption or pro- bability. Procreative power in the male. Puberty. — Until the period of puberty the testicles are small, and they increase very little in size in proportion to other parts. Mr. Curling found that the size of the seminal tubes differed but little at the ages of 18 months and 8 years. The sexual function in the male depends entirely on the development of these organs ; but the age at which it appears dif- fers in different persons. The age of puberty in a healthy male in this country varies from 14 to 17 years ; its appearance is, however, affected by climate, constitution, and the moral circumstances under which the individual is placed : in some cases it is not fully devel- oped until the age of 21. The access of puberty in the male is indirectly connected with the subject of rape. A boy under the age of fourteen years is pre- sumed in law to be incapable of committing a rape. (1 Hale, p. 631, and Mathew's "Digest," p. 57.) This presumption is probably based on the supposition that a boy at that age is impotent. The statute law, however, now merely requires proof of penetration, and rape, therefore, may be physically perpetrated by a boy at or even under 14 years of age. In Reg. v. King (York Winter Assizes, 1853), a boy aged fifteen was convicted of rape on a girl under 10 years of age. lu a case elsewhere related (see Rape), a boy aged 19 com- 6S2 ILLEGITIMACY AND IMPOTENOY. municated syphilis to a girl of 6 years of age. It appears that in India, puberty shows itself much earlier in the male. Dr. Chevers, quoting from the " Mzamut Adawlut Reports," states that a boy of 13 or 14 years of age was found guilty of rape, and sentenced, in consideration of his youth, to three years' imprisonment. A lad of fourteen was convicted of rape on a girl of the same age ; and in another case a boy only ten years old, was convicted of rape on a girl 3 years of age! He was sentenced to a year's imprisonment. ("Med. Journ. for India," p. 463.) The seminal secretion in the male is not considered to be prolific until it contains those peculiar filiform bodies which are known under the name of spermatozoa or zoosperms. These are regarded by some physiologists as parasitic animals, but by others, with some probability, as freely moviiig cilia. (" Recent Advances," Baly and Kirkes, 1848.) All agree that they are normal and essential con- stituents of the healthy and prolific seminal fluid. They are pecu- liar to the spermatic secretion, and, in healthy males, are always present in it after the age of puberty. They disappear in certain states of disease, and sometimes in advanced age : they have not been found in the undeveloped testicles of crypsorchides. In cases in which they are absent, from whatever cause, it is a fair inference that the person is impotent, or that he has lost the power of pro- creation. (See on this subject " Observations on Sterility in Man," by T. B. Curling, 1864.) In this pamphlet one case is related in which a man aged 42, who was married, and whose wife had borne a son then 8 years of age, had died after four days' illness from strangulated hernia. The testicles, from the fact of their being found in the inguinal canal, were examined separately by Drs. Gosse- lin and G-odard, and no spermatozoa were discovered in either of them ; but these may have been formerly present, though absent at the time of examination, as the child begotten was then eight years of age. In this long interval, the secretion may have under- gone a change, and have become unprolific. The presence of spermatozoa in the seminal secretion is indis- pensable to the impregnation of a female — in fact, the fecundating power resides in these living and moving molecules. It is a curious fact, too, that active motion in the spermatozoon is essential to fecundation ; thus, when they are motionless, ova are not impreg- nated by them, and the power of impregnation is in proportion to the activity of this motion. The impotence arising from advanced age in the human subject, is probably not so much owing to a de- ficiency of spermatozoa in the male secretion, as to their power of motion being exceedingly feeble. We learn, further, that impreg- nation is more certain when the quantity of spermatozoa supplied to the ovum is not reduced to a minimum ; hence, whatever may be the precise quantity of the spermatic secretion (lecessary to effect normal impregnation, it is proved that a definite quantity of spermatozoa, or of healthy spermatic fluid, is required to fecundate. Impotency from age. — It may be fairly assumed that a male is in- capable of procreating until spermatozoa have appeared in the ILLEGITIMACY AND IMPOTENOY. 683 seminal secretion, and that he loses this power when they dis- appeai". The age at which they ai'e formed varies with all the causes that affect puherty. In one instance they were found by Casper in the seminal fluid of a crypsorchid boy only 14| years old, and Mr. Curling found them in the secretion of a boy aged 18. This gentleman found spermatozoa in the liquid taken from the testicles of a man upwards of seventy years of age, and on one occasion, in the testicles of a person aged eighty-seven. Wagner states that they are to be found in the secretions of men between 70 and 80 years of age. M. Rayer found them in the secretion of a man aged 82 years (" Gaz. Med.," Juin 2, 1849.) Other cases of a similar kind are recorded by Debrou. (" Gaz. Hebdom.," 4th Janvier, 1861, p. 6.) Facts tend to render it highly probable that the fecundating power may be retained by the male up to the age of 100. According to Dr. Dupley, the seminal fluid of old men contains spermatozoa even when they are beyond the age for fecun- dation (" Med. Times and Gazette," June 4, 1853, p. 581) ; but he does not state the circumstance which enabled him to arrive at this conclusion. Sexual propensities are often strongly developed in children, and thus the}' may be prolific at an early age. Dr. E.ut- tel met with a case in which a female at the age of 14, became pregnant by a hoy of the same age. (" Henke's Zeitschrift der S. A.," 1844, p. 249.) This is the earliest age at which, so far as I can ascertain, the procreative power has appeared in the male. Dr. Hartshorne refers to an instance of extraordinary development of the male sexual organs in a child 4 years old. (" Amer. Journ. Med. Sci.," Oct. 1852, p. 561.) In a case of contested legitimacy or affiliation, this question regarding the age at which a procreative power appears in the male, may have an important bearing on the issue. Thus the person may be so young as to render it impossible that he should, be the father of a child imputed to him. Cases involving questions of legitimacy on this ground are not heard of in the present day ; but in ancient law-books, there are decisions relative to the illegitimacy of children born during marriage, because the alleged fathers were 7, 6, and even 3 years old ! (Amos.) The following case in reference to the affiliation of children oc- cured in 1840 ; a woman wished to affiliate a child on a youth who was in his sixteenth year. The boy denied that he was the father of the child : and there was reason to suspect that the imputation had been wrongly thrown upon him, in order to divert suspicion from the real offender. There was some difficulty in this case ; but it appears to me that the rule for a medical man to follow on these occasions is this : not to regard the mere age of the youth, whether he is above or below the average age of pubei'ty, but to observe whether the sexual organs are fully developed, and whether there are about him any of the marks of virility, indicated by muscular development, the growth of a beard, and a change in the voice. If these signs are present, whatever may be his age, there is strong 68-4 ILLEGITIMACY AND IMPOTENOT. reason to suppose that the sexual functions are developed. We ac- casionally hear of instances of extraordinary precocity ; but the development of sexual power is generally accompanied by other well-marked changes in tl;ie person. Sometimes these changes do not make their appearance until after the age of 21. [Some re- markable cases of precocious puberty are given in "Wharton and Stint's Medical Jurisprudence, § 424.— P.] On the other hand, it may be a question at what time the pro- creative power disappears in a male. That impotency is one of the natural consequences of advanced age is undoubted ; but this, as we know, forms no legal impediment to the marriage of parties, how- ever old. The legal presumption is, that the generative faculty does not disappear through age ; and if this be alleged, and legiti- macy disputed oh this ground, it must be satisfactorily proved by those who would benefit by the allegation. This amounts to almost an impossibility, because it is well known that there is no fixed age at which the sexual functions cease either in the male or the female ; and individuals, at least of the male sex, who had reached the ages of 60, 70, and even 80 years, have been known to be capable of fruitful intercourse. M. Dunley believes, from his anatomical observations on the bodies of aged persons, that the causes of impotency (sterility) in advanced age are to be found rather in the excretory than in the secretory apparatus. Thus, he has met with obliterations in the canal of the epididymis, the vas deferens, and the vesiculse, the effect of which is to prevent the accumulation and passage of the seminal fiuid. ("Med. Times and Gazette," June 28, 1856, p. 650.) Lord Erskine, in the Banbwy Peerage claim, quoted the case of Sir Stephen Fox, who was mar- ried at 77, and had four children, the last when he was 81. Dr. Schneider met with a case in which a man of 71 had a child by his wife, who was only 17. (" Henke's Zeitschrift," 1842, vol. 2, p. 165.) Dr. Ruttel mentions the case of a man who, at the age of 92 years, married and had two children by his wife. When the procreative power even appears to be lost at an advanced age, the stimulus for intercourse is often very great. The same authority mentions cases in which these erotic feelings were remarked by him in reference to men between 75 and 86 years of age. (Henke's " Zeitschrift," 1844, p. 252.) In all cases of prolonged virility, it is observed that the bodily and mental powers are also retained in an extraordinary degree, showing the close relation which exists be- tween the sexual function and corporeal and mental development, even to the latest period of life. Sir S. Romilly remarked, in re- ference to the retention of procreative power in advanced age, that the liberality of the English law on this subject was excessive ; for there was no age, from seven upwards, at which a man had been denied the power of procreating children ! (See, in reference to this subject, Henke's " Zeitschrift der S. A.," 1842, p. 332.) Males at the age of 14, and females at the age of 12, are legally compe- tent to contract marriage. IMPOTENCY FROM LOCAL DISEASE OK ACCIDENT. 685 Impotency from local disease or accident. — The loss or destruction of the penis or testicles, either by disease, accident, or from neces- sary operations, would be sufficient to render a man irremediably impotent. The loss of one or both testicles, from any of these causes, would be indicated by the presence of distinct cicatrices in the scrotum. When both have been removed by operation, the person is incurably impotent; but if the organs are healthy, a sufficiency of the spermatic fluid to confer procreative powers may remain in the ducts for two or three weeks after the operation. Thus it is that animals have been known to be prolific for a certain time after castration ; and one case is on record in which a man, both of whose testicles had been carried ofi:' by a gunshot, is said to have retained the power of impregnating his wife after the healing of the wound. (See a paper by Dr. Krugelstein, Henke's " Zeitschrift," 1842, vol. 1, pp. 348 and 352.) The loss of one testi- cle only, by accident or operation, does not render a man impotent. Monorchides, as they are called, have been known to be prolific. Cases of this kind must not be confounded with those in which one or both testicles have not descended into the scrotum. In some rare instances, the testicles do not descend into the scrotum at the usual period ; but one or both may remain in the abdomen, or in the inguinal canals, and only descend some time after birth ; or the one may be found in the scrotum, and the other re- main during life in the abdomen, or both may be retained in the abdomen. In some cases of partial descent the organs have been mistaken for, and treated as, ruptures by the application of a truss ! (Henke's "Zeitschrift der S. A." 1844, vol. 1, p. 249; Curling on " Disease of the Testis," 2d ed. p. 31.) In one instance, the attempt to reduce the tumor mistaken for hernia, and the application of a truss, caused the death of the person. (" Med. Times and G-az.," March 2, 1861, p. 240.) When one testicle only has descended, there is no ground, cceteris paribus, to impute impotency: the de- scended organ has been found healthy, and to contain spermatozoa, while the retained testicle and its ducts have not been found to contain spermatozoa. Mr. Curling has collected six of these cases, of which four fell under his own observation. (" On Sterility in Man," 1846, p. 6, and "Med. Times and Gaz.," Feb. 23, 1861.) When neither testicle has descended, the scrotum will be found empty, without any scar indicative of a removal by operation, but the other marks of virility may still be present. These persons have been called Crypsorchides. It has been stated that in such cases the testicles have been regarded as congenitally defective, and further, that the individual, although capable of sexual intercourse, is incurably sterile. The non-descent of the testicles is a state rarely seen. Mr. Mar- shall met with only one case of non-descent of one testicle in 1000 recruits, and with one case of non-descent of both testicles in 10,000 recruits. There are three preparations, showing the non-descent of these organs, in the museum of Guy's Hospital : one of them was taken from a gentleman who shot himself from despondency at his 686 ALLEGED STERILITY OF OB YPSORCHIDES. supposed defective condition. Hunter thought that the undescended testicles were always imperfect in both their structure and functions, and that crypsorchides were invariably impotent (sterile). Some recent researches have tended to support the views of Hunter. In January, 1860, Mr. Partridge communicated to the Pathological Society the case of a man of 25, in whom both testicles were found in the abdomen. Several specimens of the secretion were examined, and no spermatozoa were detected. Another case was examined with a like result (" Lancet," January, 1860, p. 66), and a third by Mr. Curling (" Med. Times and Gaz.," February 23, 1861). The conclusions to which these observations have led is, that although in cases of non-descent there may be a capacity of sexual intercourse, it would not be prolific: the person will be sterile. According to this view, malposition of the organs may be taken as synonymous with defective condition: as a result of this malposition they are not capable of secreting prolific spermatic fluid, and the person is as sterile as if he had no testicles. The cases of monorchides re- ported by Mr. Curling (Op. cit. p. 8) to some extent support this theory, since spermatozoa were found only in the fluid of that tes- ticle which occupied its usual position in the scrotum. He has also collected from various sources seven cases of crypsorchides, in which both testicles were either in the abdomen, or in the inguinal canals; the fluid contained in them was destitute of spermatozoa, and although impotency did not exist, these persons either were, or were presumed to be unprolific. M. Godard has noticed that horses whose testicles are retained in the abdomen, although capable of intercourse, are sterile. On the other side of the question there are, however, facts which are wholly inconsistent with this theory. Many years since I pub- lished an account of two cases of crypsorchides communicated to me by my friend and colleague Mr. Cock. The testicles in these men had not descended, but their virile functions were undisputed. One of them, before he had reached the age of 30 years, had been twice married, and had had children by each wife, besides illegiti- mate children which were affiliated on him during the time he lived in service. In a report of cases of hernia by Mr. Poland (" Guy's Hospital Eeports," 1843, vol. 1, p. 163), there is the case of a man, aged 29, a crypsorchid, whose testicles had never descended. Mr. Poland states that there was not the slightest trace of scrotum ; the penis was well developed, and there were all the other signs of virility. This man married when he was 20 : he had had two chil- dren by his first wife; and at the time of his admission into the hospital had been married two years to a second wife. In January, 1862, 1 saw, in Guy's Hospital, a patient under Mr. Durham : the testicles of this man had not descended — they were lodged in the inguinal canals. The man was 32 years of age, well developed, with every appearance of virility about him, and with the same masculine development which is seen in other men of the same age. This man was married, and had had two children by his wife. Since puberty, he had always been competent, and he ridiculed the VIRILE POWEES OF CR YPSOBCHIDES. 687 idea that his testicles were inefficient. Another case is referred to by Mr. Curling (Op. cit. p. 9), which occurred to Dr. Debrou, of Orleans. The testicles were in the inguinal canals ; there was no scrotum. The man had been married, and had had one son by his wife. These facts prove that crypsorchides, in some cases, have a power of procreation like normally constituted men. Casper relates a casein which a crypsorchid was charged with an unnatural oiFence. He was a boy between 14 and 15 years of age, and it appeared that he had been guilty of unnatural conduct towai'ds another boy 8 years of age. Spermatozoa were detected by Casper on his shirt sixteen days after the act. On examining the boy, both testicles Avere found in the inguinal canals. (" Grer. Med." vol. 2, p. 187.) By these facts, therefore, it is satisfactorily established that cryp- sorchides are not necessarily sterile, and that no absolute rule can be laid down respecting the existence or non-existence of prolific power under such circumstances. It has been objected that in the above instances of prolific power spermatozoa have not been proved to exist in the spermatic secretions of the individuals, and that the evidence is therefore incomplete. But these bodies have not been proved to be absent, and most persons will agree that there is no better evidence of prolific power than the procreation of children, whether sperma- tozoa are, or are not detected ; a matter which will sometimes depend on the accuracy of observation or experience of the examiners or, 'it may be, on a morbid state of the secretion. If none were found under these circumstances, it would only prove that our present theories of generation would require to be modified. One affirma- tive instance is sufficient, for all the purposes of law, to overthrow ninety-nine negative instances ; and as a physiological fact, it is obvious that the organs which have not descended are not always defective in structure or function. The cases hitherto observed are so nearly balanced that it is difficult to say whether it is the rule or the exception that crypsorchides should be found pi'olific ; the facts above mentioned clearly prove that there is no reasonable ground for pronouncing them to be absolutely sterile or unprolific merely because their testicles are not in the scrotum. If with a non-descent of these organs, there should be a non-development of the other external organs, and this is accompanied by a total want of the characters of virility, then the person may be impotent or sterile. The testicles may, in such a case, be either congenitally absent or physically imperfect, — a fact only ascertainable by an examination of the body after death. On the other hand, in cases in which there are no external marks of effeminacy, or other grounds for suspecting a want of procreative power, and the person is capable of sexual in- tercourse, this imperfection does not offer any bar to marriage, nor is it a sufficient ground for divorce. It would not justify a medical man in denying the paternity of a child on a question of affiliation, bastardy, or inheritance ; and so long as a power of sexual inter- course existed, it would not justify him in pronouncing a person to be incurably sterile. The capacity for sexual intercourse is the fact to which the English law commonly looks on these occasions. If EFFECT OF SEXUAL MALFOEMATION. this exists, then it will hardly entertain the question — surrounded as it may be with conflicting medical opinions — whether, from the mere retention of the organs in the abdomen, the fluid secreted is or is not, microscopically speaking, of a prolific nature ? "Women may be sterile from a variety of causes affecting the internal organs, only ascertainable after death. The ovaries may be so diseased that no prolific intercourse can take place, although there may be no physical incapacity. In a case related elsewhere, the incapability of conception on the part of a woman was held by Dr. Lushington not to be a sufficient ground for pronouncing a sentence of nullity of marriage {post) ; and doubtless the want of power on the part of a man to efi'ect impregnation, unless it depended on some visible physical defect, would be viewed in a similar light. Such persons are not impotent, but sterile, and sterility in an irremediable form is rather assumed than demonstrated to exist. The presence of what have been called supernumerary testicles does not affect the virile powers of the individual. These have in general been found, by dissection, to be tumors, connected with the healthy glands, and not at all adding to or interfering with their functions. Even the presence of two or three penes, according to Mende, is no bar to the exercise of sexual power, provided only one possesses the normal characters of the male organ. (" Ausfiihrl. Handb. d. ger. Med.," vol. 4, p. 337.) In the summer of 1865, a Portuguese youth, aged 19, 1. B. dos Santos, was seen by many medical men in London. He was well formed except in reference to the sexual organs. He had two complete and well-formed penes, placed side by side; the right somewhat smaller than the left, and both subject to erection at the same time. He stated that he used the left in sexual intercourse. On the outside of each penis was a scrotum with one testicle fully developed. Between them was a shrunken scrotum which contained two testicles until he was ten years old, when they ascended into the abdomen. When the bladder acted, urine issued from both penes. An engraving of this remark- able malformation is given in the history of the case. (" Lancet," July 29, 1865, p. 124.) In some instances there is an arrest of development in the exter- nal organs ; and with this there is generally an absence of sexual desire. Certain diseases of the appendages of the testicles may, however, render a person sterile. The spermatic secretion is com- monly suspended in most severe diseases which aftect the body. A frequent cause of impotency (sterility) in the adult, when the or- gans are apparently sound, is spermatorrhoea arising from abuse. This, however, is remediable to a greater or less extent by treat- ment. (See Curling, " Diseases of the Testis," 2d ed. p. 386 ; also " Med. Times and Gazette," Jan. 23, 1858, p. 95.) The incapacity for intercourse in either sex may arise from extensive disease affecting parts in, and around the organs of generation. The medical opinion here must be regulated entirely by the circumstances attending each case. On the absence of the penis, as well as on its defective organiza- IMPOTENCY FROM DISEASE. 689 tion, as caiases of incapacity, some remarks have been already made. Sometimes the defect is merely connected with the urethra. Thus, the orifice may be on the dorsum penis, and in other cases under- neath the organ, so that the urethra may terminate at a variable distance from the glans penis. Those laboring under the former defect are said to have epispadia, and under the latter, hypospadia. The power to have fruitful intercourse will in either case depend on the situation of the urethral aperture. Eiittel knew an instance of a hypospadian having several children. (Heuke's " Zeitschrift, 1844, p. 258.) Some doubt has existed respecting the virile powers of those who are affected with hypospadia. In September, 1850, a lad, aged 17, was summoned before the magistrates of Kidderminster on a charge of afiiliation, in reference to the pregnancy of a girl aged 18. The defence was that he could not be the father of a child, because there was such a malformation of the penis as to prevent prolific intercourse. On examination, the urethra was found to terminate on the under surface of the penis, about an inch and a half from the glans, by a small elliptical orifice, which allowed the urine to pass, but with some difficulty. One medical witness gave it as his opinion that it was not impossible, but highly im- probable, that the defendant should possess procreative power ; another freely admitted the boy's capacity, and the case was decided against him. ("Med. Times," Sept. 21, 1850, p. 321.) This decision was physiologically correct. When the urine can pass, the seminal fluid can pass ; and the only question is, whether the intromission can be such as that the misplaced orifice should come in contact with any part of the vagina ? This must depend on the situation of the orifice. [Cases^ illustrative of the fully prolific powers of hypospadians will be found in the " Med. Times," Sept. 14, 1850, p. 292, and Oct. 12, 1850, p. 392. An instance of the virility of an hypospadian has also been published by Mr. Noble, of Manchester, in the '* Assoc. Med. Jour.," March, 1853, p. 236.] Similar remarks apply to epispadians. These malformations are sometimes remedia- ble ; but whether remediable or not, they are not, under any cir- cumstances, to be regarded as absolute causes of impotency. Impotency from general disease. — The influence of local disease in affecting virility has been already considered. But there is a class of cases which may come before a practitioner, in which, with well- formed and healthy organs in the male, there will be a state of im- potency. Sometimes this may depend on natural weakness of con- stitution, or on a want of proper development of the muscular and nervous system: at other times it is due to certain diseases producing nervous exhaustion, and it is then of a temporary nature — persisting while the body is still suffering from the disease, and disappearing on recovery. As a converse fact, there are some diseases which appear to bring out the dormant virile powers of persons, or to excite to a higher degree of intensity those which already exist. Thus it is said that in convalescence from fever there is, occasionally, ex- traordinary salaciousness : but this statement requires confirmation. Again, there are diseases which neither interrupt nor affect the 44 690 IMPOTENCY FROM DISEASE. exercise of the sexual functions. As a general rule, diseases which do not affect the brain and spinal marrow, and which are not at- tended with great debility, do not prevent fruitful intercourse. On the other hand, diseases which are attended or followed by great debility, suspend or destroy sexual power. Among these may be mentioned water in the chest, general dropsy, especially if attended with effusion in the sexual organs, nervous and malignant fevers which affect the brain, apoplexy, palsy, and other diseases which directly attack the brain or spinal marrow. These last-mentioned diseases probably act by suspending the secretion, or altering the nature of the prolific fluid, as well as by preventing that erection of the male organ without which intercourse cannot take place. The sexual function is so intimately allied to bodily vigor and nervous energy, that the integrity of the one may be pronounced to be essential to the integrity of the other. Habits of drunkenness and the abuse of alcoholic liquids, tobacco, or opium, may give rise to impotency by the injury done to the brain and nervous system. (The reader will find this subject fully discussed by Mende, " Aus- f lihrl. Handb. der ger. Med.," vol. 4, p. 349.) In Wood V. Hotham, Jan. 7, 1864, the defendant, a surgeon, was sued for a sum of money for his wife's maintenance. He alleged, in defence, that his wife had been guilty of adultery, and that one of two children born during the marriage was not his. He gave as a reason for this that at the time he was so ill that it was impossible he could have had connection with his wife. He, however, was then in the habit of sleeping with her, and he was sufficiently strong to go his round of daily visits. The learned judge, in remarking upon this point, said if such evidence were to be laeld sufficient proof of illegitimacy, the whole of the law relating to the access and non-access of a husband must be set aside. The jury returned a verdict for the plaintiff. [See the case of Fage v. I)ennison, 5 Casey, 420, cited ante. — P.] Diseases and injuries of the spinal cord producing paraplegia have no direct effect on the testicles, but destroy the power to copu- late. (Curling, Op. cit. p. 371.) When there is a wasting of the testicles, as a result of general paralysis of long standing, there can be no doubt of impotency ; but Mr. Curling quotes a case from a foreign writer, in which, under paralysis (paraplegia) of some years' duration, a man retained sufficient sexual power to have prolific intercourse. When the paralytic person is advanced in age, it is highly probable that he is impotent. In December, 1857, a case was referred to me, in a question of bastardy, for my opinion on a capacity for intercourse under the following circumstances. A woman required an order of affiliation on the putative father of her bastard child. She was a widow, and the illicit connection took place about two months before her husband's death. The husband was at the time 84 years of age ; he was bedridden, and for many weeks before his death he could not move in his bed, and was unable to pass his urine without assistance. The medical opinion of those who examined him was that he was impotent from PROCBEATIVE POWER IN THE FEMALE. 691 physical infirmity, and in this opinion I concurred : stating, how- ' ever, that unless the male organs were diseased or destroyed, it could not be said that intercourse was impossible. It was, how- ever, wholly improbable that the husband could have been the father of the child. Blows on the head or spine, by aiFecting the brain and spinal marrow, may produce impotency. Several cases of impotency from this cause are related by Curling (op. cit. p. 362). It has been noticed that blows on the under and back part of the head, in the region of the cerebellum, have been followed by loss of sexual power on recovery. Sometimes this is temporary ; but at other times, when there is wasting of the testicles, it is permanent and irremediable. Of moral causes it is unnecessary to speak. The sexual desire like other animal passions, is subject to great variation ; and there are instances on record in which men, otherwise healthy-looking and healthily formed, have experienced no desires of this kind. They are in a state of natural impotency— a condition which the Canon Law designates as frigidity of constitution. This is not to be discovered by external examination, but rather from their own admission. Under this head we may class hypochondriacal affec- tions. Sterility. Definition. — Sterility is usually defined to be " the in- ability to procreate, or a want of aptitude in the female for impreg- nation. It is not usual to speak of sterility in the male, although there may be procreative incapacity ; because the defective condi- tion in this sex, from whatever cause, is, in a legal point of view, included under the term " impotency " (see p. 680, ante). In the strictness of language, a male who has been castrated is sterile ; but it is commonly said that he is impotent. Many apparently well- formed males may be sterile without being impotent, i. e., they may have intercourse without procreating ; for the power of copulating must not be confounded with that of procreation. Mr. Curling has pointed out that various causes may render a male sterile, al- though he may retain a power of sexual intercourse, and thus can- not be regarded as impotent in a legal sense. ("Diseases of the Testis," ed. 2, p. 216.) Some crypsorchides may be sterile, or de- ficient in procreating power, while at the same time impotency or incapacity for intercourse may not exist. In reference to women,, sterility implies that condition in which there is an " inability to conceive." This appears to be the true meaning of the term, and the sense in which it is used not only by the best writers, but in common phraseology. Procreative power in the female. Puberty. — In the female, the pro- creative power is supposed not to exist until after the commence- ment of menstruation, and to cease upon the cessation of this periodical secretion. The menstrual function is commonly estab- lished in females in this climate between the ages of /o«ri«en and sixteen ; but it may occur much earlier — indeed, in some rare in- 692 PREGNAKCY BEFORE MENSTRUATION. stances, a discharge resembling the menstrual has been known to occur in mere infants. In other cases its appearance has been pro- tracted to a much later period. According to Dr. Riittel, the men- strual function appears in the smallest number of females at 12, 13, and 14, and in the largest number at 16, 17, and 18 years. In some it is only first established at from 19 to 21 years ; and he states at this age he has often found the uterus small and quite undeveloped. The earliest and latest periods in a large number of cases were respectively 9 and 23 years. (" Lancet/' Nov. 30, 1844, p. 288.) Perhaps, in this country, the most frequent age for the commence- ment of menstruation may be taken at 15. It is liable to be accel- erated in its appearance by certain moral and physical conditions under which a girl may be placed. The most common intervals for the appearance of this function are twentj'^-eight and twenty- one days. It sometimes does not appear until late in life. Dr. Camps found it had not appeared in a married woman, set. 30, who had borne no children. (" Med. Gaz.," vol. 32, p. 409.) Another case is mentioned in the same volume where it appeared for the first time at the age of 47 (p. 567). So soon as this function com- mences, a woman may be considered to have acquired procreative power ; but a female may conceive before the function has com- menced, during the time of its occurrence, or after it has ceased. From facts elsewhere stated, there is some reason to believe that the period which immediately precedes or follows the discharge is most favorable to conception ; although the experience of many accou- cheurs has shown that impregnation may take place at any time between one menstruation and another. It is important to remember that these changes in the uterus may produce remarkable effects by sympathy with the brain and nervous system. At, or about the time of puberty, especially if any cause of obstruction exist, females become irritable, easilj' excited, and they have been known to perpetrate, without motive, crimes of great enormity, such as murder and arson. A propensity to steal is also stated sometimes to manifest itself. (See post, Kleptomania.) It has been remarked that acts of arson have been frequently committed by girls at this period of life, and the crime has spread by imitation. The state of the mind should be therefore carefully watched at this time, and any causes of violent excitement removed. Irregularity, difficulty, or suppression of the menstrual secretion may give rise to temporary insanity. Puberty in the male may be attended with similar morbid pro- pensities, but these are not so commonly witnessed as in the female sex. Pregnancy before menstruation. — The previous occurrence of men- struation is not indispensable to pregnancy : many cases are on record in which women who have never menstruated have conceived and borne children. One case is reported in which a woman, aged 25, became pregnant and bore a child, and menstruation was only regularly established afterwards. (" Lancet," February, 1842.) Dr. Murphy mentions another instance of pregnancy previous to men- PREMATURE PUBERTY IN FEMALES. 693 struation in a woman aged 23. (" Obstetric Reports," 1844, p. 7.) Numerous cases of conception without previous menstruation are quoted by Capuron ("MM. L^g. des Ace," p. 96); and no fewer than nine instances of pregnancy before menstruation have been collected by Mr. "Whitehead. The women were all in excellent health during the whole time, and one did not menstruate until more than two years after the marriage had been consummated. ("On Abortion," p. 223 ; see also Orfila, " M^d. L^g.," 1848, vol. 1, p. 257.) Another case will be found reported in the " Medical Gazette " (vol. 44, p. 969). Dr. W. Taylor met with an instance in which a girl aged 13, bore a child before menstruation had ap- peared. (" Med Times and Gazette," March 12, 1853, p. 277 ; see also, for remarks on this subject, " Edin. Monthly Journ.," July, 1850, p. 73.) The late Dr. Ried has stated that a patient of his bore a child at the age of 17 without having previously men- struated ; and he collected from various authorities a number of cases of pregnancy occurring in women who had not menstruated. (" Lancet," September 3, 1853, p. 296.) [At a recent meeting of the College of Physicians of Philadelphia (Sept. 4, 1861), Dr. R. P. Thomas stated that he had lately, for the third time, attended in confinement a lady who had been married about twelve years and had given birth, to six healthy children, although she had never menstruated. She was married at 22, and had always enjoyed good health ; her labors were natural, with but little show and no subsequent lochial discharge. Dr. Hays, on the same occasion, mentioned the case of a lady patient of his, who had menstruated very rarely, not oftener than once a year, and yet had borne six healthy children at intervals of fourteen months, and was a healthy woman. — H.] Instances of premature -puberty in the female are now numerous : they are far more common than in the male sex. Mr. Whitmore met with the case of a female child who, from a/ew days after birth menstruated regularly, at periods of three weeks and two or three days, until she had attained the age of 4 years, when she died. On inspection after death she appeared like a much older girl. The breasts were unusually large, and the female organs and lower limbs were considerably developed. (" Iforth Journ. Med.," July, 1845, p. 70.) Another case is reported in the " Lancet" (January 29, 1848, p. 137); this was a child aged 3 years. The breasts were as healthily developed as in an adult of 20 years, and the sexual organs were also as much developed as in a girl at the age of puberty. It was observed that this child, who had been regularly menstruating for twelve months, had the appearance of a little old woman. (For other cases of menstruation at 5 years, see " Med. Gaz.," vol. 25, p. 548 ; at 3 years, vol. 47, p. 244 ; and at 3J years, " Med. Times and Gazette," July 24, 1858.) In these instances there is great reason to believe that a procreative power is also early developed ; but it is not common to hear of such young females becoming impregnated. A case is mentioned by Dr. Beck, in which a girl menstruated at 1 year ; she became pregnant and was delivered of a child when little 694 MENSTRUAL CLIMACTERIC. more than ten years old. Dr. "Walker met with a case in which the menstrual function was established at the age of 11 J years, and the patient was delivered of a living child when only 12 years and 8 months old. ("Amer. Journ. Med. Sci.," October, 1846, p. 547.) In another, observed by Ruttel, already referred to, a female of the age of fourteen became pregnant by a boy of the same age. He also quotes three other cases, where one girl of the age of nine, and two of the age of thirteen, became pregnant (loc. cit.). The first of these three cases represents the earliest age for pregnancy yet assigned by any author. Dr. Wilson met with an instance in which a girl at the age of 13 years and 6 months gave birth to a full-grown child : con- ception must have taken place when she was 12 years and 9 months old. ("Edin. Med. Journ.," October, 1861. See also Casper's " Vierteljahschrift," January, 1863, p. 180.) Mr. Eobertson men- tions the case of a factory girl who became pregnant in the eleventh year of her age. In a case communicated to me a girl menstru- ated at ten years and two months, and became pregnant when eleven years and eight months old. Age at which menstruation ceases. Menstrual climacteric. — The average age at which this function ceases in women is usually from forty to fifty years : but as it may commence early, so it may con- tinue late in life. In one case it has been known to cease at the age of 23, and in other instances it has continued to the age of 66 and even of 75 years. (Whitehead, op. cit. p. 145 et seq.) Dr. Royle describes three cases in two of which menstruation continued up to the age of 67. (" Med. Times and Gaz.," Nov., 1860.) Mr. Thomas met with a case in which a woman had ceased to menstruate at the age of forty-five, but the discharge suddenly reappeared after an attack of illness when she had reached the age of sixty-nine. The discharge appeared several times, but not with monthly periodicity. It seems that her mother and sister had also menstruated at the ages of 69 and 60. (" Med. Times and Gaz.," Aug. 7, 1852, p. 148.) In a case which occurred to Capuron, it continued beyond the age of 60 (op. cit. p. 98); but a more remarkable case both of late men- struation and late pregnancy, is quoted by Orfila from Bernstein. A woman in whom the function appeared at 20, menstruated until her ninety-ninth year. Her first child was born when she was 47, and her seventh and last when she was 60. ("MM. L^g." 4^me M., 1848, vol. 1, p. 257 ; see also Briand, " Man. Cpmplet de M6d. L^g.," 1846, p. 137.) From these facts it is clear that it is impossible to fix the age of a woman by the period at which this " change of life" occurs. At the best, it can only be an average of a certain number of instances. Is it possible for a woman to become pregnant after menstruation has ceased ? — It is commonly asserted and believed that, after the cessa- tion of menstruation, a woman is sterile. This is doubtless the ■ general rule ; but in a medico-legal view it is necessary to take notice of the exceptions. Mr. Pearson, of Staleybridge, communi- cated to the " Lancet," some years ago, the case of a lady, aged 44, who up to September, 1836, had given birth to nine children. After FECUNDITY — LATEST AGE FOR PEEGNANCY, 695 this the menses appeared only slightly at the regular periods until July, 1838, when they entirely ceased. Owing to this she supposed that she was not liable to become pregnant; but on the Slst Decem- ber, 1839 — therefore eighteen months after the entire cessation of the menses — she was delivered of her tenth child. Hence concep- tion must have taken place at from eight to nine months after the final cessation of the discharge. Latest age for pregnancy. Fecundity. — Numerous instances are on record of women advanced in life bearing children. A case is re- ported in which a well-formed woman, who had been married nine- teen years, did not bear a child until she had reached the age of fifty. (Schmidt's " Jahrbiicher d. Med.," 1838, S. 65; Henke's " Zeitschrift," 1844, S. 251.) In this case it is stated that menstru- ation had ceased two years before conception. Riittel observed in twelve women that they bore their last children at ages varying from 45 to 50 years. Ottinger met with an instance of a woman bearing a child at 50 ; Cederschjald with another, where the woman ■vf as fifty-three and menstruation still continued. Haller records two cases in which women at sixty-three and seventy respectively bore children. (Briand, " Man. Corapl(^t de Med. L^g.," p. 137.) E'ever- mann has drawn up a table in reference to the late, ages of life in which women have borne children. Out of 1000 cases in 10,000 births, he found that 436 children were borne by females at the ages respectively — Of 41 years 101 42 43 44 45 46 47 113 70 58 43 12 18 Of 48 years 49 50 52 53 54 A case was communicated to the " Medical G-azette" (vol. 39, p. 950) by Dr. Davies, of Hertford, in which a woman was fifty-five years of age when her last child was born ; she menstruated up to that time. In Lord v. Golvin (Vice-Chancellor's Court, July, 1859), one of the questions raised was whether a woman set. 62, who had been married thirty years without having children, had then passed the age of child-bearing: her issue would in that case take the benefit of certain property under a will. It was decided that the woman had not reached an age at which it could be said to be im- possible that she might bear children. In a return of the Registrar- General for Scotland (Feb. 1862), it is stated in the Table for Glas- gow, that one mother who was only 18,had had four children, one who was 22 had had seven children, and of two who were only 34, the one had had thirteen and the other fourteen children. On the other hand, two women became mothers as late in life as at,^51, four at 52, and one mother was registered as having given birth to a child in the 57th year of her age. [Upon this point we have the testi- mony of Sir Edward Coke, who tells us that in his " time a woman above three-score yeares old hath had a childe." Co. Litt., 40, a. — P.] 696 MEDICO-LEGAL RELATIONS OF STERILITY. We cannot, therefore, pretend to fix the age beyond which preg- nancy may not occur. Questions of this kind have an impor- tant bearing on the subject of legitimacy ; and unless the law looks to something more than ordinary professional experience in such matters, the decisions of courts must be inequitable. In two recent cases, however, it appears to have been assumed that a woman could not bear a child after the age of 53. This was the decision of the Master of the Eolls in Price v. Bousted, and more recently the de- cision has been followed by Kindersly, V. C, in Haynes v. Haynes. (Feb. 1866.) The petition in this case involved the question whether a single lady, aged 53 in December, 1865, could be considered as past child-bearing, and it was decided in favor of the assumption. These decisions are not reconcilable with the cases given at p. 694. Causes of sterility. — The causes of sterility in the female system are very numerous. Some of them depend upon peculiarities of constitution, the sexual organs being well formed and developed, others upon latent changes, or congenital defects in the uterus and its appendages, only discoverable by an examination after death. Sterility rarely becomes a medical question in contested cases of legitimacy ; for a claim on the part of a person to be the offspring of a particular ^oman, unless she were in collusion with the claim- ant, could only be made after her death : and if not disproved by medical evidence, showing that the woman could not have borne children, it would in general be easily set aside by circumstances. It may be most important to prove that a woman was in such a bodily condition that she never could have conceived, or borne a child. If the uterus, ovaries, or other parts were congenitally de- fective or absent, or if there were external sexual malformation, accompanied by occlusion or obliteration of the vagina, a medical witness could have no difficulty in saying that the woman must have been sterile. ("Med. Times and Gazette," Jan. 23, 1858, p. 96.) A mere occlusion of the vagina, removable by operation, does not necessarily indicate sterility, as the internal parts may be healthy and sound. A congenital absence of the uterus and ovaries is not inconsistent with a full development of other parts, as the vagina, clitoris, and breasts. Medico-legal relations of the subject. Divorce. — Sexual malforma- tion, involving impotency or sterility, constitutes one of the canoni- cal impediments to marriage, and if matrimony be contracted by a party laboring under such malformation, the contract is voidable. The impediment constituting impotency may arise either from mal- formation, from that which the law calls frigidity of constitution, or any physical cause of what#\rer nature which may render intercourse impossible. When the physical defect is not apparent and irreme- diable, a continued cohabitation of three years is required before a suit can be entertained (Ayliff's " Parergon") ; but according to Oughton — " hsec triennalis expectatio noii est necessaria ubi statim possit constare de impotentia; coeundi." A suit for a sentence of nullity may be promoted by either party, and the medical proof required to found a sentence must be such as to satisfy the court SUITS FOR DIVORCE. 697 that the incapacity pleaded was in existence at the time of the marriage, and that it still remained without remedy. There should be no delay in instituting the suit, and there should be proof that the impediment was not known to the complaining party at the time of the contract. A longer delay in making the complaint is allowed to a female, without prejudicing her case, than to a male, by reason of the modesty of her sex. In a suit which came before the ecclesiastical courts in 1845, a singular question arose, whether, when there was a capacity for sexual intercourse on the part of a woman, with a certainty that from physical defect it could never be prolific, this was sufficient to entitle the husband to a divorce. On the part of the woman, it was insisted that in order to entitle a party to a sentence of divorce, there must be an utter impossibility of sexual intercourse. The case, it was argued, was one of mere sterility, which was no ground for a sentence. Dr. Lushington, in pronouncing sentence, said that mere incapability of conception is not a sufficient ground whereon to found a decree of nullity. The only question is whether a female is or is not capable of sexual intercourse ; or, if at present incapacitated, whether that incapacity admits of removal ; a power of sexual intercourse is necessary to constitute the marriage-bond ; and this intercourse must be ordinary and complete, not partial and imperfect ; yet it would not be proper to say that every degree of imperfection would deprive it of its natural character. If it be so imperfect as to be scarcely natural, it is, legally speaking, no inter- course at all. As to conception, there is no doubt that the malfor- mation is incurable. If there was a reasonable probability that the female could be made capable of natural coitus, the marriage could not be pronounced void ; if she could not be made capable of more than an incipient, imperfect, and unnatural coitus, then it would be void. From cases hitherto decided, it appears that in order to justify a decree of divorce on the ground of impotency or stez-ility, the im- pediment to intercourse or procreation should be established by good medical evidence, and it must be apparent and irremediable; it must also have existed before the marriage of the parties, and have been entirely unknown to the person suing for the divorce ; if it has super- vened after the marriage, this is no ground for a suit. The nature of the impediment is to be determined by private medical opinions or affidavits, based on an examination of both parties. There is one remarkable circumstance with respect to these cases, namely, that in nearly all of them the suit is by the woman against the man ; although there is no reason whatever to suppose that impotency and sexual malformation are more common in males, than malformation and sterility in females. We rarely hear of a husband instituting a suit of divorce on the ground of sterility (incapacity of procreation) in the wife ; it is, I believe, in most instances, that the wife promotes the suit on the ground of impotency or incapacity of intercourse in the husband. The difficulty of establishing incapacity in the female, and the facility of proving impotency from physical causes in the 698 SUITS FOE DIVORCE. male, may probably account for this difference. Suits of this kind are sometimes instituted many months and years after the union of the persons ; but it is pi'etty certain that the desire for separation in these cases often depends on some other cause, which the law would not recognize as sufficient of itself, while it would admit the plea of impotency. The French law very judiciously applies the principle of condonation to such cases, so that no suit for nullity of marriage can be entertained, if cohabitation has continued for six months after the discovery of the personal defect. This appears to be more consistent with justice than our own law ; but practically, these suits, after protracted cohabitation, are always regarded with great suspicion. DEFINITION OF RAPE. 699 RAPE. CHAPTER LVIII. NATURE OF THE CRIME. — SOURCES OF MEDICAL EVIDENCE. — RAPE ON IN- FANTS AND CHILDREN. — MARKS OF VIOLENCE.- — PURULENT DISCHARGES FROM THE VAGINA. — EVIDENCE PROM GONORRHCEA AND SYPHILIS. — RAPE ON GIRLS AFTER PUBERTY. — DEFLORATION. — SIGNS OF VIRGINITY. Eape is defined in law to be the carnal knowledge of a woman by force, and against her will. Medical evidence is commonly required to support a charge of rape, but it is seldom more than corrobora- tive ; the facts are, in general, sufficiently apparent from the state- ment of the prosecutrix. There is, however, one case in which medical evidence is of some importance — namely, when a false accusation is made. In some instances, as in respect to rape on infants and children, the charge may be founded on mistake ; but in others there is little doubt that it is often wilfully and designedly made for motives into which it is here unnecessary to inquire. The late Professor Amos remarked, that for one real rape tried in the circuits, there were on the average twelve pretended cases ! In some few instances, these false charges are at once set aside by medical evidence ; in others, medical men may be sometimes the dupes of designing persons ; but in the majority, the falsehood of the charge is proved by inconsistencies in the statement of the prosecutrix herself. I am informed that in Scotland, where there is a public prosecutor, and a careful preliminary inquiry, false charges of rape are exceedingly rare. The consent of the girl does not excuse or alter the nature of the crime when she is under ten years of age, since consent at this period. of life is invalid ; and the carnal knowl- edge of such a girl is rape in law, and is made a felony by the 24 & 25 Vict. c. 100, s. 50. Even the solicitation of the act on the part of the child does not excuse it. [The provisions of the Revised Criminal Code of Pennsylvania, Act of 31st March, 1860, §§ 91, 92, 93, upon this subject, are as fol- lows : — § 91. If any person shall have unlawful carnal knowledge of a woman, forcibly and against her will, or who being of the age of fourteen years and upwards, shall unlawfully and carnally know and abuse any woman child under the age of ten years, with or without her consent : such person shall be adjudged guilty of felonious rape. 700 EAPE ON INFANTS AND CHILDREN. and on conviction, be sentenced to pay a fine not exceeding one thousand dollars, and to undergo an imprisonment, by separate or solitary confinement at labor, not exceeding fifteen years. § 92. It shall not be necessary, in any case of rape, sodomy, or carnal abuse of a female child under the age of ten years, to prove the actual emission of seed, in order to constitute a carnal knowl- edge, but the carnal knowledge shall be complete upon proof of penetration only. § 93. If any person shall be guilty of committing an assault and battery upon a female, with intent, forcibly and against her will, to have unlawful carnal knowledge of such female, every such person shall be guilty of a misdemeanor, and, on conviction, be sentenced to pay a fine not exceeding one thousand dollars, and to undergo an imprisonment, by separate or solitary confinement at labor, not ex- ceeding five years. — P.] The duty of a medical witness on these occasions is very simple ; and perhaps this will be best understood by considering the subject in relation to females at different ages. On being called to examine a person on whom a rape is alleged to have been committed, the first circumstance which a practitioner should notice is the precise time and date at which he is summoned, taking an early opportunity of comparing his watch with some neighboring clock. This may ap- pear a trivial matter, and one wholly irrelevant to the duties of a medical practitioner ; but it is to be observed that the time at which a surgeon is required to examine a prosecutrix may form a material part of the subsequent inquiry. It will be highly important to the defence of a person accused, if it can be proved that the female did not take the earliest opportunity to complain ; and it may be also the means of defeating an alibi falsely set up for the defence. Medi- cal evidence in cases of rape may be derived from four sources: 1. Marks of violence about the genitals. 2. Marks of violence on the pei'son of prosecutrix or prisoner. 3. The presence of stains of the spermatic fluid or of blood on the clothes of the prosecutrix, or pri- soner. 4. The existence of gonorrhoea or syphilis in one, or both. This evidence will vary according to the following circumstances : — RAPE ON INFANTS AND CHILDEEN. The sexual organs should in these cases present marks of injury if the crime has been completed, and there has been any resistance on the part of the child ; for it is impossible to conceive that forcible in- tercourse should take place without the production of ecchymosis, the effusion of blood, or a laceration of the pudendum. Even with- out Reference to manual violence on the part of the assailant if an adult, the size of the male organ must generally cause much local injury in the attempt to enter the vagina of a child. If the violation has taken place within two or three days, the appearances presented by the parts may be as follows : 1. Inflammation, with more or less abrasion of the lining membrane. 2. A muco-purulent discharge from the vagina, of a ropy consistency and of a yellowish or greenish- MEDICAL EVIDENCE. 701 yellow color, staining and stiflening the linen worn by the girl ; the mucous membrane of the urethra is inflamed, i-endering the dis- charge of urine painful. 3. In recent cases, blood may be oozing from the abraded membrane, or clots of blood may be found de- posited in the vulva. 4. The hymen may be entirely destroyed, or (what is more commonly observed) it may present on careful exami- nation one or more slight cuts or lacerations. Owing to the inflamed state of the parts, the proper examination of the hymen is rendered difficult — any attempt to separate the thighs for this purpose causing great pain. For this reason, also, the child walks with difficulty and complains of pain in walking. 6. Lastly, the vagina may be unnaturally dilated. It has been propounded as a serious question, whether a rape can be perpetrated on children of tender age by an adult man ; and medi- cal witnesses at ti'ials have adopted conflicting opinions. Some are inclined to regard all such charges as unfounded, and to seek for other medical explanations of the symptoms above described. This practice has been carried of late years to an undue extent, simply because many of these charges have been proved to be false ; but common experience, supported as it is by the accurate observations of Casper (" Ger. Med.," vol. 2, p. 130), shows that there is too fre- quently a real foundation for the charge in reference to children, and that a girl is not to be discredited merely because of her tender age. This would be conferring impunity on the acts of a vile class of offenders. In all cases, there should be good medical evidence, and a corroboration from circumstances. For the legal establishment of the crime, proof of penetration only is demanded (24 & 25 Vict. c. 100, s. 63), and a sufficient de- gree of penetration to constitute rape in law may take place with out necessarily rupturing the hymen. There must be medical evi- dence to show that, in a special case, there was actual penetration — the degree of penetration being quite immaterial. It is true that there could not be a complete introduction of the adult male organ into the vagina of a child without a rupture or laceration of the soft parts ; but the absence of such marks of violence would not justify a medical witness in denying the perpetration of the crime, since the law does not require proof either of a complete, or of a violent introduction. It has been decided that penetration to the vulva alone, is sufficient to constitute this crime. Medical men have some- times fallen into an error on this point, considering that when the hymen was entire, rape could not have been committed ; but the Statute Law says nothing about the rupture of the hymen as a necessary part of the medical evidence ; it merely requires from the medical witness proof of vulval penetration ; this may occur, and the hymen remain intact. In Scotland, this question came formally before the judges in the case of Macrae (High Court of Justiciary, 1841). It was insisted by the prisoner's counsel, that there should be proof of full and com- plete penetration ; and there was no sufficient evidence to show that penetration had taken place into the canal of the vagina beyond the 702 MARES OF VIOLENCE. vulva. Lord Meadowbank charged the jury to the effect, that the evidence of the prisoner's guilt was complete ; that scientific and anatomical distinctions as to where the vagina commenced, were worthless in a charge of rape ; and that bj the law of Scotland it was enough if the woman's body was entered. In a case like this, where there was no evidence of emission, and the girl was young, he did not consider it necessary to show to what extent penetration of the parts had taken place — -or to prove that it had gone either past the hymen, into what was anatomically called the hymen, or even so far only as to touch the hymen. The prisoner was con- victed. (" Cormack's Edin. Jour.," January, 1846, p. 48.) I am in- formed that up to the date of the case of Macrae, it had been the practice with the Scotch judges to require proof oifull and complete penetration. See on this question a paper by the late Dr. Easton (" Glasgow Med. Jour.," July, 1859, p. 129). [" In this country the , rule that there must be some entrance proved of the male within the female organ, but that neither rupture of the hymen nor emission need be proved, has been universally followed." Wharton & Stills, Med. Juris., p. 471. — H.] Mat'ks of violence. — When there are no marks of violence, or physical injury about the pudendum of a child, whether because none originally existed, or had disappeared in the course of time, a medical witness must leave the proof of rape to others. He can only answer questions of possibility or probability, according to the special facts proved. It is, however, in all cases his duty to be guarded in giving an opinion that a rape has been perpetrated, when there is a total absence of marks of violence on the genitals. It is true that rape in a legal sense may be perpetrated without necessarily producing such marks on a child, but then the proof of the crime will not depend on medical evidence only. The ab- sence of marks of violence on the genitals, when an early examina- tion has been made, furnishes a strong presumption that rape has not been committed on these young persons. It is obvious that a false charge might be easily made and sustained, if medical opin- ions were hastily given on the statements of a mother and child, when there was no physical appearance to corroborate the accusa- tion. See on this subject a paper by M. Toulmouche, " Ann. d'Hyg.," October 1 (8, p. 338). Supposing at the period of examination no marks exist, it may be necessary to consider whether there has been time for them to disappear since the alleged perpetration of the offence ; but in such cases, it is rarely in the power of a medical witness to express an affirmative opinion of the perpetration of the crime ; he should leave this to be proved by the general and circumstantial evidence. Casper met with a case in which a man set. 37 committed a rape on a girl only eight years of age ; he was seen in the act, and defended himself on the plea of drunkenness. The girl was examined by a medical man on the day following — the labia were then reddened, and there was injection of the membrane at the entrance of the vagina, which was very sensitive. As an illustration of the rapidity APPEAEANCES IN CHILDREN. 703 with which the marks of rape disappear in young children, when not attended with great physical injury, it may be stated that this girl was carefully examined by Casper eleven days after the assault. The sexual organs were then in their natural state ; there was not the least appearance of local injury, and no inference could have been drawn at this date, that the girl had been subjected to any violence. Medical practitioners are not always sujBficiently careful in the in- ferences which they draw from an examination of children at dis- tant periods after an alleged rape. They allow themselves to be deceived by a plausible story, apparently consistent, and thus see, or think they see, proofs of rape on examining the sexual organs of a girl many weeks after the alleged perpetration of the crime ; whereas, had the girl been brought before them as a casual patient, and no suggestion of violent intercourse had been made, they would have probably ridiculed the idea of basing a charge of rape on so slender a foundation. The delay in having the examination made, unless satisfactorily explained, is in itself always a suspicious circumstance. In one case sent for trial to the assizes, but rejected by the Grand Jury, a medical man gave strong evidence that a rape had been committed on a girl seven years of age, although he did not examine her until six weeks had elapsed from the date assigned by the parents ! On the other hand, when marks of violence on the genitals are present, they must not be hastily assumed as furnishing proofs of rape ; for cases are recorded in which such injuries have been pur- posely produced on young children by women, as a foundation for false charges against persons with a view of extorting money. The proof or disproof of facts of this kind must rest more upon general than on medical evidence, unless the injuries obviously in- dicate the use of some weapon or instrument. It should be remem- bered that the hymen is not always present in young children ; it may be, according to some, congenitally deficient, or, what is more probable, it may have been destroyed by ulceration or suppurative inflammation of the parts, a disease to which female infants of a scrofulous habit are very subject. The mere absence of this mem- " brane, therefore, can afford no proof of the perpetration of the crime, unless we find traces of its having been recently torn by violence. Other and more important deductions may, however, be drawn from the presence of severe injuries on the genitals, i. e., of rupture, or laceration of the vagina or perinseum. It is difficult to obtain accurate medical reports of these cases as they occur in England : but it is quite clear that the male organ may produce much physi- cal injury whether the child does, or does not resist the attempt. (Casper's " Vierteljahrschrift," April, 1863, p. 837.) Dr. Chevers, in referring to Indian experience, says that in a'large proportion of rapes on children, it was very clearly proved that rather severe in- juries had been inflicted on them. In the "Nizamut Adawlut Re- ports" (1853-5) there are several instances recorded in which the 704 APPEARANCES OP GENITAL ORGANS IN CHILDREN. vagina was lacerated. Out of 6fi trials of rape, there were 25 con- victions : and in one-half of these, the females were under the age of twelve years. In one case of a girl, set. 12, there was a rupture of the lower part of the vagina to the extent of half an inch. In another, a child of six, but apparently much younger, had suffered as a result of rape, from rupture of the hymen and laceration of the perinaeum and vagina. In one instance the violence proved fatal, but the medical particulars were not given. (" Med. Journ. for India," p. 468.) When it is alleged that injuries have been inten- tionally produced on the genitals of a child by mechanical means, with a view of extorting money, in laying a false charge of rape, the medical evidence can do no more than show that a girl with such appearances about her sexual organs has suffered from some violence applied to the part; but whether by the human member, or any other physical means, it would be impossible to say. The only , chance of getting at the truth in such a case, is by a rigorous cross- examination of the mother and child in the absence of each other. Sometimes, owing to the violence used, the parts are much lace- rated ; and inflammation, followed by sloughing or mortification, may set in and destroy life, especially in children of an unhealthy habit. Care should be taken that the symptoms of a malignant form of disease {noma) to which female children when in a dirty or nesjlected state are liable, are not mistaken for the results of crimi- nal violence. Some cases are reported, from which it would appear that men have narrowly escaped conviction for a crime which had really not been perpetrated. Dr. Percival, in his " Medical Ethics" (3d ed., 1849, p. 117), has related a case which has been the subject of fre- quent quotation and comment in reference to false charges of rape. A girl, set. 4, was admitted into the Manchester Infirmary, in Feb- ruary, 1791, on account of a mortification of the female organs and general depression of strength. She had been in bed with a boy fourteen years old, and it was supposed that he had taken criminal liberties with her. The ifiortification increased, and the child died. The boy was tried on a charge of rape at the Lancaster Assizes, but acquitted, on' evidence being adduced that several instances of a similar disease had appeared among girls about the same period of time, in which there was no reason to suspect injury or guilt. In one of these cases, there was typhus fever with a modification of the genitals. There was no cause of death discoverable on inspec- tion ; the lumbar glands were of a dark color, but all the viscera were sound. This case, with the -v^hole of Mr. Kinder Wood's paper on the subject, has been republished by Mr. Kesteven. (« Med. Times and Gaz.," 1859, April 23 and 30.) On the other hand, fatal injury may be done to these organs in criminal assaults. Mr. Colles has reported a case in which a rape was committed by an adult on a child eight years old ; it terminated fatally from peritonitis, as a result of violence, six days after the assault. There were no marks of violence (bruises ?) externally, but PURULENT DISCHARGES IN CHILDREN. 705 the orifice of the vagina was lacerateii in its entire circumference and the perinseuin was nearly torn through. It was found, on in- spection, that the orifice, as well as the whole of the vagina, was in a state of gangrene, and its posterior wall had been lacerated at its line of junction with the uterus to the extent of an inch. There was no ulceration ; the labia and clitoris had not undergone any change. (" Med. Times and G-az.," June 2, 1860, p. 560.) The prisoner subsequently confessed his guilt. A case was communi- cated by Dr. M'Kinlay to the " Glasgow Medical Journal" (July, 1859, p. 140), which proves that extensive injuries may be produced on a child by the act of violation. The girl in this instance was about six years of age, and very intelligent. From her description of the assault, it appears that she fainted, probably owing to the severity of the pain. When examined, it was found that the vagina was ruptured in various directions. One laceration extended from the lower part downwards, dividing the recto-vaginal septum and perinpeum down to the verge of the anus. There was a lacerated opening in the coats of the rectum ; the orifice of the vagina was lacerated upwards as well as laterally ; the parts were raw, swollen, and very tender. When the child was first seen, there was blood on the limbs and clothes ; she recovered from these serious injuries in about two months. In a case of alleged rape, it was a question raised in favor of the prisoner, whether rupture of the perinfBum could or could not be effected in rape on a girl. Some eminent members of the profession appear to have doubted the possibility of rupture being produced under these circumstances (see Sir W- Wilde's paper, "Dub. Med. Journal," February, 1859); but the facts here recorded show that such an opinion is erroneous. Purulent discharges from the vagina. Vaginitis. Infantile leucor- rhma. — The existence of a purulent discharge from the vagina, as a result of vaginitis or inflammation of the vagina, has been fre- quently adduced as a sign of rape in young children. The parents, or other ignorant persons who examine the child, often look upon this disease as a positive proof of impure intercourse ; and perhaps lay a charge against an innocent person, who may have been ob- served to take particular notice of the child. A purulent discharge with aphthous ulceration of the mucous membrane is occasionally a result of vaginitis (inflammation of the vagina) in young children. It may arise from dentition, or local causes of irritation — as worms or uncleanly habits — and is observed especially in children of a scrofulous habit. It is fre(juently met with in girls up to six or seven years of age ; and children thus aft'ected have been tutored to lay imputations against innocent persons for the purpose of extorting money. This state may commonly be distinguished from the effects of violence, either by the hymen being entire, or by the non-dilata- tion, or laceration of the vagina or perinseum ; by the red and inflam- matory condition of the mucous membrane; by the absence of blood, and the abundance of the purulent discharge, which is com- monly much greater than that which takes place as a mere result of violence. Capuron mentions two cases in which charges of rape 45 706 PUEDLENT DISCHAEGES IN CHILDREN. on children were falsely made against innocent persons, on account of the existence of a purulent discharge the nature of which had been mistaken. (" M^d. L^g. des Accouchemens," p. 41.) Sir Charles Locock observes that the purulent discharges of female children are attended with redness and swelling of the sexual orga!ns, and are sometimes accompanied with excoriation and sloughing of the skin, owing to the irritating nature of the matter. They are so connected with dentition, that they not only appear with the first and second set of teeth, but even when the wisdom teeth are irri- ' fating the system at a mature age. Mr. South, commenting on this statement (" Chelius's Surgery," vol. 1, p. 161), justly remarks that a knowledge of these facts " is highly necessary, and is very pro- perly insisted on, as there is no doubt that many men have suffered capital punishment from the ignorance of practitioners on this point : and even now, with our better knowledge, it is by no means unfrequent to hear of medical men giving a decided opinion which is almost certainly erroneous upon the gonorrhoeal character of pudendal discharges, and thus jeopardizing the character if not the life of an innocent man. In giving his opinion or evidence in such cases, a practitioner is bound to speak with extreme caution, and only on the most incontestable proof (which by a mere examination of the parts it is almost impossible for him to attain), before he makes a positive statement as to the gonorrhceal character of a discharge." Although the facts are, or ought to be, well known to medical men, there is still much poj^ular ignorance in reference to this disease, and false charges of rape on children are now not unfrequently made. Mr. Kesteven met with a case in which a discharge from the vagina of a child nine j'ears of age was considered by the parents to indicate that intercourse had been had with her. There was no mark of contusion or violence on or about the pudendum or in the vagina, and the case was very properly pronounced to be one of vaginitis. (" Med. Gaz.," vol. 47, p. 372.) A similar case was refei'red to me, in which a soldier was supposed to have infected a child ; but an investigation showed that it was a purulent discharge depending on inflammation of the vagina. A gonorrhoeal discharge is generally very profuse — much more profuse than that purulent discharge which is simply the result of such violence as is produced in the commission of rape. There is another fact worthy of notice, namely, that the last mentioned dis- charge, besides being less profuse, lasts for a much shorter time. Casper has recommended that in doubtful cases, another examina- tion of the sexual organs should be made in ten or twelve days. If the purulent discharge has then ceased, or is ceasing, there is good reason to believe that it was not the result of gonorrhoea, but of some temporary cause of inflammation in the raucous membrane. (" Klinische BTovellen," 1863, p. 10.) Of false charges of rape arising from mistakes on the subject, he furnishes various instances (p. 19). Assuming that the surgeon is satisfied, from a careful examina- tion, that the purulent discharge must have existed before the al- leged assault, and that it is of the ordinary inflammatory character LEUCOEEHCBAL DISCHARGES IN CHILDREK. 707 witli which youTig girls are liable to be attacked, this would not justify him in affirming that no rape had been attempted, or perpe- trated on the child. Q-irls laboring under this disease may be the subjects of rape, and it will then be necessary to seek for further evidence on the condition of the hymen, the lining membrane of the vagina, and the vulva. If nothing is found beyond what is consistent with disease, there is an absence of medical evidence to prove that any rape has been committed. An aphthous state of the membrane of the vagina must not, under these circumstances, be ascribed to inj ury caused by mechanical violence. (Casper's " Ge- richtliche Medicin," vol. 2, p. 148.) Infantile leucorrhcea has been fully investigated by Sir W. Wilde, of Dublin. (" Medico-legal Observations," etc., 1853.) This gen- tleman has collected numerous instances illustrating in a remark- able manner the great danger to which innocent persons are ex- posed by reason of false charges of rape on children. Two of these are especially noticed in his essay. A charge was raised against a respectable man, that he had had intercourse with, and produced disease in, two children. The day and hour were circumstantially given, extorted as it appears from the children by the parent, and the man was put upon his trial. The appearances were such as are usual in these cases — a purulent discharge from the vagina with some excoriation, but no bruise, laceration, or mark of violence on the pudendum. There had not been any penetration of the vagina. The charge against the prisoner, although unsupported by any affir- mative circumstances, received some strength from the admission made by one medical witness for the prosecution — namely, that the appearances might have been the result of violence, arid that the discharge might have been produced by friction with the member of a healthy man. (Wilde, op. cit. p. 14.) It was proved that the prisoner was not afl'ected either with gonorrhoea or syphilis. Drs. Geoghegan, Churchill, and other medical witnesses of repute, gave testimony to the effect that the child was laboring under an ordi- nary form of disease, and that there was no medical indication that it had been subjected to any kind of violence. This testimony was not considered by the court to furnish a complete answer to the charge, since it was inferred that the appearances on the child might have been caused by the accused, without any- marks of violence being left on the pudendum ! So strong was this feeling that, had the case rested here, it is probable the accused would have been convicted upon the unsupported statement of the child. An alibi was, however, clearly proved, and the man was acquitted. In this instance, it will be perceived, it was alleged that a man who labored under this disease had caused a purulent discharge in a child ! At the same time, it was admitted that the pudendum had sustained no violence whatever. Medically speaking, there appears to have been not the slightest pretence for charging the accused with the perpetration of rape ; the appearances might, or might not have beep caused in the manner suggested. Under such loose medical evi- dence as this no person would be safe. An acquittal from an un- 708 LEUCOREHCBAL DISCHAEGES IN CHILDBEN. founded charge would depend upon the man who is accused being able to prove a distinct alibi, i. e., he must prove his innocence. The statement of the child may be simple, and artlessly made. At this tender age a girl may be easily induced, by the fear of punish- ment, and by the aid of leading questions put by a parent, to admit that some one had committed an assault upon her. The statement once made may be persevered in, and its inconsistency may not always be brought out by cross-examination. If the child is really laboring under syphilis or gonorrhcea, this is, ccBferis paribus, evidence of impure intercourse, either with the ravisher, or some other person; but we should be well assured, before giving an opinion, that the discharge is really of a gonorrhoeal and not simply of a common inflammatory (purulent) character. The party accused may have been at the time free from the disease, or, if laboring under it, then we should expect to find that the discharge had suddenly made its appeai-ance in the child, with its usual severe symptoms, at a certain interval of time after the alleged intercourse — i. e., from the third to the eighth day. When these conditions do not exist, it is extremely difficult to form a medical opinion on the subject ; since there are no certain means, by the microscope or otherwise, of distinguishing common purulent dischai-ges from those which are gonorrhoeal or syphilitic. A case occurred to M. Biessy, in which a merely mucous discharge in a girl was pro- nounced to be syphilitic, and the person who was falsely accused of rape narrowly escaped conviction. (Briang, " Man. Complet. de MM. L^g.," 1846, p. 81.) The purulent matter of gonorrhoea does not differ microscopically from that produced in other forms of disease. We should further distinctly satisfy ourselves that gonorrhoea in a child, if it exist, could not have arisen from infection by any accident irrespective of intercourse. This limitation is rendered necessary by the publication of a report of two cases by Dr. W. B. E.yan (" Med. Gaz.," vol. 47, p. 744), in which two sisters, one of one year, and the other of four years of age, received the infection by reason of their being washed in a vessel of water with a sponge used by a young woman affected with profuse gonorrhoeal discharge. Dr. Ryan clearly traced the origin of the discharge to this unex- pected accident. Had an accusation of rape been made against a man laboring under gonorrhoea, it is not at all improbable that this condition of the children, resulting from an unsuspected accident, would have been taken as an unanswerable proof of his guilt. Cases of this kind, thus accurately observed, convey an important caution to medical witnesses: i. e., that they should not infer crimi- nal intercourse merely from the existence of a gonorrhoeal discharge, in the absence of marks of violence to the genitals, or of other strong corroborative proofs. As a summary of these remarks with respect to purulent dis- charges, we may observe that they should not be admitted as fur- nishing corroborative evidence of rape, except — 1st, when the accused party is laboring under gonorrhoeal discharge ; 2dly, when RAPE ON YOUNG FEMALES AFTER PUBERTY. 709 the date of its appearance in a child is from the third to the eighth day after the alleged intercourse ; and 3dly, when it has been satis- factorily established that the child had not suffered from any such discharge previously to the assault. It may be said, however, that all these conditions may exist, and yet the accused be innocent ; for a child may, either through mistake or design, accuse an inno- cent person. This, however, removes the case entirely from the hands of a medical jurist. (The reader will find much useful in- formation on this subject in a paper by Dr. Penard, " Ann. d'Hyg.," 1860, vol. 2, pp. 130, 345.) "With respect to marks of violence on the body of a child, these are seldom met with, because no resistance is commonly made by mere children. Bruises or contusions may, however, be found occasionally on the legs. RAPE ON YOUNG FEMALES AFTER PUBERTY. When the crime is committed on a girl from the age of ten to twelve years, the facts are much the same as those already referred to with respect to children below the age of ten years. There is, however, some difference in the legal complexion of the offence. If carnal intercourse be had, with the consent of a female between the ages of ten and twelve years, the offender is guilty of misde- meanor only (24 & 25 Vic. c. 100, s. 51) ; above the age of twelve years, the consent of the girl does away with any imputation of a legal offence. Grirls who have passed this age are considered capa- ble of offering some resistance to the perpetration of the crime ; and therefore, in a true charge, we should expect to find not only marks of violence about the pudendum, but also injuries of greater or less extent upon the body and limbs. It is probable that in these cases, if the charge were well-founded, the hymen would be ruptured, as the intercourse is always presumed to be violent ; but there might be some degree of penetration without this being a necessary result, especially if the membrane were small, or placed far up. At any rate, a girl at this age may sustain all the injury, morally and physically, which the perpetration of the crime caa possibly bring down upon her, whatever may have been the degree of penetration ; and for this reason it is very properly laid down by our law, that the crime consists in the mere proof of penetra- tion. The fact, however, is generally clearly made out by the statement of a girl. Grirls of tender age are sometimes violated by boys; the amount of physical injury inflicted in such cases is less than when the assailant is an adult. "With respect to marks of violence on the person, the exact form, position, and extent of these should be noticed, also their appear- ance whether recent or of old-standing. A false accusation of rape may be sometimes detected by the violence being in a situation in which it was not probable that the ravisher would have produced it. When bruises are found, the presence or absence of the usual zones of color may occasionally throw light upon the time at which 710 RAPE ON YOUNG FEMALES AFTER PUBERTY, the alleged assault was committed. As these marks of violence on the person are not likely to have been produced with the concur- rence of the girl, they are considered to furnish some proof of the intercourse having been against her will. But the physical appear- ances of rape about the genital organs may be found, whether the connection has been voluntarj'- or involuntary. Thus, recent rup- ture of the hymen, laceration of the vagina with effusion of co- agula of blood, swelling and inflammation of the vulva, and stains of blood upon the person, dress, or furniture, may be met with in both cases. In making an examination, the greatest care should be taken by the practitioner to fix, at the time of examination, a probable date for the marks of injury to the genitals or other parts of the body, as it is by the aid of such observations that the truth or falsity of a charge may be sometimes clearly established. Girls and unmarried young women are liable to muco-purulent dis- charges from tlie vagina, as a result of which the hymen may be destroyed. This kind of discharge arises from inflammation of the vagina (vaginitis), and it has been observed to follow an attack of scarlatina. When it exists, its real cause requires the closest scrutiny. At a more advanced age, young women are frequently subject to leucorrhcea. These cases are not likely to be mistaken for gonorrhoea, as here the female has in her power to give some account of the circumstances, from which a medical opinion may . be easily formed. It is possible, however, that a woman laboring under leucorrhcea may charge a man with the crime of rape, and afiirm that this discharge had arisen from the act of the man. An inflamed and partially ulcerated (aphthous) state of the lining membrane of the vulva may apparently give support to the accusa- tion. The discharge in leucorrhcea is of a mucous nature; that of gonorrhoea is of a purulent character; but purulent discharges may take place from the vagina as the result of intense inflammation, and quite irrespective of impure intercourse. (" Ghelius's Surgery," by South, vol. 1, p. 160.) It would be impossible to distinguish such discharges from those of gonorrhoea; while a leucorrhoeal dis- charge under great inflammatory action may also resemble that of gonorrhoea. Defloration. Signs of virginity. — It will be necessary to say a few words respecting the signs of virginity — a subject upon which, in some medico-legal works, a great amount of poetical discussion appears to me to have been wasted. Independently of cases of rape, this question may occasionally assume a practical bearing in relation to the signs of defloi'ation. In civil cases, a medical wit- ness ma-y be asked whether a woman has ever had intercourse or not ; and proof of the fact may be necessary in order to confirm or rebut statements made by her in evidence. The question may be, not whether a female has had a child,. for this would resolve itself into a proof whether delivery had or had not taken place — it may be limited to the probability or possibility of intercourse on her part, at some antecedent period. llTow, a medical jurist, when con- sulted in such a case, can be guided only by the presence or absence SIGNS OF VIRGINITY. 711 of the external signs of virginity. The hymen may be intact, but this does not prove non-intercourse, because females have been known to conceive with the hymen uninjured ; and an operation for a division of this membrane has been actually rendered neces- sary before delivery could take place. (Henke's " Zeitschrift der S. A.," 1843, vol. ii. p. 149.) Two cases of impregnation without rupture of the hymen are reported in the "New Orleans Medical Gazette" for June, 1858 (pp. 217, 220). The hymen in each case required to be divided to allow of the delivery of the child. An- other case is reported in the " American Journ. Med. Sciences," for April, 1859 (p. 576). These facts may be explained by the mem- brane being hard and resisting and at the same time small in extent, i. e., only partially closing the vagina. Under opposite con- ditions, the pei'sistence of this membrane might fairly lead to the inference that the female was chaste, and that there had been no intercourse ; but the hymen may be destroyed by ulceration, as a result of inflammation of the genital organs. When the mem- brane has been thus destroyed by disease or other causes, or when it is congenitally absent, a medical opinion must be more or less conjectural ; for one intercourse could hardly so affect the capacity of the vagina, as to render the fact evident through life, and there is no other datum upon which an opinion could be based. The presence of the hymen is of course quite incompatible with the assumption that the female had borne a child. A question of this kind incidentally arose in Frazer v. Bagley (Common Pleas, Feb. 1844). It was alleged by defendant that the plaintiff, a married man, had had adulterous intercourse with a young woman, and that at an antecedent period she had left her home for the purpose of giving birth to a child privately. The late Dr. Ashwell was called upon to examine the woman, and he deposed that, in his opinion, she was a virgin, and had never had a child. In spite of this evi- dence, the jury returned a verdict for the defendant. It is possible, however, that abortion may take place at the early periods of preg- nancy, without the necessary destruction of the hymen. (See Henke, " Zeitschrift," 1844, vol. i. p. 259.) The question is of importance not only as it may affect the repu- tation of a woman, but the credibility and character of the person who makes the imputation of a want of chastity. Fruitful inter- course, it is well known, may take place without rupture of the hymen ; but such cases may be regarded as of an exceptional nature. The real question is, whether, unless the hymen be in an abnormal state, intercourse can possibly occur between young and active per- sons without a rupture of this membrane. Intercourse is not likely to be confined, under these circumstances, to a mere penetration of the yulva. In the case of an old man, or one of weak virile power, vulval intercourse might be had without destroying the membrane ; but such a case could only be decided by the special circumstances which accompanied it. The presence of an unruptured hymen affords a presumptive, but not an absolute proof that the woman is a virgin ; and if of the ordinary size and shape, and in the ordinary 712 ALLEGED UNCHASTITT — MEDICAL PEOOFS. situation, it shows clearly that, although attempts at intercourse may have been made, there can have been no vaginal penetration. In the case of Dehfosse v. Fortescue (Exeter Lent Ass. 1853), which involved an action for defamation of character, the plaintiff, a mar- ried man, set. 64, had been charged with committing adultery with a certain woman. Several witnesses for the defendant positively swore that they had seen these persons in carnal intercourse. This was denied by the plaintiff; and, as an answer to the case, medical evidence was tendered to the effect that the woman with whom the adulterous intercourse was alleged to have taken place had been examined, and the hymen was found intact. In cross-examination this was admitted not to be a conclusive criterion of virginity. A verdict was returned for the defendant. The form and situation of the hymen in this case were not described ; but it is to be presumed that these were not such as to constitute a physical bar to inter- course, or this would have been stated by the medical witness. Hence the existence of the membrane was not considered to dis- prove the allegations of eye-witnesses. A somewhat similar case {Howes V. Barber) was tried in the Common Pleas in June, 1865. Defendant alleged that he had seen plaintiff", as he believed, in in- tercourse with an unmarried lady. This was denied by the plain- tiff and the lady, and to support this denial, medical evidence was called to show that there had been no intercourse. Drs. Oldham and Barnes examined the lady, and deposed that the hymen was entire, and that she was virgo intacta. In Scotland this kind of medical evidence is not admissible. I am indebted to Mr. Trayner, a member of the Scotch Bar, for the subjoined case, in which a wife sued the husband for divorce, on the ground, inter alia, that he had committed adultery with C. In defence, the defendant denied the adultery, and adduced C. as a witness, who swore that such connec- tion had never taken place. She also swore that she had submitted to an inspectio corporis by Sir I. Simpson. The defendant then pro- posed to examine this gentleman, that he might speak to the result of his examination. He argued that this was the best evidence that he could adduce in support of his innocence, as if the girl was still a virgin, the adultery alleged could not have been committed. The court refused to admit the evidence, on the ground that it was merely in the form of an opinion from the learned professor; that other medical men might differ from him, even from the same ob- servations; and that, as the court could not compel, G. to submit to another examination, the proposed evidence must be considered ex parte and inadmissible. (Session Cases, Edinburgh, Feb. 11, 1860.) In Hunt V. Hunt a verdict was obtained at common law against the alleged paramour in a case of adultery, and the damages were assessed at 50?. It was subsequently proved that the lady was virgo intacta! So long as there are facts which show that women have actually conceived with the hymen still in its normal state, it is inconsistent to apply the term " virgo intacta" to women merely because this membrane is entire. A woman may assuredly have an RAPE ON ADULT WOMEN. 713 unruptured hymen, and yet not be a virgo intacta. This can only be decided by the special circumstances proved in each case. Such virgines intactce have frequently required the assistance of accou- cheurs, and in due time have been delivered of children! CHAPTER LIX. RAPE ON MARRIED AND ADULT WOMEN. — CIRCUMSTANCES UNDER WHICH IT MAY BE PERPETRATED ON ADULT WOMEN. — LOSS OF PHYSICAL EVIDENCE. — PREGNANCY POLLOWINa RAPE. — -MICROSCOPICAL EVI- DENCE. — SODOMY. On married and adult women. — The remarks already made apply generally to married women, with this difference — that when a woman has already been in habits of sexual intercourse, there is commonly much less injury done to the genital organs. The hymen will, in these cases, be found destroyed, and the vulva dilated. Still, as the intercourse is presumed to be against the consent of the woman, it is most likely that when there has been a proper resist- ance some injury will be apparent on the pudendum ; and there will be also, probably, extensive marks of violence on the body and limbs. Such cases are generally determined without medical evi- dence, by the deposition of the woman, corroborated, as it should always be, by circumstances. An experienced barrister has sug- gested to me that this statement regarding the presence of marks of violence on the pudendum of a married woman, on whom a rape is alleged to have been committed, requires some qualification. He informed me that he was engaged in the prosecution of two cases of rape on married women, in which the crime was completed in spite of the resistance of the woman, and there were no marks of violence on the genital organs in either case. {Reg. v. Owen and others, Oxford Circuit, 1839.) This may happen when the assail- ant is aided by accomplices. On the other hand, the vagina alone may be the seat of violence, and no marks to indicate a struggle or the application of force be found on the body. I was consulted in April, 1862, on a case of this description. A woman was knocked down, her clothes were pulled over her face, and the crime of rape was perpetrated by the assailant. In the position in which she was held, with her arms and ha.nds covered over, she was half suffocated and unable to offer any effectual resistance. She was examined on the evening of the day of the assault, by Dr. Mayne. He found no marks of violence on her body, but the mucous membrane of the vagina at its com- mencement was contused and some portions lacerated : blood was oozing from these parts. It was properly considered that, under 7li RAPE ON ADULT WOMEN. these eh'cumstances, the statement of the woman was consistent with the fact that there were no marks of violence on her body. There was no reason to suppose that the injury to the vagina had been caused in any other way than by a criminal assault. When a charge of rape is made by a prostitute, it is justly re- ceived with suspicion, and the case is narrowly scrutinized. Some- thing more than medical evidence would be required to establish a charge under these circumstances. The question turns here, as in all cases of rape upon adult women, on the fact of consent having been previously given or not. This is the point at which the greater number of these cases of alleged rape break down ; and it need hardly be observed that this question has no relation to the duties of a medical witness : all that he can do is to establish, occasion- ally, whether or not sexual intercourse has been had with, or with- out some violence. It is obvious that there may be marks of vio- lence about the pudendum, or on the person, and yet the conduct of the woman may have been such as to imply consent on her part : we must not suppose that medical proof of intercourse is tanta- mount to legal proof of rape. [While it is no defence that a woman was a common strumpet, or even that she was the defendant's mistress, the question of prior chastity is always a material one to be considered by the medical examiner, since unchastity can be shown by the defendant, not as an excuse or iustiti cation, but as a fact throwing much light on the subject. (Wharton & Stills, 2d ed., p. 466.) In England, and in many of the United States, general evidence of reputation may be shown, but not particular acts of unchastity. Ih. McGombs v. State, 8 Ohio (K". S.) 643 ; Peo'ple v. Jackson, 3 Parker, C. R. (N. Y.) 391. It has been held, however, that it is competent to inquire of the prosecutrix, on cross-examination, as to particular acts before and after, at specified times and places, with specified men. State v. Johnson, 2 Wms. (Vermont) 512. In California, where the prosecu- trix was the only witness, it was held that evidence that she had committed acts of lewdness with other men is admissible, and that it is immaterial by whom these acts are proved, and that the prose- cutrix need not be questioned about them. People v. Benson, 6 Oal. 221.— P.] Possibility of perpetrating rape on adult women. — Some medical jurists have argued that a rape cannot be perpetrated on an adult woman of good health and vigor ; and they have treated all accusa- tions made under these circumstances as false. Whether, on any criminal charge, a rape has been committed or not, is of course a question of fact for a jury , and not for a medical witness. The fact of the crime having been actually perpetrated can be determined only from the evidence of the prosecutrix and of other witnesses ; still a medical man may be able to point out to the court circumstances which might otherwise escape notice. Setting aside the cases of infants, idiots, lunatics, and weak and delicate or aged women, it does not appear probable that intercourse could be accomplished EAPE ON WOMEN WHILE UNCONSCIOUS. 715 against the consent of a healthy adult, except under the following conditions : — 1. "When narcotics or intoxicating liquids have been administered to her, either by the prisoner, or through his collusion. It matters not, in a case of this kind, whether the narcotics have been given merely for the purpose of exciting the female, or with the deliberate intention of having intercourse with her while she was intoxicated — the prisoner is equally guilty. (See Reg. v. CampUn, "Law Times," June 28,1845; also "Med. Gaz.," vol. 36, p. 443.) The nature of the substance whereby insensibility is produced is of course unimportant. Thus the vapors of ether and chloroform have been criminally used in attempts at rape. In a case which occurred in France, a dentist was convicted of a rape upon a woman, to whom he had adminstered the vapor of ether. The prosecutrix was not perfectly unconscious, but she was rendered wholly unable to offer any resistance. (" Med. Gi-az.," vol. 40, p. 865.) A dentist was re- cently convicted of rape under somewhat similar circumstances in the United States, but it was thought that the woman had made the charge under some hallucination or delusion. [The American case here referred to is that of Beale, the dentist, convicted on extremely vague and inconsistent, and entirely uncorroborated evidence of the complainant, of violating a young lady while she was stupefied and disabled by the inhalation of ether. This case was generally be- lieved to be one of anaesthetic illusion, similar to many which have since been clearly testified to as having occurred in the experience of different operators. See the " Philada. Med. Exam.," Dec. 1854, for a full review of the case ; also Wharton and StilM, " Med. Jurisp.," §§ 443, 445, 459. See also the same authors for a report of the case of Dr. Davis Green, of Mercer Co., Ohio, convicted of rape on a young girl while partially affected by chloroform adminis- tered to her while asleep. — H.] In Heg. v. Snarey (Winchester Lent Assizes, 1859), there was a clear attempt at fraud. The prosecu- trix asserted that she was instantly rendered insensible by the pri- soner forcibly applying a handkerchief to her face, and she accused him of having committed a rape on her. The charge was disproved by a distinct alibi, as well as by the improbability of all the circum- stances. When the state of unconsciousness arises from natural infirmity, as in idiocy or insanity, carnal intercourse with a woman is regarded as rape. {Reg. y. Ryan., Cent. Crim. Court, September, 1846.) The woman was in this case an idiot, and it was proved that her habits were not loose or indecent. Piatt, B. held that if she was in a state of unconsciousness at the time^the connection took place, whether it was produced by any act of the prisoner, or by any act of her own (?), any one having intercourse with her would be guilty of rape. The prisoner was convicted. [See also the case of State v. Grow (Com- mon Pleas of Athens Co., Ohio) " Western Law Journal," vol. x. p. 501. — P.] In Reg. v. White (N'ortharapton Winter Assizes, 1856), the learned judge, in charging the jury, stated that some doubts were entertained whether the crime of rape could be committed (in 716 RAPE ON WOMEN WHILE UNCONSCIOUS. law) on the person of a woman who had rendered herself perfectly insensible by drink, so as to be unable to make any resistance : he thought it could not be alleged as an excuse for the man. The ques- tion was not reserved, as the prisoner was acquitted of rape, and found guilty of an indecent assault. It may be a question whether a man can have intercourse with a woman without her knowledge while thus in a state of unconscious- ness from natural sleep. Casper met with a solitary case in which a girl aged 16 accused a man of having had intercourse with her while she was sleeping in her bed, of which she was not conscious until he was in the act of withdrawing from her. On her own state- ment, she was virgo intacto up to the date of this occurrence. Upon the facts of the case, Casper came to the conclusion that, if her statement was true, the man could not have had intercourse with her without causing pain, and rousing her to a consciousness of her posi- tion. The hymen was not destroyed, but presented lacerations in two places. This and other facts showed that there had been inter- course, but did not prove that this had taken place without the con- sciousness of the woman. (" Klinische Ifovellen," 1863, p. 31.) A man was charged with rape before a police magistrate, and the pros- ecutrix swore that he had effected his purpose during her sleep. The bare possibility of the offence being perpetrated under these circum- stances cannot be denied; but this admission could only apply to a case in which the woman had been accustomed to sexual intercourse, and in which the sleep was preternatural or lethargic. In this in- stance the woman was a prostitute, and the charge improbable. A respectable married woman who had had children, the wife of an inn- keeper, threw herself on her bed with her clothes on, late one evening, and fell fast asleep. She was first awalcened by finding a man upon her body, in the act of withdrawing from her. This man, William McJEwan, a servant in the house, was given into custody on a charge of rape. In the first instance he did not deny the act, and there was no reason to believe that the prosecutrix was aware of the pri- soner's conduct until the crime was completed, and she was awakened in the manner described — apparently by the weight of the prisoner's body. The prisoner was convicted and sentenced to ten years' penal servitude. (" Edin. Month. Journ.," December, 1862, p. 570.) A case which may serve to throw a little light upon this question occurred to Casper. (" Gerichtliche Medicin," vol. 2, p. 574.) A married woman alleged that a man had had intercourse with her while in bed, and when she was asleep. In her deposition, however, she admitted she was conscious that some one was lying upon her, and that she asked who it was ; showing, as Casper remarks, that she had a knowledge of what was going on, and some doubt whether the person was her husband. In reference to the question whether it is possible to commit a rape upon a woman while asleep, a majority of the Scotch judges decided, in the case of Sweenie (Irvine's " Judiciary Reports," vol. 3, p. 109), that the feloniously having connection with a woman while asleep was not indictable under the name of rape, inasmuch EAPE ON WOMEN WHILE UNCONSCIOUS. 717 aa, apart from the force implied in the act of connection, there was no force used to overcome the will of the woman. But they held, however improbable it might be, it was quite possible that a man might have connection with a woman while'asleep. (" Edin. Month. Journ.," December, 1862, p. 570.) [We are indebted, for a case in point, to our friend Dr. D. F. Lewis, formerly of London, and now librarian to the Pennsylvania Hos- pital of Philadelphia. "While practising in London, in 1853, he was called to attend a young woman previously well known to him as of excellent character, and found her in a violent hysterical paroxysm, brought on by the discovery that she had been violated, during sleep, by her accepted admirer. She had returned to her mother's home with him, from a long walk, very much fatigued, and after having drank a glass of ale, had sunk into a profound slumber, during which the act had been perpetrated without the slightest evidence of con- sciousness on her part. This was admitted by her companion ; and her prompt discovery of the wrong, and immediate alarm and agita- tion, as well as her known liability to unusually heavy sleep, fully established the truth of her assertion. The usual physical signs of recent defloration were presented on her person. — H.] The condition of the so-called magnetic or unnatural sleep has given rise to a question connected with the alleged perpetration of rape. A girl (aged 18) consulted a therapeutic magnetizeras to her health. She visited him daily for some days. Four-and-a-half months afterwards she discovered that she was pregnant, and made a complaint to the authorities against the magnetizer. They di- rected a phj'^sician and surgeon to determine the date of her preg- nancy, and whether the complainant might have then been vio- lated and rendered pregnant contrary to her will, i. e., whether her volition could have been completely or partially annihilated by magnetism. The medical inspectors were satisfied that the preg- nancy did not extend further back than four-and-a-half months ; and founding their opinion on M. Husson's report, made to the Academy in 1831, concluded that as a person in magnetic sleep is insensible to every kind of torture, sexual intercourse might then take place with a young woman without the participation of her will, without consciousness of the act, and consequently without the power to resist the act consummated on her. This opinion was confirmed by that of Devergie. (" G-azette Medical de Paris," and " Edin. Month. Journ.," December, 1860, p. 566.) There is another view of this case which does not seem to have occurred to the French medical experts, namely : ^'■Non omnes dormiunt qiuB clausos habent oculos." [Where the testimony was to the eft'ect that the person alleged to be ravished was awakened by the act of the prisoner, to which she made no resistance or outcry, when there was another person in the room who could have heard her, it was held not to be a case of rape. Pollard v. The State, 2 Clarke (Iowa), 567.— P.] 2. A rape may be committed on an adult woman if she falls into a state of syncope, or is rendered powerless by terror and exhaustion 718 PREGNANCY FOLLOWING KAPE. from long struggling with her assailant. An eminent judicial au- thority has suggested to me that, in his opinion, too great distrust is commonly shown in reference to the amount of j-esistance offered by women of undoubted character. Inability to resist from terror, or from an overpowering feeling of helplessness, as well as horror at her situation, may lead a woman to succumb to the force of a rav- isher, without offering that degree of resistance which is generally expected from a woman so situated. As a result of long experience, he thinks that injustice is often done to respectable women by the doctrine that resistance was not continued long enough. 3. When several are combined against the female, in which case we may expect to find some marks of violence on her person, if not on the genital organs. 4. A woman may yield to a ravisher, under threats of death, or duress ; in this case her consent does not excuse the crime, but this is rather a legal than a medical question. An aged woman can scarcely be expected to resist a strong man. Dr. Chevers mentions a case in which a man was convicted of rape and aggravated as- sault on a woman of seventy years of age. Loss of physical evidence. — It is necessary to observe, in relation to the examination of married women, that the indications of rape on the genitals, however well-marked they may be in the first in- stance, either soon disappear or become obscure, especially in those who have been already habituated to sexual intercourse. After two, three, or four days, unless there has been an unusual degree of vio- lence, no traces of the crime may be found about the genital organs. In the case of an adult married woman examined by Dr. Mayne, the appearances of injury which he discovered in and about the vagina had begun to heal in less than forty -eight hours ; but in a case examined by Casper, on the ninth day the lining membrane of the vagina was still reddened, and the parts were painful. In this case the hymen was completely torn through. (" Gerichtliche Medicin," vol. 2, p. 157.) In married women, or in those accustomed to sexual intercourse, no inference can be drawn from a dilated state of the vagina. In unmarried women, and in children when there has been much violence, these marks may persist and be ap- parent for a week or longer. If there has been great laceration of the sexual organs, then certain appearances in the form of cica- trices may remain ; but in all cases great caution should be ob- served in giving an opinion of rape having been perpetrated, from an examination even two or three weeks after the alleged com- mission of the offence. Marks of violence on the person can never establish a rape ; they merely indicate, cmteris paribus, that the crime may have been attempted. Pregnancy following Rape. — It has been a question, whether when intercourse has taken place against the will of a woman, i. e., in the perpetration of rape by violence, pregnancy could possibly follow. It was, at one time, thought that the will of a woman was always necessary to the act of impregnation, and therefore if she became pregnant, she must have consented to the act, and that the charge of EXAMINATION OF STAINS. 719 rape was unfounded. Such a defence would not be admitted as an answer to a charge of rape, or to show, under any circumstances, that intercourse had been had with consent. Conception, it is well known, does not depend on the consciousness or volition of a female. Tf the state of the uterine organs be in a condition favorable to im- pregnation, this may take place as readily as if the intercourse was voluntary ; even penetration to the vagina is not absolutely neces- sai-y for impregnation. See cases by Dr!"01dham, " Med. Gaz.," vol. 44 p. 48.) In a case communicated to me by the late Mr. Carring- ton, a woman became pregnant, after a rape committed on her by a man who subsequently married her ; the date of intercourse was accurately fixed, and a child was born after 263 days' gestation. It has been supposed, that in cases of pregnancy following rape, in spite of resistance at first, a woman may in the end have volun- tarily joined in the act. I know of no ground for adopting this theory ; the general opinion is, that conception may occur, and is neither accelerated, nor prevented by the volition of the sexes. Many women in married life who anxiously wish for children have none, and vice versa ; and physical impediments do not suffice in all cases to explain these facts. Women are reported to have conceived during the states of asphyxia, intoxication, and narcotism. Dr. Ryan mentions a case in which a young woman became unconsciously pregnant from intercourse had with her by a man while she was in a state of intoxication, and in which it was clearly impossible that her volition could have taken any share. (" Med. Juris.," p. 245.) In married life there is no doubt that women frequently become preg- nant against their will, and in a great number of cases without any consciousness of their condition until pregnancy is far advanced. Those who affirm that without the active will of the woman there can be no conception, must deny the existence of cases of impreg- nation in a state of unconsciousness (p. 504) ; but the facts are too strong and too numerous to be met with a single denial. A medical jurist, therefore, who relied upon pregnancy following alleged rape, as a proof of consent on the part of the woman, and who would infer from this result that the intercourse must have been voluntary on her part, would inflict great injustice by such an opinion. The ex- trusion of an ovum does not depend on the will of a woman, but is a periodical condition ; the action of the spermatozoa on this ovum is as much removed from the will of the woman, as it is from that of the man. Examination of stains. — As part of the medical evidence in cases of rape, it may be necessary to examine spots or stains on the linen of the prosecutrix and the accused. Cases of rape are, however, com- monly tried in this country without reference to this species of evi- dence ; and it is not easy to perceive how this can be necessary to the proof of the crime in the living, when the present law of England demands only proof of penetration, and not of emission. (24 and 25 Vict. c. 100, s. 63.) Thus, a rape may be legally completed without reference to emission ; and, medically speaking, it appears quite possible that there might be marks of emission without any penetra- 720 EXAMINATION OF STAINS. tion. Admitting that certain stains of this description are found on the clothes of an accused person, — are these to be taken as furnish- ing undeniable proof of the legal completion of rape ? It appears to me that without corroborative evidence from the state of the female organs, they cannot be so taken ; and therefore the affirmative evidence from the microscope, under these circumstances, is as liable to lead to error as that which is purely negative. The fact that sper- matic stains are found on the linen of the prosecutrix may, however, become occasionally of importance in charges of assault with intent. {Reg. V. Hamilton^ Edinburgh, Nov. 27, 1843. ) There are no chemical tests on which we can safely rely for the detection of spermatic stains. The appearance produced by a dried spermatic stain on linen or cotton is like that produced by a diluted solution of albumen. The fibre of the stufi' is stiffened, and the stain, particularly at the margin, has a slightly translucent appear- ance, as if the stuff" had been wetted by diluted gum or albumen, but without any shining lustre. In the dry state, the stain presents no well-marked color or odor. Slips of the stained linen, when soaked in a small quantity of distilled water, yield a muco-albumi- nous liquid slightly alkaline. It was long since noticed by Orfila that this liquid, unlike a solution of albumen, was rendered rather strongly yellow by diluted nitric acid. By the action of warm water, the stained linen, even although it may have been kept dry for ,a considerable period, has been observed to evolve the peculiar faint odor of the spermatic secretion. The stained linen, or a portion of it, should be cut out, taking care that it is not roughly handled. It should be put into a small porcelain capsule, with a sufficiency of cold distilled water (eight or ten drops) to soak it thoroughly, and to allow the fibre of the stuff to become quite penetrated by the liquid. Unless the stained stuff is very coarse, or is not easily penetrable by water, the necessary digestion will be completed in a quarter of an hour. The stained linen may then be removed, and any water loosely adhering to it allowed to drain from it. The soaked portion of the stain should thea be squeezed, so that some drops of the liquid may be collected on several glass slides, already well cleaned and prepared for the purpose. The liquid thus obtained by squeezing the stained linen is slightly opaline. It should now be covered with thin microscopic glass, and examined by a microscope. The spermatozoa are best seen in a good light, with a power of 500 diameters ; the head is ovoid and flattened — sometimes rather pointed ; the tail is from nine to twelve times the length of the head : they are usually asso- ciated with granular bodies, and with epithelial scales. Fibres of cotton, linen, or wool may be also mixed with them : and they may be mixed with pus, mucus, and blood-globules. Their form is so peculiar that, when once well seen and examined, they cannot be confounded with any other substance, vegetable or animal, nor with ordinary care, can any vegetable fibres be mistaken for them, although these may be mistaken for their tails, or filaments. Hence the microscopical evidence is not satisfactory unless it is based on EXAMINATION .OF STAINS. 721 the detection of at least one perfect spermatozoa. Dr. Koblanek expresses the opinion that when they are not discovered by the process above described, the stains cannot be due to the spermatic secretion : in this, however, he is in error. When the stained article of dress is of very coarse texture, when it has been much rubbed, much worn, or wetted by urine, blood, mucus, or pus, it will be a matter of considerable difficulty to discover these bodies, although there may really have been spermatic stains upon it. Most of these foreign substances, however, may be removed by the addition of one or two drops of diluted acetic acid, which exerts no dissolving ac- tion on the bodies of the spermatozoa. As it has been elsewhere stated, these bodies, although peculiar to the seminal fluid, are not found in the very young, the very old, or in those who are laboring under long-standing disease of the testicles (p. 682). Even in the cases of healthy married men, who have had children, spermatozoa are not always found in the spermatic secretion ; their presence, size, and number are subject to great uncertainty. Exhaustion from frequent intercourse, or constitutional causes without actual bodily disease, appear to influence their production. There are also various other conditions in which they are not found ; these have been fully examined by Casper (" Gerichliche Medicin," vol. 2, p. 141). Hence the discovery of spermatozoa in stains on articles of clothing demonstrates that they have been produced by the sper- matic liquid; but their non-discovery under these circumstances, does not prove that the stains have not been caused by this liquid. Dr. Koblanek's conclusions on this subject are, therefore, not borne out by facts. The detection of dead or motionless spermatozoa in stains may be made at long periods after emission, when the fluid has been allowed to dry. In three cases, at intervals of from one week to seven weeks after the perpetration of the crime, Casper was enabled to demonstrate the presence of spermatozoa on articles of clothing, and thus to furnish strong corroborative evidence. (Op. cit., vol. 2, p. 161.) Dr. Koblanek made experiments on this subject, in refer- ence to diflferent periods of time; he found these bodies distinctly, after three days, one month — three, four, six, nine, and even twelve months. The number of distinct and perfect bodies diminished ac- cording to the length of the period at which the examination was made. Thus, at the end of a year, only two perfect specimens could be perceived ; but it may be stated, that the discovery of one dis- tinct and entire body is quite sufficient to justify a medical opinion of the spermatic nature of the stain. M. Bayard states that he had been able to detect spermatozoa in stains after the long period of six years ! _(" Man. Prat, de M^d. L^g.," p. 277.)' A medical witness must be prepared to consider the precise value of evidence furnished by the microscope, in the examination of stains on the dress of a man accused of rape. A shirt may present stains of blood, urine, mucus, or gonorrhoeal discharge, some of which, but for the microscope, might be mistaken for spermatic stains. Admitting that, by the process above described, the micro- 46 722 RAPE — MICROSCOPICAL EVIDENCE. scope enables an examiner to affirm that the stains have really been caused by the spermatic secretion, this does not prove that a rape has been committed, or even that intercourse has been necessarily had with a woman. Such stains may arise from spontaneous natural discharge, or from disease (spermatorrhoea), and therefore, in them- selves, they afford no proof of intercourse. If, from other circum- stances in the case, it should be clearly and satisfactorily proved that there has been intercourse, then the presence of blood mixed with the spermatic stains might, in certain cases, justify an opinion that violence had been used. The discovery of spermatic stains on the dress of a woman furnishes stronger evidence of intercourse, attempted or perpetrated, than their discovery on the dress of a man; but admitting that intercourse is thus proved, it may still have taken place with the consent of the woman. These stains, when found on the clothing of girls and infants, afford a strong corroborative proof of the perpetration of the crime. Microscopical evidence from the woman. — It may become necessary to determine, in reference to a woman, whether intercourse has, or has not recently taken place. All observers agree that, within a certain period after connection, the fact may be established by the examination of the vaginal mucus. A small quantity of this mucus placed upon glass, and diluted with water, will be found to contain spermatozoa, if the suspiciSn be correct. In addition to other characters, it may be remarked that the living spermatozoa move for many hours out of the body when kept at a temperature of 98°, and they even retain their rapid motions when the spermaticliquid is mixed with water; but these motions cease immediately on the addition of urine, or chemical re-agents. According to Mtlller, the spermatozoa may retain vitality (or free motion) in the body of a woman, for the period of seven or eight days, and even longer. M. Bayard states that he has thus detected them in the vaginal mucus of females not subject to morbid discharges, at various intervals up to three days after intercourse (op. cit.,p. 277); and Donn^ found them under similar circumstances, in a woman who had been admitted into the hospital the day before (op. cit., p. 305). This evidence may become of value in a charge of rape, but it may be easily de- stroyed by the presence of leucorrhcea: and it is open to an objec- tion, that, in certain morbid states of the vaginal mucus of the human female, there is found in it a microscopic animalcule, called by Donn^ the Trichomonas vagince; but this has a much larger body and a shorter tail than the spermatozoon. Other substances may be sometimes found in the vaginal mucus ; see case by Dr. Lender (Horn's "Vierteljahrschrift," April, 1865, p. 355). Marks of blood, on clothing. — Marks of blood upon the linen can, of course, furnish no evidence, unless taken with other circum- stances. The linen may be intentionally spotted or stained with blood for the purpose of giving apparent support to a false accusa- tion. Dr. Bayard met with a case of this kind, in which a woman charged a youth with having committed a rape upon her infant child. On examination, the sexual organs were found uninjured ; EAPE — BLOOD-STAINS. 723 and on inspecting the marks of blood on the clothes of the child, it was observed that the stains were produced on the outside of the stuft", and bore the appearance of smearing ; the whole fibre had not even been completely penetrated by the liquid. The falsehood of the charge was thus established. (" Ann. d'Hyg.," 1847, vol. 2, p. 219.) A case involving a false charge of rape was tried at the Glasgow Autumn Circuit in 1859. One of the witnesses, an ac- complice, proved that she had purchased some blood and handed it to the woman who made the charge, and she saw her smear it over her person and on some sheets on which it was alleged the rape was perpetrated. The woman (Boyle) and her husband, who made this false charge, were convicted of conspiracy. It may be a question whether marks of blood on the linen of a prosecutrix were caused by eflusion as a result of violence or by the menstrual fluid. In its normal state this fluid is said to contain no fibrin ; but in respiect to the presence of red corpuscles and. of serum, it resembles blood. That fibrin is, however, frequently present, and in large quantity, is obvious from its being occasion- ally discharged in a clotted state ; hence, the discovery of fibrin in a stain would by no means necessarily imply that the blood was not derived from the menstrual fluid. Supposing the blood-stain to have been caused by imbibition from another article of dress already stained, the secondary stain would be free from fibrin, which would remain in the stuff originally wetted. A man might thus wrongly pronounce this secondary stain to be due to men- strual blood. Even the presence of epithelial scales and mucus would not prove the stain to be menstrual, unless it could be shown that the mucus was actually efiused with the blood which caused the stain. The epithelial scales naturally found in vaginal mucus are flat nucleated cells, oval, round, or polygonal in shape, and vary- ing in size. They are spread over the mucous membrane not only of the vagina, but of the mouth, pharynx, oesophagus (gullet), conjunctiva, and the serous and synovial membranes. (" .Eirkes' Physiology," p. 304.) There must be great caution in relying upon, this microscopical evidence. It may be right to state for the information of medical practi- tioners who have hitherto thought that they could easily distin- guish menstrual blood, and swear to it on charges of rape, that a few years since ^the French Academy of Medicine appointed as a committee MM. Adelon, Moreau, and Le Canu, to examine this question in the most comprehensive manner. These gentlemen reported that, in the present state of science, there is no certain method by which menstrual blood can be distinguished from that efl['used from the bloodvessels in a case of child-murder or abortion. ("Ann. d'Hyg.," 1846, vol. 1, p. 181 ; see ante, p. 546.) Evidence of violation in the dead. — The body of a child or woman is found dead, and a medical witness may be required to determine whether her person has or has not been violated before death. There is here some difficulty, because there will be no statement from the prosecutrix herself. The witness can seldom do more 724 SODOMY. BESTIALITY. than express a conjectural opinion, from the discovery of marks of violence on the person and about the genital organs. Even if spermatozoa were detected in the liquid mucus of the vagina, or on the dress of a woman, this would merely prove that there had been intercourse ; whether it had been violent or not, and against the will of the woman, would depend on the circumstantial evi- dence. In a case of murder tried in Edinburgh some years ago, the first point to determine in the dead body was, whether a rape had, or had not been committed. The examination of the stains on the dress- was conclusive when taken in conjunction with the other evidence. The jury convicted the man of a rape, but ac- quitted him of the murder. Eor a case in which evidence was obtained on the examination of a dead body see Casper's " Klinis- che Ifovellen," p. 17. Ra'pe by females on males.— ;-^o far as I can ascertain, this crime is unknown to the English law. Several cases of this kind have, however, come before the French Criminal Courts. In 1845, a female, aged eighteen, was chai'ged with having been guilty of an act of indecency, with violence, on the person of Xavier T., a boy under the age of fifteen years. She was found guilty, and con- demned to ten years' imprisonment. In another case, which oc- curred in 1842, a girl, aged eighteen, was charged with rape on two children — the one eleven, and the other thirteen years of age. It appeared in evidence that the accused enticed the two boys into a field, and there had forcible connection with them. This female was proved to have had a preternatural contraction of the vagina, which prevented intercourse with adult males. She was found to be laboring under syphilitic disease, and the proof of her ofience was completed by the disease having been communicated to the two boys. She was condemned, by the Court of Assizes of the Seine, to fifteen years' hard labor at the galleys. (" Ann. d'Hyg.," 1847, vol. 1, p. 463.) Casper describes cases of this description which have fallen under his observation. (" Handbuch der Gericht- lichen Medici n," vol. 2, p. 129; and " Klinische Novellen,"1863, p. 15.) By the Penal Code of France, it is a crime in either sex to attempt intercourse with the other, whether with or without violence, when the child is under eleven ydirs of age. That this oft'ence is perpetrated in England cannot be doubted. It is by no means unusual to find, in the wards of hospitals, mere boys afl'ected with the venereal disease. In some instances this may be due to precocious puberty ; but in others, it can only be ascribed to that unnatural connection of adult females with male children, which is punished as a crime in the other sex. The only accessible medi- cal proof would consist in the transmission of gonorrhoea or syphi- lis from the woman to the child. Sodomy. Bestiality. Pederastia, or Sodomy, is defined to be the unnatural connection of a man with mankind, while the term bestiality is applied to a SODOMY. BESTIALITY. 725 similar connection with an animal. The evidence required to es- tablish this crime is the same as in rape, and therefore penetration alone is sufficient to constitute it. There are, however, two excep- tions : 1st, it is not necessary to prove the offence to have been committed against the consent of the person upon whom it was perpetrated ; and 2dly, both agent and patient (if consenting) are equally guilty ; but tlae guilty associate is a competent witness. In one case {JRex v. Wiseman)^ a man was indicted for having com- mitted this offence with a woman, and a majority of the judges held that this was within the statute. Unless the person is in a state of insensibility, it is not possible to conceive that this offence should be perpetrated on an adult of either sex against his or her will; the slightest resistance would suffice to prevent its perpetra- tion. In August; 1849, a question on this point was referred to me from Kingston, Jamaica. A man was convicted, and sentenced to transportation for life, for the crime 'of sodomy, alleged to have been committed on the complaining party while he was asleep. The only evidence against him was the statement of the complain- ant. The opinion given was in conformity with that of Dr. J. Ferguson, who referred the case to me, namely, that the perpetra- tion of the act during a state of natural sleep was contrary to all probability. The remarks already made in reference to rape during sleep may be applied with greater force to acts of this nature, (p. 716.) If this crime be committed on a boy under fourteen years, it is felony in the agent only ; and the same, it appears, as to a girl under twelve. ("Archbold," p. 409.) The act must be in the part where it is usually committed in the victim or associate of the crime, and if done elsewhere it is not sodomy. The facts are commonly sufficiently proved without medical evi- dence, except in the case of young persons, when marks of physical violence will in general be sufficiently apparent. In some instances proof of the perpetration of the crime may be obtained by resort- ing to microscopical evidence. (See Donn^, op. cit. p. 305.) Stains upon the linen of young persons may thus furnish evidence that the crime has been attempted, if not actually perpetrated. For a case of this kind see p. 687. Trials for sodomy and bestiality are very frequent, and convic- tions of men and boys have taken place for unnatural connection with cows, mares, and other female animals. It is punishable by penal servitude for life, under the 24th and 25th Vict. c. 100, s. 61. There cannot be the slightest doubt that false charges of sodomy are more numerous than those of rape, and that this is too often a successful mode of extortion. This is rather a legal than a medical question ; but it is especially deserving of notice, that these accu- sations are very frequently made by soldiers and a bad class of policemen ! [It is a remarkable fact, that in cases of trials for rape, the maxim of the law that innocence is to be presumed until guilt is proved, is often reversed. The most glaring inconsistencies and contradictions 726 EAPE — LEGAL DECISIONS. Oil the part of the prosecution seem to escape the notice, or make no impression upon the mind of the jurj. The remai'ks of Sir Matthew Hale, so often quoted that they have become trite, contain nevertheless a truth that cannot be controverted ; " It is true," he says (1 Hal. P. C. 635), " that rape is a most detestable crime, and therefore ought severely and impartially to be punished with death ; but it must be remembered that it is an accusation easy to be made, hard to be proved, but harder to be defended by the party though innocent." He then mentions some cases within his own observa- tion of malicious prosecution of this crime, and adds : " I mention these instances that we may be the more cautious upon trials of offences of this nature, wherein the court and jury may with so much ease be imposed upon, without great care and vigilance, the heinousness of the offence many times transporting the judge and jury with so much indignation, that they are over-hastily carried on to the conviction of the persons accused thereof by the confident testimony of sometimes false and malicious witnesses." Many cases might be cited to illustrate these remarks ; the books are full of them, however, and it would be unnecessary to occupy space by doing so. The conviction of Dr. Beale, for instance, was a surprise to the legal and medical professions, and could only be accounted for by this remarkable tendency on the part of the jury. In allusion to this case, Mr. Wharton, in treating of what degree of penetration is required to complete the offence of rape, says ("Med. Juris."! 471): "Perhaps the furthest limit to which the rule has reached, is in a recent case in Philadelphia, where, though there was no medical examination, it was held that proof by the pi'osecutrix of pain in the sexual organ, and of the juxtaposition at the time of the defendant's face to her own — she at the time being in a dentist's chair, under the influence of ether — was enough to justify a jury in pronouncing that there was penetration, and that the penetration was sexual. The general result of both medical and legal opinion, however, is, that while the learned and able judge who tried the case, properly left it to the jury as a question of fact as he was obliged to do, to determine whether penetration had then taken place, the verdict was not sustained by the evidence, and forms an unsafe precedent for the future." And in a note to section 443 of the same work, the following remarks are added : " We sincerely believe that a great wrong may have been inflicted upon an innocent man, which can only be compensated by the pro- bability that the fallible nature of the evidence upon which he was convicted, will hereafter render it difficult to sustain an accusation upon similar proof." In the same note is mentioned the case of a dentist in Montreal, who was indicted in 1858, for attempting to commit a rape upon one of his patients under the influence of chloroform. At the trial, a witness testified that his wife was un- der the strongest impression that she had been violated by the prisoner while under the influence of chloroform ; yet her husband was present during the whole time she was unconscious. The ver- EAPE. 727 diet of the jury was, "Gruilty of an attempt to commit rape, with a recommeudation to mercy !"^ ' Sancho Panza's judgment, in the case of rape wliicli was heard before him during his brilliant, thougli brief, administration aa governor of Barataria, was certainly more creditable to the cause of justice. The historian thus reports it : "This cause was no sooner ended, than there came into court a woman keeping fast hold of a man, clad like a rich herdsman. She came, crying aloud : 'Justice, my lord-governor, justice ! If I cannot find it on earth, I will seek it in heaven ! Lord-governor of my soul, this wicked man surprised rne in the middle of a field, and made use of my person as if it had been a dish-clout. Woe is me ! he has robbed me of what I have kept above these three-and-tweuty years, defending it against Moors and Christians, natives and foreigners. Have I been as hard as a cork-tree, and preserved myself as entire as a, salamander in the fire, or as wool among biiers, that this honest man shall come with his clean hands to handle me?' 'That remains to be inquired into,' said Sancho: 'let us now proceed to see whether this gallant's hands are clean or not;' and turning to the man, he asked him what he had to say in answer to this woman's complaint. The man, all in confusion, replied : ' Sir, I am a poor herdsman, and deal in swine ; and this morning I went out of this town, and having sold, under correction, be it spoken, four hogs, and what between dues and exactions, the officers took from me little less than they were worth. As I was returning home, by the way I lighted upon this good dame, and the devil, the author of all mischief, yoked us together. I paid her handsomely : but she, not contented, laid hold of me, and has never let go of me until she has dragged me to this place. She says I forced her ; but by the oath I have taken, or am to take, she lies. This is the whole truth.' Then the governor asked him if he had any silver money about him. The man answered that he had about twenty ducats in a leathern purse in his bosom. Sancho ordered him to produce it, and deliver it just as it was to the plaintifl'. He did so trembling : the woman took the purse, and making a thousand curtsies, and praying to God . for the life and health of the lord-governor, who took such care of poor orphans and maidens, out of the court she went, holding the purse with both hands, taking care first to see if the money that was in it was silver. "She had no sooner left the room than Sancho said to the herdsman, who was in tears, and whose eyes and heart were gone after his purse; 'Honest man, follow that woman, and take away the purse from her, whether she will or not, and come back hither with it.' This was not said to one deaf or stupid, for the man instantly flew after her like lightning, and went about what he was bidden. "All present were in great suspense, expecting the issue of this suit. In a few minutes came in the man and woman, clinging together closer than the first time, she with her petticoat tucked up, &nd the purse lapped up in it, and the man strug- gling to take it from her, but in vain, she defended it so stoutly. ' Justice from God and the world !' cried she at the top of her lungs ; ' see, my lord-governor, the im- pudence and want of fear of this varlet, who, in the midst of the town and of the street, would take from me the purse your worship commanded to be given to me.' ' And has he got it ?' demanded the governor. ' Got it !' answered the woman : ' I would sooner let him take away my life than my purse. A pretty baby I should be indeed ! Other-guise cats must claw my beard, and not such pitiful, sneaking tools as this. Pincers and hammers, crows and chisels, shall not get it out of my clutches, nor even the paws of a lion. My soul and body shall sooner part.' ' She is in the right,' added the man; ' I yield myself worsted and spent, and confess I have not strength to take it from her.' That said he left her. Then said the governor to the woman): ' Give me that purse, chaste and valiant heroine. ' She presently delivered it, and the governor returned it to the man, and said to the violent but not violated damsel : ' Sister of mine, had you shown the same, or but half so much, courage and resolution in defending your chastity, as you have done in defending your purse, the strength of Hercules could not have forced you. Begone, in God's name, and in an ill hour, and be not found in all this island, nor in six leagues round about it, upon pain of two hundred stripes. Begone, instantly, I say, thou prating, shameless, cheating hussy !' The woman was confounded and went away, drooping her head, and discontented ; and the governor said to the man : ' Honest man, go home, in the name of God, with your money, and henceforward, unless you have a mind to lose it, take care not to yoke with any body.' " The countryman gave him thanks as clownishly as he could, and went his way. 728 BAPE. In the case of People v. Benson, 6 Cal. 221, the court say that "no case of this class (rape) should go to the jury on the sole testi- mony of the prosecutrix, unsustained by facts and circumstances, without the court warning them of the danger of conviction on such testimony." — P.] The bystanders were in fresh admiration at the decisions and sentences of their new gOTcrnor, all which, being noted down by his historiographer, were immediately transmitted to the duke, who waited for them with great impatience." (Don Quixote, vol. ii. 289.) DEFINITION OF INSANITY. 729 INSANITY. CHAPTER LX. WHAT IS INSANITY ? — MEDICAL DEFINITIONS. — DISTINCTION OF SANE FROM INSANE PERSONS. — MORAL INSANITY. — LEGAL DEFINITIONS. — "NON COMPOS MENTIS." — SYMPTOMS OF INCIPIENT INSANITY. — HALLU- CINATIONS AND ILLUSIONS. — LUCID INTERVALS. What is insanity? Medical definitions. — The terms insanity, lu- nacy, unsoundness of mind, mental derangement, madness, and men- tal alienation or aberration have been indifferently applied to those states of disordered mind in vehich a person loses the power of regu- lating .his actions and conduct according to the ordinary rules of society. In all cases of real insanity, the intellect is more or less affected — hence the term intellectual insanity. In a medical sense this implies a deviation of the mental faculties from an assumed normal or healthy standard. In an insane person there may be no bodily disease, but his language and habits are changed — the rea- soning power which he may have enjoyed in common with others is lost or perverted, and he is no longer fitted to discharge those duties which his social position demands. Further, from perversion of reason, he may show a disposition to commit acts which may endanger his own life, or the lives of those around him. It is at this period that the law interferes for his own protection, and for that of society. Many attempts have been made by psychologists to define insa- nity, but the definitions hitherto given are so imperfect that it would be difficult to find one which includes all who are insane, and excludes all who are sane. This difficulty is fully accounted for by the fact that mental disorder varies in its degree, as well as in its characters ; and the shades of disordered intellect in the early stages are so blended, as to be scarcely distinguishable from a state of sanity. It is this twilight condition of the mind, when it is fluc- tuating between sanity and insanity, which no definition can com- prise, especially as the mind differs in its power and manifestations in most persons, and it is therefore difficult to fix upon a standard by which a fair comparison can be made. The vulgar notion of insanity is that it consists in an entire deprivation of reason and consciousness ; but the slightest acquaintance with the insane, proves that they are not only perfectly conscious of their actions in gene- 730 INTELLECTUAL AND MORAL INSANITY. ral, but that they reason upon their feelings and impressions. The late Dr. Abercromby considered insanity to consist in a loss of the faculty of attention — the power by which we are capable of chang- ing, controlling, arresting, or fixing the current of our thoughts. Dr. ConoUy regards it as a disorder of the power of comparison or judgment, and Professor Marc as a loss of the faculty of volition ; so that, in the latter point of view, the acts of the insane are involun- tary, and depend upon impulses which they cannot control. These definitions are defective, inasmuch as they are not adapted to the various forms of the disease. In some cases of insanity, as in confirmed idiocy, there is no evidence of any exercise of the in- tellectual faculties : but in most instances, these faculties and the moral feelings are partially diseased, or partially destroyed, in every variety and degree. Thus we may meet with cases in which the faculties of attention, comparison, and volition are more or less im- paired or absent, or, if present, they are never perfect, although each may not be equally affected. When no two cases are precisely similar, no definition can include all varieties of the disorder. A medical witness who ventures upon a definition, will generally find himself involved in numerous inconsistencies, for no words can pos- sibly comprise the variable characters which this malady is liable to assume. Those who take an interest in definitions of insanity and who think they can defend them from the critical acumen of lawyers, will find, them fully set forth in their medical and medico- legal aspects in a paper by Dr. Rorie. (" Ed. Monthly Journal," July, 1865, p. 13.) There are, however, cases in which a medical man may find himself compelled, if not to define insanity, at least to show some clear distinction between a sane and insane person. Thus, in cases in which there has been an alleged breach of the law regarding the custody of lunatics, it may be pleaded that the per- son is sane, and a medical expert must then be prepared to say whether the person concerning whom the question is raised, is idiotic, lunatic, or of unsound mind, and to assign satisfactory rea- sons for his opinion. [The difiiculty of definition is thus expressed in a leader in the " London Times " of July 22, 1854, cited in Dr. Bucknill's Prize Essay on Criminal Lunacy (Law Library, vol. 92) : " ITothing can be more slightly defined than the line of demarcation between sanity and insanity. Physicians and lawyers have vexed themselves with attempts at definition in a case where definition is impossible. There has never yet been given to the world anything in the shape of a formula upon this subject, which may not be torn to shreds in five minutes by any ordinary logician. Make the definition too nar- row, it becomes meaningless ; make it too wide, the whole human race are involved in the drag-net. In strictness, we are all mad when we give way to passion, to prejudice, to vice, to vanity; but if all the passionate, prejudiced, vicious, and vain people in this world are to be locked up as lunatics, who is to keep the key of the asylum? As was very fairly observed, however, by a learned Baron of the Exchequer, when he was pressed by this argument, MOR^L INSANITY. 731 if we are all mad, being all madmen, we must do the best we can under such untoward circumstances. There must be a kind of rough understanding as to the forms of lunacy which can't be tolerated- "We will not interfere with the spendthrift, who is flinging his patri- mony away upon swindlers, harlots, and blacklegs, until he has de- nuded himself of his possessions and incurred debt. We have no- thing to say to his brother madman, the miser, who pinches his belly to swell the balance at his bankers — being 73 years of age, and without family — but if he refuses to pay taxes, society will not ac- cept his monomania as pleadable in bar." Perhaps the definitions of sanity and insanity by Dr. Bucknill are as accurate as the subject admits of. Sanity, he defines to be, " that condition of the mind in which the emotions and instincts are all in such a state of subordination to the will, that the latter can direct and control their manifestations ; in which, moreover, the intellectual faculties are capable of submitting to the will sound reasons for its actions. Such co-ordinate action of the faculties is termed sanity ; a condition in which that is lost is termed insanity, or derangement, or alienation, or unsoundness, all terms having reference to the deprivation of the power of the will so directed." " It is evident," he adds, " that in this definition of sanity there are three terms, the subjected emotions, the directing intellect, and the middle term of free will. Supposing our nature to be fallible throughout its composition, it is evident that erroneous action may originate at any of these points ; the mutinous emotions may be indomitable, the power of the will may be abortive, or the intellect may mislead by false guidance. Insanity may thus be Intellectual, Emotional, or Volitional, and though in the concrete it is not easy to find pure and unmixed cases under either of these heads, such cases do occasionally subject themselves to observation. The ex- perienced psychopathist will also find little difliculty in apportion- ing a vast number of the other cases according to their predominant character, under one or other of these headings. " Insanity, therefore, may be defined as, A condition of the mind in v}hich a false action of conception or Judgment, a defective power of the will, or an uncontrollable violence of the emotions and instincts, have separately or conjointly been produced by disease." — Bucknill on Crimi- nal Lunacy, pp. 27, 28.— P.] Moral insanity. — In addition to that form of insanity in which the mind is effected, known as intellectual insanity. Dr. Pritchard and other medico-legal writers have described a state which they call moral insanity {Mania sine delirio), which is manifested simply by a perverted or disordered state of the feelings, passions, and emotions, irrespective of any apparent intellectual aberration. There are no hallucinations or illusions, and there is no evidence of delusion, but simply a perversion of the moral sentiments. Thus, it is alleged that this form of insanity may appear in the shape of a causeless suspicion, jealousy, or hatred of others, especially of those to whom the affected person ought to be attached ; and it may also manifest itself under the form of a wild, reckless, and cruel disposition to- 732 MORAL INSANITY. wards mankind in general. It does not seem probable, however, that moral insanity, as thus defined, ever exists, or can exist in any person without greater or less disturbance of the intellectual facul- ties. The mental powers are rarely disordered without the moral feelings partaking of the disorder ; and, conversely, it is not to be expected that the moral feelings should become to any extent per- verted without the intellect being affected, for perversion of moral feeling is generally observed to be one of the early symptoms of disordered reason. [See Bucknill on Criminal Lunacy, Appendix, note E. — P.] The intellectual disturbance may be sometimes diffi- cult of detection ; but in every case of true insanity it is more or less present, and it would be a highly dangerous practice to pro- nounce a person insane, when some evidence of its existence was not forthcoming. The law does not recognize moral insanity as an independent state ; hence, however perverted the affections, moral feelings, or sentiments may be, a medical jurist must always look for some indications of disturbed reason. Medically speaking, there are, according to Dr. Pritchard, two forms of insanity, moral and intellectual ; but in law there is only one — that which affects the mind. Moral insanity is not admitted as a bar to responsibility for civil or criminal acts, except in so far as it may be accompanied by intellectual disturbance. [But see the case of Heg. v. Grockroft (Leeds Autumn Assizes, 1865), cited post, in chapter 63. It is ad- mitted in Pennsylvania. See cases of Com. v. Mosler, 4 Barr 266. Com. V. Shurlock, 14 Leg. Int. 33. lb. v. Smith, 15 Leg. Int. 33. lb. V. Freath, 6 Am. Law Register, p. 400. See also Lewis's Crim. Law 404. In most of the States, however, the law is as stated in the text, and the test still is the knowledge of right and wrong. See Farrar v. State, 2 Ohio St. R. 54. State v. Spencer, 1 Zabrieski 196 (New Jersey). Fisher v. People, 23 111. 283. Loeffner v. State 10 Ohio (E. S.) 598. — P.] Dr. Mayo denies its existence, and con- tends that no abnormal state of mind should confer irresponsibility unless it involves intellectual as well as moral perversion. (" Medi- cal Testimony," p. 69.) The late Sir B. Brodie also considered that there are no reasonable grounds for admitting this to be an inde- pendent form of insanity. There has been, as he suggests, much mystification on the subject. The term has been applied to cases in which the name of insanity ought not to have been applied at all, i. e., to " moral depravity," and also to cases in which delusions have really existed, and which might therefore have been more pro- perly classed with cases of ordinary mental aberration. (" Psycho- logical Inquiries," p. 99.) Of one fact we may be well assured ; if in these cases of alleged moral insanity there is no indication of a perversion of intellect, medical evidence is not required to deter- mine the fact, or the degree of responsibility in reference to these persons. Those who administer the law, and any man endowed with plain common sense, will be as well qualified as a medical ex- pert, to decide the question of criminal responsibility. Further, until medical men can produce a clear and well-defined distinction between moral depravity and moral insanity, such a doctrine, em- UNSOUNDNESS OF MIND. 733 ployed as it has been for the exculpation of persons charged with crime, should be rejected as inadmissilile. Legal definitmis. — The law of England recognizes two states of mental disorder or alienation : 1. Dementia naiuralis, corresponding to idiocy; and 2. Dementia adventitia, or aocidentalis, signifying general insanity as it occurs in persons who have once enjoyed rea- soning power. To this state the term lunacy is also applied, from an influence formerly supposed to be exercised on the mind by the moon. Lunacy is a term generally applied to those disordered states of mind which are known to medical men under the names of mania, monomania, and dementia; and which are frequently, although not necessarily, accompanied by lucid intervals. The main character of insanity, in a legal view, is considered to be the existence of delusion — i. e., that a person should believe something to exist which does not exist, and that he should act upon this belief. Man}'^ persons may labor under harmless delusions, and still be fitted for their social duties ; but should these delusions be such as to lead them to injure themselves or others, in person or property, then the case is considered to require legal interference. Beside the terms Idiocy and Lunacy, we find another frequently employed in legal proceedings, namely, " unsoundness of mind" — {non compos mentis) — of the exact meaning of which it is impossible to give a consistent definition. From various legal decisions, it would appear that the test for unsoundness of mind in law has no imme- diate reference to the existence of delusion in the mind of a person, so much as to proof of incapacity, from some morbid condition of intellect, to manage his affairs with ordinary care and propriety. (Amos.) E"either condition will suffice to establish unsoundness without the other; for the intellect may be in a morbid state, and yet there may be no legal incompetency ; or the incompetency alone may exist, and depend on bodily infirmity or want of education — conditions which must not be confounded with mental disorder. Thus, then, a person may be of unsound mind, i. e., legally incom- petent to the control of his property, and yet not come up to the strict legal standard of lunacy or idiocy. Some medical practitioners have attempted to draw a distinction between insanity and unsoundness of mind. A case occurred in 1839, in which a medical man hesitated to sign a certificate for the con- finement of an alleged lunatic, because in it the words " unsound mind" were used. He said he would not have hesitated to sign it had the term " insane" been employed. The diflerence, if any exist, is purely arbitrary, and depends on the fact that " unsound mind" is a legal, and not a medical phrase, referring to an incapacity to manage affairs ; which insanity, in its most enlarged sense, does not always imply. The law, however, appears to admit some sort of distinc- tion ; for, according to Chitty, it is a criminal and an indictable act maliciously to publish that any person is afilicted with insanity, since it imputes to him a malady generally inducing mankind to shun his society ; although it is not libellous to say that a man is not of sound mind, because no one is of perfectly sound mind but 734 SYMPTOMS OF INSANITY — DELUSIONS. the Deity! ("Med. Jur.," vol. 1, p. 351.) In reference to the sign- ing of certificates of insanity, it is, however, an error to suppose that the use of one term can involve a practitioner in any greater share of responsibility than the use of the other. Symptoms of incipient insanity. — The symptoms by which insan- ity is indicated at an early stage are liable to great variation, ac- cording to the sex, age, and social position of the person. In refer- ence to suicide, the execution of wills, or the perpetration of crim^, we often find after the death of the person, or at the trial which follows the crime, that the most trivial and irrelevant circumstances are brought forward as indications of insanity. This subject has been ably treated by Dr. Forbes Winslow (" Obscure Diseases of the Brain," p. 88), and to his work I must refer the reader for much useful information. The facts are there gathered chiefly from the accounts furnished to him by those who have recovered. There is great irritability at the most trifling circumstances ; impatience of contradiction, loquacity, great difficulty in directing attention to, and steadily occupying the mind with any train of thought, neglect of usual employment, sleeplessness, depression of spirits without reasonable cause, a disposition to seclusion, doubts about personal identity, followed by hallucinations and illusions. A lady, who was gradually affected, remained insane for nearly eleven months ; she informed Dr. Winslow that during the whole of that time she fancied she was in hell and tormented by evil spirits ; she thought every person near her was the devil. Sometimes a patient fancies he is continually watched by spies, that policemen are looking after him, and that conspiracies and plots among his relatives or friends are going on secretly against him ; he believes that his food is drugged or poisoned, and will refuse to eat. Great anxiety on any subject, followed by headache, may be the fore- runner of an attack ; there is generally an entire loss of interest in the usual occupations, a silent manner, and a great desire for soli- tude. In one instance, fits of immoderate laughter at the most trivial occurrences preceded the attack. Sooner or later these symptoms are attended by perverted taste or smell ; by illusions of hearing or sight; voices are heard, and objects are seen, which at first perplex, and then confuse the patient; they continue until he feels overpowered metally and bodily ; and he then falls into delusions regarding himself, his friends who are about him, his profession or occupation, and his worldly circumstances. Halluciations and illusions. Delusions. — These are the most strik- ing symptoms which are met with in a confirmed state of insanity. Hallucinations are those sensations which are supposed by the patient to be produced by external impressions, although no material objects act upon his senses at the time ; illusions, on the other hand, are sensations produced by a false perception of objects. A man has visions of all kinds, including the forms of the dead and the living, floating before him when he is gazing upon vacancy. He fancies he hears voices speaking, or mysteriously whispering to him while there is profound silence : these are halluciations. An- ILLUSIONS. LUCID INTERVALS. 735 other may erroneously imagine that the taste or smell of his ordi- nary food is earthy, metallic, or poisonous, when the perversion is in his own senses : these are illusions. Both conditions depend upon a disordered state of the mind. Instances of hallucination are furnished by the act of dreaming; while illusions occur often during the act of suddenly waking from sleep, — giving rise occa- sionally to serious questions involving criminal responsibility. The state of insanity is in other points of view analogous to dreaming. There is equally a want of power in the two states to change or control the current of thought passing through the mind. Things which are impossible and inconsistent, are believed to have an actual existence. A voice heard during the act of dreaming some- times becomes an illusion connected with a current of thought then passing through the mind; it is the same in a case of confirmed insanity, with this difference in the latter, that some power of will, or some exercise of reason may still exist. Illusions are sometimes met with in the sane ; but when arising from external objects, the false perception is soon corrected by a reference to the other senses ; and herein consists the main difference between sanity and insanity, — namely, delusion, or a misleading of the mind. "When the hallucination or illusion is believed to have a positive existence, and this belief is not removed either by reflection or an appeal to the other senses, the person is insane ; but when the false sensation is immediately detected by the judgment, and is not acted on as if it were real, then the person is sane. Delusion, thei'e- fore, properly refers to the judgment, and illusion to the senses. The meaning of these terms is often confounded ; but while delusion is always connected with insanity, illusion is not necessarily indicative of mental disorder. Hallucinations and illusions are the main features of those forms of insanity which are known as mania and monomania. They are rarely met with in cases of idiocy and imbe- cility, sometimes in dementia ; but they are most common in parox- ysms of mania. Acts of murder may generally be traced to their existence, for the person laboring under mania or monomania is un- able during a paroxysm to divest his mind of the belief that what he sees has a positive existence before him. He feels impelled to suicide by the hallucination of voices calling to him, and to murder by the illusion that he is not destroying a wife, child, or friend, but an evil spirit substituted for them. The acts of the insane are gen- erally connected with their delusions, although it is not easy to trace the connection, except by their own admissions. When the acts are unusual and strange, it is most probable that they depend on hallu- cination, illusion, or both. Lucid intervals. — By a lucid interval, we are to understand in a legal sense, a temporary cessation of the insanity, or a perfect resto- ration to reason. This state differs entirely from a remission, in which there is a mere abatement of the symptoms. It has been said that a lucid interval is only a more perfect remission, and that although the lunatic may act rationally and talk coherently, yet his brain is in an excitable state, and he labors under a greater disposi- 736 LUCID INTERVALS. tion to a fresh attack of insanity than one whose mind has never been aftected. Of this there can he no doubt, but the same reasoning would tend to show that insanity is never cured ; for the predispo- sition to an attack is undoubtedly greater in a recovered lunatic than in one who is and has always been perfectly sane. Even admitting the correctness of this reasoning, it cannot be denied that lunatics do occasionally recover for a longer or shorter period, to such a de- gree as to render them perfectly conscious of, and legally responsible for their actions like other persons. The law intends no more than this by a lucid interval ; it does not require proof that the cure is so complete that even the predisposition to the disease is entirely ex- tirpated. Such proof, if it could even be procured, would be totally irrelevant. If a man acts rationally and talks coherently, we can have no better proof of a restoration to reason. If no delusion af- fecting his conduct remained in his mind, we need not concern our- selves about the degree of latent predisposition to a fresh attack which may still exist. Lucid intervals sometimes appear suddenly in the insane ; the person feels as if awakened from a dream, and there is often a perfect consciousness of the absurdity of the delu- sion under which he was previously laboring. The duration of the interval is uncertain ; it may last for a few minutes only, or may be protracted for days, weeks, months, and even years. In a medico- legal view, its alleged existence must be always looked upon with suspicion and doubt, when the interval is very short. Lucid intervals are most frequently seen in cases of mania and monomania ; they occasionally exist in dementia when this state is not chronic, but has succeeded a fit of intermittent or periodical mania. They are never met with in cases of idiocy and imbecility. It is sometimes a matter of great importance to be able to show whether or not there exists, or has existed a lucid interval, since, in this state, the acts of persons are deemed valid in law. The mind should be tested, as in determining whether the patient is laboring under insanity or not. He should be able to describe his feelings, and talk of the subject of his delusion, without betraying any signs of unnecessary vehemence or excitement. It may happen that the person who is the subject of a Commission of Inquiry is at the time of examination under a lucid interval, in which case there may be some difficulty in forming an opinion of the existence of insanity. It has been said that a person in a lucid interval is considered by law to be responsible for his acts, whether these are of a civil or criminal nature. In regard to criminal offences committed during a lucid interval, it is the opinion of some medical jurists that no per- son should be convicted under such circumstances, because there is a probability that he might at the time have been under the influ- ence of that degree of cerebral irritation which renders a man in- sane. (Pritchard.) This remark applies especially to those instances in which the lucid interval is very short. Juries now seldom con- vict, however rationally in appearance a crime may have been per- petrated, if it can be clearly proved that the accused was really insane within a short period of the time of its perpetration. VAEIETIES OF INSANITY. 737 CHAPTER LXI. VARIETIES OF INSANITY. — MANIA. — ABSTINENCE FROM FOOD. — DELUSIONS REGARDING POISON. — DELIRIUM DISTINGUISHED FROM MANIA. — MONO- MANIA. DEMENTIA. IDIOCY. IMBECILITY. HEREDITARY TRANS- MISSION. — FEIGNED INSANITY. — APPEARANCES AFTER DEATH. — ECCEN- TRICITY. Varieties of insanity. — Medical jurists have commonly recognized four distinct forms of insanity: Mania, Monomania, Dementia and Idiocy {Amentia). This division was prepared by Esquiroi, and al- though of a purely artificial nature, it is highly convenient for the arrangement and classification of the facts connected with the sub- ject. In some instances there is great difficulty in assigning a par- ticular case to either of these divisions, which is owing to the cir- cumstance, that these states of disordered mind, if we except idiocy, are frequently intermixed, and are apt to pass and repass into each other. On other occasions a case may represent mixed characters which appertain to all the divisions. Some psychologists have pro- posed two subdivisions, namely, Incohereney and Imbecility ; but the former is merely a mixed state of mania and dementia, while the latter is a term applied to those cases of idiocy wherein the mental faculties are susceptible of some degree of cultivation after birth, without reaching the normal standard. Mania. — In this form of insanity there is a general derangement or perversion of the mental faculties, accompanied by greater or less excitement, sometimes amounting to violent fury. (Pagan's " Med. Jur. of Insanity," p. 59 : Marc. " De la Eolie," vol. 1, p. 211.) Ideas flow through the mind without order or connection, the person losing all control over his thoughts, and believing and acting upon them, however absurd and inconsistent they may be. Rapidity of utter- ance and incessant agitation accompany this state ; there is also great irritability, so that not the least contradiction can be borne. Mania may take place suddenly, as after a violent moral shock, but in general it comes on slowly. It may be chronic or acute, recurrent or continued. There are very few cases which do not present re- missions, more or less complete ; and in some instances, after a vio- lent attack, the reason appears to be perfectly restored, forming then what is termed a lucid interval, the clear distinction of which, in a legal point of view, is of material importance. A person affected with mania sometimes has a dread or fear of everything around him ; he cowers down, tries to conceal himself, and shudders at the approach of any one. This state has been called fanophobia. A7 738 INSANITY — MANIA. There is a popular notion, that violent fury is met with in all cases of mania ; but this is an error. In some instances, as in those just referred to (panophobia), this symptom is wanting. These persons are seldom excited to any act of violence, and should they give way to passion, they are easily subdued by the slightest menace. In the greater number of cases of mania there is excitement, coming on in paroxj'sms without any obvious cause, and leading the patients to acts of violence either towards themselves or others. These are the instances which chiefly require close personal re- straint; this, however, has a tendency to increase the severity of the fit, and a more simple plan of treatment, i. e., of watching by personal attendants, has been generally adopted. The fits of violence some- times come on in a sudden and unexpected manner. In recurrent mania the attack comes on without any obvious cause. It may last for a week, a month, or even longer. There is usually a stage of excitement followed by depression before recovery. Persons laboring under mania, especially when it is associated, as it frequently is, with paralysis, are comparatively insensible to severe injuries. They will bear exposure to cold without complaining, and even conceal the existence of a fracture or other injury which would cause great pain to a sane person. They will also sustain the privation of food for a great length of time without any apparent injury to health. In some instances, owing to a suspicion that the food is poisoned, they refuse to take any ; it is then necessary to feed them with a stomach-pump. (Winslow's " Obscure Diseases of the Brain," p. 71.) This delusion respecting the poisoning of food is very common in the early stages of mania. The patient will fancy that he himself, or some favorite animal, is undergoing a process of slow poisoning by a secret enemy. In the greater number of cases of mania there is excitement coming on in parox- ysms without any obvious cause, and leading the person to acts of violence either towards himself or others. It is necessary that a medical jurist should be able to distinguish mania from delirium depending on bodily disease. Delirium closely resembles the acute form of mania — so closely that mistakes have occurred, and persons laboring under it have been improperly ordered into confinement as maniacs. The following are perhaps the best differences : A disordered state of the mind is the first symptom remarked in mania ; while delirium is a result of bodily disease, and there is greater febrile excitement in it than in mania. Delirium, being a mere symptom attendant on the disease which produces it, exists so long as that disease, and no longer ; while mania, depending on widely different causes, is persistent. Delirium disappears suddenly, leaving the mind clear ; while mania commonly experiences only remissions. (See " Pagan's Med. Jur. of Insanity," p. 69.) In delirium there is generally acuteness of the senses. In- flammation of the brain or its membrane (phreniiis) is distinguished from acute mania by the mode of its attack, the presence of severe CHARACTERS OF MONOMANIA. 739 pain in the head, and excessive sensibility with intolerance of light and sound. Monomania. — This name is applied to that condition in which the mental alienation is only partial ; in other words, it is nothing more than partial insanity. In mania, the mind is disordered on all kinds of subjects ; in monomania, the disorder is confined chiefly either to one subject or to one class of subjects. Monomaniacs are infected with false ideas on certain points, of which they cannot divest themselves, and out of which they cannot be reasoned ; they start from false principles, but setting this aside, their inferences and deductions from these principles often possess logical accuracy. In every subject not connected with their special delusion, they are like the rest of the world ; they talk and reason as justly upon facts as before the access of their malady, but their general deportment, habits, and character are changed. Thus, a miser may become a spendthrift, and a hard-working a,nd industrious mechanic may pass his time in idleness ; a man of moral habits will become immoral in conversation and conduct, and an abstemious man may become a drunkard. The monomania may be so slight that the person will have the power of so controlling his thoughts and actions, as to appear like one who is sane, provided the subject of his delusion is not referred to. There is no doubt that those who are affected with monomania in an early stage, are frequently able to direct their minds with rea- son and propriety to the performance of their social duties, so long as these do not involve any of the subjects of their delusions. Their power of controlling their thoughts and feelings, as well as of concealing their delusions, implies a certain consciousness of their condition not usually met with in mania ; and it also appears to imply the existence of such control over their conduct, as to ren- der them equally responsible with sane persons for many of their acts. In a case of confirmed monomania, however, it is not to be- supposed that a man is insane upon one point only, and sane upon all other subjects.' The only admissible view of this disorder is that which was taken by Lord Lyndhurst, in one of his judgments. In. monomania the mind is unsound ; not unsound in one point only, and sound in all other respects, but this unsoundness manifests itself' principally with reference to some particular object or person. (Pri- chard.) There is no doubt that all the mental faculties are more or less afl'ected, but the affection is more strikingly manifested in. some than in others. Monomaniacs frequently reason with correctness from false pre- mises. A man fancying himself to be made of butter, will avoid going into the sun or sitting near a fire ; another, who fancied himself to be made of glass, would allow no one to approach or touch him lest he should be broken. A common delusion relates to the presence of poison in food ; this leads to abstinence from all kinds of food, or from food prepared by a particular person. When these harmless and absurd delusions exist, they require no inter- ference unless they betray the person into acts of violence which 740 MONOMANIA AND ECCENTRICITY. are likely to injure himself or others. The mind may be generally unsound, but if the conduct of the person in the ordinary aftairs of life is not irrational, there is no reasonable ground for interfer- ing with his liberty of action. The delusion of a monomaniac will be generally uppermost in his mind ; his will is powerless to dismiss it, just as in mania the will is powerless to stop the constant and rapid succession of dif- ferent and perhaps heterogeneous ideas which present themselves to the mind in this form of insanity. In the first stage of mono- mania, the judgment may be strong and the mind apparently sound upon every point except the particular subject of delusion, and even in some instances, there may be such a control over this delu- sion, that it would be difficult to discover whether or not there was any just ground for imputing mental unsoundness ; but in a more advanced form of disease, the delusion, whatever it may be,whether relating to wealth, ambition, religion, or politics, so overpowers the patient that he loses self-control. His character is changed, and his habits are such as to render him unfit for social intercourse ; he becomes incoherent ; his ideas are pervei'ted on all subjects, and he gradually lapses into mania or dementia. The last condition hap- pens when the monomania is of long standing. Monomania may be remittent or intermittent, and it is sometimes accompanied with lucid intervals. Its progress is rapid, and its termination often unexpected ; in some instances the disease ceases suddenly without any previous warning, owing to the effect of a strong moral shock or impression. Monomania, in its early stage, is liable to be confounded with eccentricity ; but there is this difference between them : In mono- mania there is obviously a change of character — the person is dif- ferent from what he was ; in eccentricity, such a difference is not remarked ; he is, and always has been, singular in his ideas and actions^ — there is no observable change of character. An eccentric man may be convinced that what he is doing is absurd and con- trary to the general rules of society, but he professes to set these rules at defiance ; a true monomaniac cannot be convinced of his error, and he thinks that his acts are consistent with reason and the general conduct of mankind. In eccentricity, there is the will to do, or not to do ; in real monomania, the controlling power of the will appears to be lost. Eccentric habits suddenly acquired are, however, presumptive insanity. It will be seen hereafter, that the distinction of these states is of considerable importance in relation to the testamentary capacity of persons. Monomania frequently assumes one of two forms: either the thoughts are lively and gay, or they are oppressed with gloomy melancholy. In the-first state, the persons will fancy themselves to be kings and queens, and overflowing with wealth, which they are prepared to distribute with regal profusion ; in the second state, we find silence, seclusion, and the most heart-rending sorrow. The latter condition, by no means uncommon as a form of mono- mania, is called melancholia (mania with depression), or lypemania DEMENTIA. 741 {%v7iri, sorroio). Those who are aftected with it suppose they have committed some unpardonable sin, and pass their hours in silence and in the most gloomy forebodings of temporal and eternal pun- ishment. They do not sleep, and will sometimes neither eat, speak, nor move ; force must be used to make them take food and exercise. In some instances, no persuasion can conquer their silence ; one patient thus affected was not heard to utter a word during four years. If spoken to, they shed tears, and violently repulse the person who addresses them. Melancholia frequently leads to an act of suicide or murder, and persons affected with it require very close watching. In the lighter forms of the disease there is no sign of mental aberration, and the patient will go through his usual routine of duty, but always with the same desponding air — so that his occupation seems scarcely to distract his thoughts from the delu- sion for a single instant. In other cases the delusion is so well concealed that no suspicion exists, until an act of suicide leads to inquiry, and some evidence of strangeness of conduct is then for the first time forthcoming. There is either an entire absence of motive for the act, or the motive is based on a delusion. Dementia. — -This is a state which, although sometimes con- founded with mania, is very different in its characters. Dementia, when confirmed, consists in a total absence of all reasoning power, and an incapacity to perceive the true relations of things ; the lan- guage is incoherent, and the actions are inconsistent ; the patient speaks without being conscious of the meaning of what he is say- ing ; memory is lost, and sometimes the same word or phrase is repeated for many hours together; words are no longer connected in meaning, as they are in mania and monomania. This state is often called, fatuity ; it is a not unfrequent consequence of mania or monomania. Dementia varies in degree. The disordered mind of aged per- sons is one form of dementia ; here we find memory and some mental power, although the memory is restricted to objects long since past, and the exertions of the mind are only momentary. Some persons in dementia are quiet, otjiers are in constant motion as if in search of something. There is generally a strong disposi- tion manifested to collect all kinds of useless articles, which are hoarded up as if they were of great value. In some instances this disease comes on gradually — the faculties, both moral and intellec- tual, decay one by one ; while in other instances, although much more rarely, dementia may occur suddenly from a violent shock or impression on the mind. Dementia may be acute or chronic, re- mittent or intermittent. The countenance of the patient is gener- ally pale, vacant, and without expression, the look vague and un- certain, and tears are abundantly shed from the slightest causes. The following may be taken as the most striking differences be- tween mania and dementia-: In mania there is an incoherence of ideas, but depending on too great rapidity of thought and excite- ment of the intellectual powers ; in dementia there is a want of ideas, and the incoherence depends on the loss of the power of con- 742 IDIOCY AND IMBECILITY. necting them, owing to defect of memory ; volition is lost and the brain seems in a state of collapse. (Esquirol, " Maladies Mentales," vol. 2, pp. 224 and 232.) In fact, in dementia there is a more or less complete abolition of the moral, intellectual, and voluntary powers ; in mania, and also in monomania, they are in a state of perversion. Dementia is often a consequence of these states, and sometimes alternates with them. Idiocy. Imbecility. — Idiocy is the dementia naturalis of lawyers. The term idiot is applied to one who from original defect has never had mental power. Idiocy differs from the other states of insanity in the fact that it is marked by congenital deficiency of the mental faculties. There is not here a perversion, or a loss of what has once been acquired, but a state in which, from defective structure of the brain, the individual has never been able to acquire any degree of intellectual power to fit him for his social position. It commences with life, and continues through it, although idiots are said rarely to live beyond the age of thirty. (Esquirol, '• Maladies Mentales," vol. 2, p. 284.) The deficiency of intellect is marked by a peculiar physiognomy, an absence of all expression, and a vague and un- meaning look ; there is no power of speech, or only the utterance of a cry or sound ; there is no will, but the actions of these beings appear to depend upon impulse, a po^wer of imitation, or mere ani- mal instinct ; they recognize no one, they remember no one, and the mind seems to be a blank. Such is the picture of what may be termed a complete idiot. In Switzerland, this state of idiocy is often accompanied with great bodily deformity, and enlargement of the thyroid gland, both in 'males and females; it is there termed cretinism. Cretins resemble monsters more than human beings. A confii'med idiot may in almost all cases be recognized by the expres- sion of countenance, and the form of the skull. Idiocy is not always so complete as this description implies. There is a state scarely separable from idiocy, in which the mind is capable of receiving some ideas, and of profiting to a certain extent by in- struction. Owing, however, either to original defect, or to a defect proceeding from arrested development of the brain as a result of disease, or other causes operating after birth, the minds of such per- sons are not capable of being brought to a healthy standard of intel- lect, like that of an ordinary person of similar age and social posi- tion. This state is called imbecility ; it is nothing more than idiocy in a minor degree. In common language, persons laboring under it are often called idiots, but for the sake of precision in medical lan- guage they are more correctly described as imbeciles. (Esquirol, op. cit. vol. 2, p. 286.) In imbecility, the physical organization dif- fers but little from the ordinary standard ; the moral and intellectual faculties are susceptible of cultivation, but to a less degree than in a perfect man, and even this capacity does not exist beyond a certain point. Imbeciles never attain a normal standard of intellect, and when placed in the same circumstances as other men, they never make a similar use of their intellectual powers. They can form no abstract ideas, and sometimes their capacity to receive instruction is IMBECILITY. 743 limited only to a certain subject — as for instance arithmetic. Their memory and judgment are limited, although sometimes the former is remarkably strong. They express themselves in a hesitating man- ner, and differently from other men ; they require time to perceive the relations of objects which are immediately perceived by sane persons. The degree to which imbecility exists is well indicated by the power of speech. In idiots there is no speech, or only an utter- ance of single words ; in the better class of imbeciles the speech is often easy and unaffected, while there is every grade between these two extremes. Some have arranged imbeciles in classes, according to their capacity to receive instruction ; others according to their power of speech ; but such divisions are practically without value ; each case must be judged by itself. The precise boundary between idiocy and imbecility cannot be defined. The major degrees of im- becility approach so closely to those of idiocy, that there is no dis- tinction between them, and in a practical view no distinction is re- quired. Idiocy has been here described as that condition in which the congenital defect is not susceptible of being removed by any kind of instruction; but many medico-legal writers apply the term idiot to one who does manifest capacity to receive instruction, although in a low degree. The difference is immaterial so long as the meaning of the word is understood. How are the minor degrees of imbecility to be distinguished from sanity ? This is a question by no means easy to answer, for the reason that sane persons differ remarkably in their mental power to receive instruction, to retain what they have been taught, and to allow them to make a practical use of it in the world for their own benefit. How many persons pass through life and advance in the world, who are yet undoubtedly weak-minded, and who have the reputation among all who know them of being so ! The truth is, the lowest degrees of intelligence legally constituting sound mind, are not separable from the minor forms of imbecility, so far as the moral and intellectual faculties are concerned. By running this distinction too closely, one half of the world might easily reason itself into the right of confining the other half as insane. Idiocy and imbecility must not be confounded with mania and monomania. In idiots and imbeciles, ideas are wanting, and the power of thought is absent or defective ; in maniacs and monoma- niacs, the ideas flow freely, but they are perverted, and the power of thought is irregular and uncontrolled. In idiocy and imbecility, we do not meet with the hallucinations and illusions which constitute the main features of mania and monomania. Idiocy is much more likely to be confounded with dementia, and indeed, when dementia is confirmed and complete {fatuity), there is no appreciable diffei-- ence, for in neither state is there any evidence of the exercise of mental power. In idiocy no ideas have ever been formed ; in imbe- cility they have been partially formed, but arrested ; in dementia they have been more or less completely formed, but have subse- quently become entirely obliterated. It is important to remember that in idiocy and imbecility there .is no gradual loss or sudden im- 7i4 HEEEDITAEY TRANSMISSION. pairment of the mental faculties,as is generally observed in dementia ; the person is what he always has been ; mentally weak and unsus- ceptible of any degree of improvement by instruction. From these remarks it will be perceived that imbecility is a state existing from birth, or from childhood-rfor it is possible that it may supervene from disease after birth, in a child in whom there was no reason to suspect its existence — but it is more common to find the deficiency congenital. Still, the term is often applied to that weakness of the mental powers which takes place in the aged at the close of life, even when the mind has been well developed in maturity. Thus we speak of the imbecility of age: this is truly nothing more than a state of senile dementia, and to apply to it the term " imbecility" tends to create confusion. Such then are the four forms under which insanity or mental aberration may present itself to our notice, and although there are occasionally mixed states, as of mania and dementia {incoherency), yet it is an important feature in the distinction of mental disorders, to observe that in real insanity the characters presented to us in any given case do not vary materially from those which have been described as peculiar to each of these states. This medical classifi- cation, it must be remembered, is made for the sake of convenience, because by it a practitioner may be led to form a safe diagnosis of the real state of mind of a person. It is not recognized in any of the law proceedings connected with the insane: for in these the term unsoundness of mind — comprehending lunacy, idiocy, imbe- cility, and all forms of mental weakness — is almost exclusively employed. In adopting this arrangement, a medical jurist must take care not to fall into an error which has been sometimes com- mitted — i. e., of pronouncing a person to be of sound mind, because his case could not be easily placed in any one of these four great divisions of insanity. This would be as serious an error as that formerly committed by some law-authorities — namely, of giving I'estricted and incorrect definitions of lunacy, idiocy and imbecility, and then contending that whoever was not a lunatic, idiot, or imbecile according to these arbitrary legal definitions, must be a person of sound mind. Hereditary transmission. — The hereditary transmission of insanity has sometimes presented itself as a medico-legal question in relation to the criminal responsibility of the insane. According to Chitty, it is an established rule of law, "that proof that other members of the same family have decidedly been insane is not admissible either in civil or criminal cases." ("Med. Jur." vol. 1, p. 352.) But recent decisions have shown that this statement is not correct. In Eeg. V. Boss Touchet (1844), in which the accused was tried for shooting a man, and acquitted on the ground of insanity, Maule, J., held that evidence that the grandfather had been insane might be adduced, after it had been proved by medical testimony that such a disease is often hereditary in a family. It was also ad- mitted in Oxford's case — the prisoner having been tried for shoot- • ing at the Queen (" Law Times," Oct. 26, 1844), and since that date HEREDITARY TRANSMISSION. 745 it has been adniitted in a number of cases in which insanity Avas urged as a defence on a charge of murder. [It was also admitted in Pennsylvania, in the case of Smith v. Kramer'^ (1 Am. Law. Reg. p. 355), upon the question of a testator's sanity. So in Massachu- setts, Baxter v. Abbott (7 Gray 71). In Delaware, in a trial for murder, the evidence was admitted, and it was said "that reputa- tion in the family of such cases (of insanity) may be proved on the principle of births, deaths, genealogies, etc." {State v. Windsor, 5 Harrington 512.) In State v. Christmas (6 Jones, Law IsTorth Carolina, 471), it was held that where hereditary insanity is offered as an excuse for crime, it must appear that the kind of insanity proposed to be proven, as existing in the prisoner, is no temporary malady; but that it is notorious, and of the same species as that with which other members of the family have been afflicted. — P.] ' [Chief Justice Gibson, in admitting the evidence in this case, thus expressed himself: •'! admit the deposition ■without hesitation, notwithstanding the dicta of Mr. Shelford ('Treat, on Lunacy,' 59), and Mr. Chitty ('Med. Juris.' 355), that it is an established rule of law not to j^dmit proof of insanity in other members of the family in civil or criminal cases. Established ? When, where, and by whom ? Certainly not by the House of Lords in McAdam v. Walker (1 Dow's Par. Ca. 148), the only case cited for it, for the question there was avowedly dodged. That high court would not shock common sense by affirming the order of the Scotch Court of - Sessions ; nor would it gratuitously reverse it, where the decision could be safely put on another ground. The authority of a judgment appealed from, and left in dubio, cannot be very great." ***** "Does not proof of hereditary madness bear directly on the condition of the mind which is the subject of investigation ? " What if the point had been ruled by the Chancellor and law judges in the House of Lords ? Profoundly learned in the maxims of the law, they were profoundly ignorant of the lights of physiology ; yet, free from the presumptuousness of which ignorance is the foster-father, they refused to rush on the decision of a question to which they felt themselves incompetent." ***** " When it is admitted by Mr. Chitty and Mr. Shelford themselves, that insanity is a descendible quality, they give up the argument. There can be nothing unreasonable in referring wild, furious, and unnatural actions, not otherwise accounted for, to the aberrations of a mind, the reflex of that of a crazy father. Mr. Taylor, a distinguished lecturer on Medical Jurisprudence in Guy's Hospital, London, says that 'in making a diag- nosis of a case of insanity, the first question put is commonly in reference to the present or past existence of the disorder in other members of the family. There can be no doubt, from the concurrent testimony of many writers on insanity, that a disposition to the disease is frequently transmitted from parent to child, through many generations. M. Esquirol has remarked that this hereditary taint is the most common of all the causes to which insanity can be referred. ' (Taylor on Med. Juris., 502.)" ***** "The knowledge attained by men of a subject with which they have grappled all their lives, ought surely to prevail against knowledge gleaned from the handbooks of a profession to which the gleaners did not belong. Strange that a source of information, open to every one else, should be closed to those who are to pass on the fact ! Every man has observed that there are families, through which insanity has been handed down for generations. " * * * " An objection to the inquisition which does not disclose the specific nature of the ancestor's infirmity might stand in a different light, but testimony which brings the fact of madness home to him ought to be received like evidence of family likeness, which, though less reliable, was allowed to be corroborative proof of paternity in the Douglas Peerage case in 1767, and again in the Townsend Peerage case in 1843." ***** "In prosecutions for bastardy, the practice in the Quarter Ses- sions was, in my day, not exactly to give the child in evidence, but to put it before the jury, sometimes by the prosecutor, and sometimes by the putative father. But ancestral irregularity in the action of the brain is more frequently transmitted than any resemblance in form or feature ; and it is diflicult to imagine an objection to evidence of it for purposes of corroboration."— P.] 746 DETECTION OF PEIGHiTED INSANITY. This kind of evidence has, however, been frequently rejected, and it is not admitted in the law of Scotland. {Gibson's case, Edin- burgh, December, 1844.) Feigned insanity. — Insanity is frequently feigned by persons ac- cused of criminal oifences in order to procure an acquittal or dis- charge. In the first place, when feigning is suspected, it will be proper to inquire whether the person has any motive for pretending to be insane. ISo sane person feigns without a motive. It is neces- sary to remember that insanity is never assumed until after the commission of a crime and the actual detection of the criminal. 'Eo one feigns insanity merely to avoid suspicion. In general, as in most cases of imposture, the part is overacted — the person does either too much or too little, and he betrays himself by inconsisten- cies of conduct and language which are never met with in cases of real insanity. There is commonly some probable cause to which insanity may be traced, but when the malady is feigned there is no apparent cause : in this case the appearance of the assumed in- sanity is always sudden — in the real malady, the progress of an attack is generally gradual ; and when the attack is really sudden, then it will be found to be due to some great moral shock or other very obvious cause. "We should observe whether for some time previously there has been any marked change of character in the person, or whether his conduct, when he had no interest to feign, presented any of the usual indications of a disordered mind. Some difiiculty may arise when fits of eccentricity or strangeness of char- acter are deposed to by witnesses; but these statements maybe inconsistent with each other, and the previous acts of the person may bear no resemblance whatever to those performed by him in the recently assumed condition. A difficulty of this kind rarely presents itself, since in an impostor no act indicative of insanity can be adduced for any antecedent period of his life : it is only after the perpetration of a crime and its detection, that any action simu- lating the habits of the insane will be met with. In real insanity, the person will not admit that he is insane ; in the feigned state all his attempts are directed to make you believe that he is mad ; and an impostor may be induced to perform any act, if it be casually observed to another in his hearing, that the performance of such an act will furnish strong evidence of his insanity. Mania is perhaps more frequently assumed than any other form, because the vulgar notion of insanity is, that it is made up of vio- lent action, and vociferous and incoherent language: but mania rarely comes on suddenly, or without some obvious cause. A maniacal patient is also equally furious day and night, while an impostor is obliged to rest after his violent exertions. Dr. Burrows recommends that close attention should be paid to the expression of the eye. The mobility of the features may be as rapid as the imagination is vivid ; but when every feature may vary, or be kept under control and be steady, the eye will still indicate the erring thought — its expression cannot be easily assumed. There is about the eyes in mania a restlessness which cannot fail to attract atten- APPEARANCES AFTER DEATH. 747 tion ; the patient sleeps but little, and the sleep is disturbed — an impostor sleeps as soundly as a healthy person. The violence of a maniac continues whether he is alone or not, while the impostor acts his part only when he thinks he is observed; hence the impo- sition may be detected by watching him when he is not aware that an eye is directed upon him. The feigning of monomania is a matter of some difficulty: it would be easily susceptible of detection. As in mania, the part would be overacted, and an impostor would thus betray himself. Dementia is more easily feigned : in general, this state comes on slowly, and is obviously dependent on organic changes, as old age, apoplexy, paralysis, or hemiplegia ; or it is a consequence of recur- rent mania or monomania. As this form of insanity consists in an entire abolition of all mental power, so the discovery of any con- nected ideas, reasoning or reflection, either by language, writing, or gestures, would at once show that the case was not one of real dementia. Idiocy and imbecility could hardly be feigned success- fully, because these are states of congenital deficiency, i. e., they must have existed from birth. Hence it would be easy to show, by reference to the antecedent life of a person, whether he has or has not always been such as he represents himself. There is another fact worthy of notice. An impostor cannot long main- tain his part. If the case is really of long duration without ma- terial change in symptoms and conduct, it is more likely to be one of real than feigned insanity. The difficult cases of feigned in- sanity are really limited to those forms of the malady which are liable to attack a person suddenly. But for a sudden attack of real insanity there should always be some obvious cause : the non- existence of this, with the presence of a strong motive for deception, will justify a suspicion that the malady has been assumed. Causes of insanity. — The causes of insanity may be either moral or physical. A full account of them, with the relative numbers attacked, has been published by Dr. Hawkes. (See " Lancet," 1872, 2, 666.) Among the ordinary causes may be enumerated severe domestic affliction — loss of near relatives or friends — great pecuniary losses — diappointments — long watching — anxieties either as to the health of friends or success in business — severe and long- continued mental exertion — excessive study-^-ambition — the puer- peral state — amenorrhoea — masturbation — -drunken habits — over- excitement on the subject of religion or politics, and in general all tliose disorders which cause depression of health and spirits, and which are accompanied by loss of sleep. About one-third of the existence of man is passed in sleep, and this quiescence or repose is as necessary to mental as it is to bodily health. One of the earliest symptoms of insanity is extreme wakefulness. (Millar, op. cit. p. 9.) Appearances after death.— In some cases a medical practitioner may be required to state whether certain appearances foundin the brain of a deceased person do, or do not indicate the past existence of insanity, or imbecility. Such a question is only likely to arise in chronic cases, in which the past existence of insanity from oral 748 APPEARANCES AFTER ItEATH. testimony may be disputed. (Case of Stulz, Prerog. Court, 1852.) The appearances commonly met with on an inspection of the head are thickening of the bones of the skull, close adhesions of the dura mater (the lining membrane), with great congestion of the pia mater, and opacity and thickening of the arachnoid or inner mem- bi'ane of the brain. There is a general fulness of the bloodvessels of the brain, with remains of old cysts, hardened deposits, or even abscesses in various parts of the cerebral substance. Inferences from the existence of these appearances in the brain must, however, be drawn with caution, because it cannot be said that they necessarily indicate insanity ; nevertheless, such chronic changes must be con- sidered as producing greater or less derangement of the mental functions; but the actual degree to which the impairment has ex- isted ought properly to be determined by evidence of the conduct and actions of the deceased during life. In a communication made by Dr. Webster to the Medico-Chirurgical Society in April, 1855, there is a statistical summary of the appearances met with in the examination of the bodies of 290 insane patients. In 226 cases the pia mater was infiltrated ; in 207 effusion had taken place in the ventricles; in 184 fulness of the bloodvessels in the brain or mem- branes was observed; in 117 the arachnoid membrane was thick- ened and opaque ; in 64 the color of the brain appeared changed from its natural hue ; in 51 the bloody points {punda cruenta) were large and numerous upon the cut surface of the medullary substance ; while in 40 instances blood was effused, sometimes to a considera- ble extent, within the cranium. This effusion had evidently been the immediate cause of death in most of the patients. From these data it appears that — first, infiltration of the pia mater; secondly, effusion of fluid in the ventricles; and thirdly, fulness of the cranial vessels, are the principal as also the most frequent diseased altera- tions of structure observed in patients who die while suffering under symptoms of mental disorder. As neither the symptoms nor the duration of the insanity is given, it is difficult to apply these I'esults to special instances. In the case of Roberts v. Kerslake (Warwick Aut. Assizes, 1854), the main ques- tion was whether certain appearances in the brain and its membranes did or did not indicate disease of long standing as well as insanity at the particular date at which a will was made. Dr. Conolly and I considered that the appearances were not inconsistent with the sup- position that the testator was sane at the time of making his will. ("Journal of Psychological Med." Oct. 1854, p. 573.) IMPOSITION OF RESTRAINT. 749 CHAPTER LXII. MEDICO-LEGAL QUESTIONS IN RELATION TO THE INSANE. — IMPOSITION OP RESTRAINT. — ILLEGAL IMPOSITION OE RESTRAINT. — VIOLENCE OF TEMPER. — CERTIFICATES OF INSANITY. — RULES FOR THE DISCHARGE OF LUNATICS. Among the questions which may come before a medical jurist in relation to the subject of insanity are the following: A practitioner may be required to say whether a person affected with the malady should, or should not be confined in a lunatic asylum — whether he should be deprived of his civil rights by interdiction, or whether he is so completely cured of his malady as to justify his liberation from confinement. Then again medicfil evidence may go far to determine whether a will or deed executed by an alleged lunatic should be set aside; whether a marriage-contract or debt should be annulled; and lastly, whether a criminal act was committed by a person while laboring under insanity — a question involving either the life or, according to circumstances, the perpetual imprisonment of a person accused of crime. Imposition of restraint. — By restraint, in a legal sense, we are to understand the placing of attendants to watch or control the actions of an alleged lunatic, or his forcible removal from friends or relatives, with or without the confinement of his person by physical force. What are the circumstances which will justify a practitioner in applying restraint to the insane? The law has given great power in this respect to members of the medical profession, but, owing to certain abuses, the power has been of late years much restricted by various Acts of the Legislature. Most medico-legal writers agree that we are not justified in ordering restraint except when,/rom symptoms witnessed by ourselves, we have reason to apprehend that the lunatic will injure his person or property, or the person or property of others. It is then not sufficient to seek merely for evidence of the existence of some delusion, but to determine how far that delusion, if present, affects the conduct of the person. Unless the delusion be such as to render it probable that the patient's own interests or those of others may he damaged by his insane conduct, careful superintendence will answer all the purposes of the closest restraint. (For some remarks on this subject, see "Med. G-az." vol. 44, p. 1061.) The act of resorting to restraint on all occasions has been justified on the principle that it may tend to the cure of a patient, by removing his delusion. In this point of view, the subject has reference to medical practice, and not to legal medicine. It may be urged with more plausibility, that by withholding restraint in 750 RULES EESPEOTING IMPOSITION OF RESTRAINT. incipient cases, mischief may be done by the lunatic to himself or others, and that then it will be too late to interfere; but even here careful superintendence may render close confinement unnecessary. The legal rule for interference with the liberty of a person, which restraint always implies, pay be inferred from the following state- ment by Mr. J. F. Stephen : " There is a normal state in which all human creatures act on the same principles, and the general mean- ing of sanity is, that the person conducts himself in this normal manner ; that he is acquainted with the circumstances by which he is surrounded ; that he has objects in view in his actions, and that he regulates his conduct with reference to them and to the general considerations which affect matters of that class." (" General View of the Criminal Law of England," pp. 87 et seq.) It cannot be too strongly impressed on the mind of a medical man that, before he employs the powers conferred upon him by law to confine a person who is said to be mad, he should have well in his mind what lawyers imply by the term " madness," in a practical sense. As defined by Mr. Stephen, it means conduct of a certain character — not, as it is usually interpreted by medical men, a certain disease of the brain, the existence of which is speculative, but one of the effects of which, if present, is to produce such conduct. In examining an alleged lunatic, with a view of determining whether he should or should not be placed in confinement, his conduct must therefore be com- pared with that of other men in a normal state: and here, in order to constitute sane behavior, we must look for a generic, and not for a specific resemblance. Any degree of ignorance, vice, or folly is perfectly consistent with sane conduct in a legal sense. The power of restraint is not intended to be applied to such cases as these ; they are properly under certain circumstances amenable to the criminal law. An ignorant, vicious, or foolish man may do a great amount of mischief, but he has a liberty of choice and freedom of action; and if from folly or depravity he selects a bad course, he is not therefore insane, but is as much responsible for his actions as a sane man who prefers a good course. Such a man should not be treated as a lunatic, or confined in an asylum under a medical certificate. It may be sometimes difficult to define the line which separates acts of depravity from those of insanity : but medical men have not been in many cases sufficiently cautious in endeavoring to make a dis- tinction. Lawyers look closely to conduct as a ground of inter- ference with personal liberty: the conduct must be such as to be inconsistent with the usual behavior of a normally sane person placed under similar circumstances. In examining a person proposed to be placed under restraint, we must take care not to confound acts depending on violence of temper with those which proceed from unsoundness of mind. A man may have always had a violent temper, subject to occasional fits of aggra- vation ; but this condition must not be mistaken for mental disease. In order to determine whether the acts of a person be due to violent temper or insanity, it will be proper to ascertain what may have been his natural habits. The great feature of insanity is change of RULES EESPECTING IMPOSITION OF BBSTRAINT. 751 character — a man who is really insatie is different from what he has previously been ; but it may be proved of a violent-tempered man that he has always been the same. The greatest abuses of the re- straint system have been chiefly observed in respect to monomania, where persons have ■ been forcibly imprisoned and confined in their persons, because they entertained some absurd delusions, over which however, they had so great a power of control as to render it some- what difficult even for a shrewd and experienced examiner to detect them. "When at last after many hours' cross-examination, the ex- istence of a delusion has been made apparent, the result has been looked upon as furnishing matter for triumph and exultation ; but, as Dr. ConoUy justly remarks, one point in these cases appears to have been wholly lost sight of, namely — What possible injury could have resulted to the patient or his friends from the existence of a delusion over which he had such complete control and mastery as to render it a most laborious task to obtain any evidence whatever of its existence ? (" Indications of Insanity.") It may be freely ad- mitted that where delusion does exist, there is reason to suppose that the mind must be more or less disordered in all its faculties ; but such patients require only close watching, not a rigorous imprison- ment in an asylum. The greatest danger is to be apprehended in all those cases where there is the least power of self-control. The forci- ble removal of a person from his home to a lunatic asylum, unless the circumstances are of such a nature as to render immediate inter- ference necessary on the ground of admitted or proved insanity, is unjustifiable in law, and may involve those concerned in the removal in a serious responsibility. In cases of incipient insanity, interfer- ence would not be legally justifiable, and a practitioner placing restraint on a person so situated, might find himself defendant in an action for damages. In Hill V. Philp the judges decided that a medical man, when called upon to give a certificate for the confinement of a person, may act upon the directions of a wife, but that the directions must be considered as only guiding his judgment, and not absolutely dictating to him and justifying his proceedings ; that he is still bound to exercise his own professional knowledge and discretion so far as to refrain from doing anything, or adopting any course which might be injurious to the patient. A medical man is, there- fore, ultimately responsible for the treatment of a lunatic: no person can give him authority to do that which is not in accordance with general practice or the necessity of the case. (For a report of this case, and some judicious remarks upon the decision, see the " Legal Examiner," May 29, 1852, pp. 307, 318.) In Scott v. Wakem (Guild- ford Summer Assizes, 1862), the defendant, a medical practitioner, was sued for damages in placing under restraint, and without neces- sity or authority, a man laboring under delirium tremens. In this case the wife denied that she had given any authority for interfer- ence, and on this point her evidence conflicted with that of the de- fendant, the medical man whom she had consulted. Fortunately the facts were adverse to her statement ; but in future cases of this 752 CEETIFICATES OF INSANITY. kind, it would be desirable for a medical man to have a written authority for such proceeding, bearing in mind that he does not exceed what is necessary, proper, or usual for the treatment of the person ; and on this he must always exercise his own judgment, irrespective of the opinions or suggestions of others. Medical men, even when acting most conscientiously in discharge of their duties, cannot hope to escape harassing and vexatious actions when they are called upon to deal with cases of delirium tremens. The pecu- liarity of this disorder is that, with the cause, it may soon disappear, and thus medical evidence may be easily procured to show that a person, at a short period before or after the imposition of restraint, was in a sane state of mind and not in a condition to justify any interference with his personal liberty. In order to provide for the protection of lunatics and for the pre- vention of undue violence or frequency in the application of restraint, the law compels the keepers of asylums to enter in a book a report of each case, or of each occasion on which any mechanical restraint is resorted to. An omission to make this entry is a misdemeanor: and at the Maidstone Lent Assizes, 1851, two medical men were convicted and fined for placing patients under restraint without having made the proper entries required by law. {Reg. v. Maddock: see also " Med. Gaz." vol. 47, p. 556 ; and a paper on the " Use and Abuse of Restraint," in the " Journ. Psychol. Med." 1849, p. 240.) Certificates of insanity. — It will here be necessary to state the cir- cumstances which require the attention of a practitioner when he is called upon to sign a certificate of insanity, whereby a person may be placed in confinement in an asylum. The Acts which specially refer to this subject are the 16th and 17th Victoria, c. 96 and 97. These Acts, which came into operation on the Ist of November 1853, are a consolidation of the statutes on the regulation of the care and treatment of lunatics. Their provisions are very stringent, both with respect to medical men who sign certificates, and those who keep asylums for the reception of lunatics. According to s. 74, c. 97, no person (not a pauper) can be received into or detained in any asylum, without an order from some person (generally the near- est relative) and two medical certificates, which must be signed by two physicians, surgeons, or apothecaries not in partnership or an as- sistant to the other, and each of whom shall separately from the other have personally examined the person to whom it relates not more than seven clear days previously to the reception of such person into such asylum. These certificates need not be filled up, signed, and dated on the day of examination ; but the examination of the patient must be made in every case within seven clear days before admission. The following is the form of a medical certificate in the case of private patients : — I, the undersigned, being a (duly registered) physician or surgeon or apothecary [here set forth the qualification'], and being in actual CEETIFICATES OF INSANITY. 753 practice as such, hereby certify that I, on the day of , at [here insert the street and number of the house (if any), or other like -particulars'], in the county of , etc., separately from any other medical practitioner, personally examined A. B., the person named in the accompanying statement or order, and that the said A. B. is a lunatic [or an idiot, or a person of unsound mind], and a proper person to be taken charge of and detained under care and treat- ment, and that I have formed this opinion upon the following grounds, viz. : — 1. Facts indicating insanity observed by myself [here state the facts]. 2. Other facts (if any) indicating insanity, communicated to me by others [here state the information, and from whom]. (Signed) Name. Place of abode. Dated this day of , One thousand eight hundred and Under s. 10, c. 96, no person can be received into any registered hospital or licensed house, or as a single patient, under any certifi- cate which purports to be founded only upon facts communicated by others. A medical certificate may be amended, if incorrect or defective. No medical man can receive as a boarder in his house any insane person, whether for medical treatment or otherwise, un- less he has previously obtained a license from the Commissioners of Lunacy, and one certificate duly signed by two other medical men. In January, 1861, a medical practitioner was convicted of misdemeanor for thus receiving illegally a lunatic patient. (Seg. v. Kelley, C. C. C, Jan. 29, 1861.) This was a clear breach of the regulations. The defence was that he was ignorant of the law," but this was no answer to the charge. (" Med. Times and Gaz.," Jan. 28, 1861, p. 105 ; and " Lancet," Feb. 9, 1861, p. 151.) Dr. Millar, who has had considerable experience as the superin- tendent of a large lunatic asylum, states that, as a rule, very few of the certificates which are brought with private patients are cor- rectly filled up, notwithstanding the plainness of the instructions. The omission of particulars apparently of no importance has often, caused them to be rejected as illegal ; and it will therefore be use- ful to point out the chief errors which, according to this gentle- man, are committed by medical men. Ist. A neglect in stating the qualification which empowers the medical practitioner to prac- tise. It is not unusual for the blank space to be filled up with the words " physician," " surgeon," or " apothecary," instead of insert- ing the qualification which enables him to practise in any of these isapacities. 2dly. Omitting the address of the house at which the examination was made. If there should be no number to the house, it will be sufiicient to state, "At the dwelling house of , in street, village, etc." 3dly. Omitting the address and occu- pation of the person examined. In nine cases out of ten, accord- ing to Dr. Millar, an omission of one of these three simple and- obvious particulars occurs — a degree of carelessness not creditable tO' 48 754: CEETIFICATES OF INSANITY. the profession. Medical men no doubt err from regarding them as having no bearing whatever on the sanity or insanity of a patient. (See Millar's " Hints on Insanity," p. 78.) By s. 13, c. 96, a medical practitioner who gives a false certificate, or any person not being a registered physician, surgeon, or apothe- cary in actual practice, who gives a certificate as such, is declared to be guilty of a misdemeanor. For any act done by a registered medical practitioner contrary to any of the provisions of the Act (although not declared to be a misdemeanor), he is subjected for each proved offence to a penalty of twenty pounds. By s. 36 the words "physician," "surgeon," or " apothecary" shall respectively mean one duly " licensed or registered to practise as such bj', or as a mem- ber of some College, University, Company, or Institution, legally constituted and qualified to grant such authority or license in some part of the United Kingdom., or one who was in practice! as an apo- thecary in England or Wales on or before the 1st day of August, 1815, and being in actual practice as such physician, surgeon, or apothecary." (16 & 17 Vict. cap. 96, s. 36.) Thus, the certificates of Irish medical practitioners are valid for the confinement of lunatics in England, and conversely those of English practitioners are valid for asylums in Ireland. A special Act has been passed for Scotland (20 & 21 Vict. c. 71) : and by sections 34 and 35 the rules regarding certificates are similar to those of the English statute. A medical practitioner must not be too ready to lend himself to the signing of certificates for the confinement of persons who may be laboring under harmless delusions. In violent mania, or in mono- mania with a homicidal or a suicidal propensity, there can be no doubt of the propriety of applying some degree of restraint, for here the necessity is imminent. If a remarkable change has sud- denly taken place in the character of a person, if he has become irritable, outrageous, or threatened personal violence to any one, or if he has recklessly endangered the interests of himself and family, he is undoubtedly a fit subject for restraint. (See Pagan, p. 75.) The more he approaches to this condition, the less difficulty we shall have in coming to a decision ; and in a really doubtful instance there will be no impropriety in employing restraint ; since, although the person is thereby deprived of liberty, it is better that this should happen than that he or his friends should incur the risk of sujSering severely by his insane conduct. The 74th section of cap. 97 provides that in cases of emergency a person (not a pauper) may, under special circumstances (these being stated in the order), be received into a house or hospital, upon a cer- tificate signed by one medical practitioner only, provided that within three days two other such certificates are signed by two other me- dical practitioners not being connected with such house or hospital, upon a like examination. The detaining of a person upon one medical certificate only beyond the period of three days, without such further certificates, is a misdemeanor in the keeper of the house or hospital. By s. 67, c. 97, the certificate of one medical practitioner only, signed according to the above rules, will suffice CERTIFICATES OF INSANITY. 755 for a pauper lunatic, provided the person has been previously ex- amined by a justice, clergyman, and overseer or relieving officer. By 8. 12, c. 96, no medical practitioner who is interested in or attends a licensed house or hospital, or whose father, brother, son, partner, or assistant is wholly or partly the proprietor of, or a regular professional attendant in, such house or hospital, shall sign any certificate for the reception of a patient into it. It is obvious from the terms of the Act that one person cannot sign a certificate as a substitute for another, and yet there have been several instances of its violation under these circumstances. In December, 1855, a medical assistant was committed for trial because he had signed the name of the surgeon with whom he was living to a certificate of in- sanity for the confinement of a pauper lunatic. There was no doubt about the insanity of the person, and the plea urged in defence was that the surgeon whose name was thus forged was in ill health, and had given the assistant an authority to sign papers for him. This, however, was no justification of a violation of the terms of the Act : the words of the certificate are so explicit on this point, that no reasonable person can have any doubt about their meaning. [The principal hospitals for the insane of the United States have printed forms and obligations, which are furnished to the friends of patients to be filled up and signed according to the law of the State, and the rules of the hospital. The form of the medical cer- tificate generally requires the patient to have been seen and ex- amined by the physician signing, on the day on which the certifi- cate is dated. In all cases, the certificate is expected to apply only to the actual condition of the patient at the time of signing, and to be used without delay in order to be available. The medical certificate must always be accompanied by a formal application ~for admission of the patient, signed by a responsible guardian, near relative or friend. These papers have also annexed to them, a series of questions relating to the past history and exist- ing condition of the patient, the peculiar symptoms of the case, and the probable cause of the attack; which questions are to be answered by the friends and relatives, and the attending physician. Some hospitals require the signatures of two physicians to the medical certificate, neither of them, of course, being connected with the hospitals applied to. The State Lunatic Hospital of JSTew Jersey requires the medical certificate to be formally deposed to by two physicians before a magistrate. Patients sometimes obtain their discharge on a writ of habeas corpus, but are generally removed by friends or discharged, when sufficiently recovered, at the discretion of the superintendent. We are not aware of any legal restriction in this country on the libera- tion of insane patients, except in cases of homicidal or otherwise dangerous lunatics, who have been confined by order of a magistrate or of a court of law. Such patients can only be released by an authority similar to that which first committed them. There are patients of this class now in durance at the Eastern State Peniten- tiary of Pennsylvania, and in the different State Asylums.— H.] 756 SPECIFICATION OF FACTS. As ignorance of the law is not allowed to be an excuse for its violation, so a medical man, unless acquainted with all the particu- lars above mentioned, may easily subject himself to a prosecution or a civil action ; and he is not likely to be spared the disgrace and mortification attendant upon either, should it happen that the case is of a doubtful nature. The law expressly requires from each medical man a separate visit, a separate personal examination of the alleged lunatic, and a separate medical certificate, setting forth the special fact or facts (whether observed by himself or derived from the information of others) upon which his opinion is based. Dr. Conolly has shown that there are objections to the severity of the restrictions regarding the certificates ("Journal of Medical Sci- ence," April, 1861, p. 127), but some recent cases have proved that they are not even strong enough to prevent sane persons from being wrongfully sent as lunatics to asylums. Specification of facts. — It will be observed that every medical practitioner signing a certificate of insanity is required to specify the facts upon which his opinion is formed, and whether such facts are derived from his own observation or from the infoi'mation of any other person. Medical practitioners have had some difficulty in performing this duty, i. e., in assigning the fact or facts upon which their judgment of the insanity of a person is based. ("Med. Gaz.," vol. 36, p. 1434; and vol. 37, p. 485.) What will constitute the de- scription of a fact to render a certificate valid ? This important question was raised and decided in the case of Shuttleworth (Queen's Bench, 'Nov. 17, 1847). An application was made for the discharge of a lunatic on the ground that the medical certificates did not set forth the facts from which the opinion of those who signed them was derived. In one it was stated that the lunatic labored under a variety of delusions, and that she was dirty and indecent in the extreme ; in the other the certifier stated that he had formed his opinion from the conversation which he had that day had with her. It was con- tended that the statement in the first certificate was not so much a fact as a conclusion drawn from other facts, which ought to have been mentioned in the certificate itself. Lord Denman, in giving the judgment of the court, held that the certificates were valid — that it was not necessary to have all the delusions of an insane per- son stated in the certificate. The statement that the lunatic was dirty and indecent in the extreme was primd facie suflicient to justify the imputation of insanity, even if the certificate did not state that the patient labored under a variety of delusions: the allegation that the opinion respecting insanity was founded upon a conversation with the alleged lunatic was also sufficient to render the certificate valid. ("Med. Gaz.," vol. 38, p. 932; also "Law Times," Nov. 21, 1846, p. 145.) Hence it follows that a general statement of the circumstances which have led to the belief in the insanity of a person, will be a sufficient compliance with the re- quirements of the statute to render a certificate valid, provided the examination has been made bond fide, and with due care and at- tention. PROOFS OF INSANITY. 757 Dr. Millar has shown how little the words " Facts indicating in- sanity observed by myself," are appreciated or even understood by many medical men, who are legally empowered as registered mem- bers of the profession to sign these certificates. The facts are fre- quently stated in a loose and careless manner, showing a complete misapprehension of their meaning. "What is really required by the law is a statement of facts observed or witnessed by the medical man himself, which would carry conviction to the mind of any non-professional man reading it, that the person to whom it re- ferred was of unsound mind. A medical man should in all cases avoid giving as a fact indicating insanity, any delusion which might in reality have some foundation in truth. With respect to the second requirement of the statute — namely, " Other facts (if any) indicating insanity communicated by others " — it may be ob- served that, although these do not supersede the facts observed by the medical man himself, they are of great importance in throwing light upon the propensities or habits of the patient, and thus serve as a guide for treatment. (Op. cit., p. 79.) A medical man must take care to draw a clear distinction between the facts observed by himself and the facts communicated to him by others, and avoid such vague expressions as that he " thinks " and " believes," etc. As every medical certificate, although accepted by the Commis- sioners of Lunacy, may become at a future time a subject of close and hostile criticism in court, a medical practitioner should be fully prepared to justify the use of the terms which he has employed; It is therefore desirable that he should studiously avoid any mis- statement or exaggeration of the symptoms. One of the facts cited as indicative of insanity in an old lady was, that she kept a cockatoo ! In the case of Davies, the tea-dealer, Lord Brougham, then a counsel at the bar retained to oppose the commission against the alleged lunatic, elicited from one of the witnesses as a fact upon which he relied to indicate insanity — that when asked the question, Mr. Davies did not know how much change he had in his pocket ! Another relied upon the fact as indicative of weak mind, that the alleged lunatic had said he preferred seeing the people come from Epsom races rather than the racing on the course ! Vague and trivial facts which do not indicate insanity, naturally tend to produce a feeling in the minds of the jury the very reverse of that for which they are brought forward. Thus, in this case, although there could be no doubt, from what subsequently occurred, that Mr. Davies was a lunatic, and a fit and proper person to be placed under restraint, yet the eloquence of Lord Brougham, and the result of a skilful cross-examination in bringing into promi- nence the weakness of the facts on which the witness relied to establish insanity, had such an influence with the jury that they returned a verdict in favor of the lunatic, and for a time he was considered as the unhappy victim of an unjust persecution on the part of his mother and other relatives. In a case referred to by Dr. Bucknill, one of the medical men certifying to the insanity of a gentleman, who was at that time undoubtedly insane, had stated 75S DISCHARGE OF LUNATICS. as facts observed by himself, that "his (the patient's) habits were in- temperate, and that he had squandered his property in mining speculations." But on cross-examination in the Queen's Bench, he was obliged to confess that the only act of intemperance he had actually observed was the patient's drinking one glass of beer, and that the squandering of property was the loss of what was to him a mere trifle in a mining speculation, which eventually turned out to be a very good one. (Millar's " Hints on Insanity," 1861, p. 187.) Counsel properly hold a medical practitioner strictly to the com- mon and accepted meaning of the words which he uses. No professional man is compelled to take upon himself the re- sponsible duty of signing certificates of insanity ; but if he does undertake it, he must perform it with reasonable care and ordinary skill. If he certifies that a person is laboring under delusions, he must take care that he understands the meaning of the term and what are the delusions ; and admitting that he is correct in believ- ing from his own observation that they exist in the mind of the patient, it must be remembered that, in order to justify restraint or imprisonment in an asylum, the law looks always to the influ- ence of these delusions upon conduct. In reference to the important question of medical responsibility, the following observations were made by the learned judge in the case of Hall v. Semple (Q. B. Dec. 1862) : " The true ground of complaint is the negligence of the defendant, and the want of due care in the discharge of the duty thrown upon him ; and I think that if a person assumes the duty of a medical man under this statute, and signs a certificate of insanity which is untrue, without making the proper examination or inquiries which the circum- stances of the case would require from a medical man using proper care and skill in such a matter — if he states that which is untrue, and damage ensues to the party thereby, he is liable to an action, and it is to that I desire to direct your particular attention. In point of law, if a medical man assumes, under this statute, the duty of signing a certificate, without making due and proper examina- tion which a medical man under such circumstances ought to make, not in the exercise of the extremest possible care, but in the exer- cise of ordinary care, so that he is guilty of culpable negligence, and damage ensue, then an action will lie against him, although there may have been no improper motive, and the certificate may not be false to his knowledge." In this case the jury found a ver- dict for the plaintiff — that the certificate was untrue in effect, and that it had been signed without proper examination and inquiries, and without probable cause. Discharge of lunatics. — In forming an opinion relative to the {iropriety of discharging a person who has once been confined as a unatic in an asylum, it is proper to isxamine the particulars of his case with the same caution as if the object were to confine him for the first time. The question of liberation is commonly restricted, like that of restraint, to cases of mania and monomania. It may so COMMISSIONS OF LUNACY. 759 happenthat the person has had a lucid interval at the time of ex- amination, in which case it will be necessary to make more than one visit. One who has been guilty of a heinous crime like murder, should never, on any pretence, be discharged. There are often long lucid intervals in homicidal mauia, and it is impossible to be certain that the disease is entirely removed. If the person has manifested the least disposition to suicide, we should be extremely cautious in liberating him ; for suicidal mania is often artfully concealed under a cheerful exterior. We cannot always test the propriety of grant- ing liberation by the lightness of the offence for which a criminal lunatic has been confined. The circumstances under which the most trifling offence has been committed may show that the mind is wholly unsettled with regard to moral responsibility; and such lunatics can never be trusted, even when there is a great improve- ment in their language and deportment. The 16th and 17th of Victoria, c. 97, has placed certain restric- tions on the power of liberating lunatics. Under ss. 83 and 84, the person originally signing the order which is required in addition to the medical certificates, may write an order for the discharge or removal ; but under s. 84 this order is of no effect, if a medical practitioner certify that in his opinion such patient is dangerous and unfit to be at large, together with the grounds on which his opin- ion is founded, unless the commissioners or visitors shall, after the production of such certificate, give their consent in writing for the removal or discharge of such patient. Under other clauses, addi- tional powers of dischai'ge are given to the commissioners and visi- tors, subject to such restrictions as to leave the control for the most part in the hands of professional men. These powers of discharge do not, however, apply either to criminal lunatics or to those found insane under a commission issued by the Lord Chancellor. CHAPTER LXIII. INTERDICTION. — COMMISSIONS OF LUNACY. — EXAMINATION OF ALLESED LUNATICS. — MEDICAL AND LEGAL TESTS OF COMPETENCY. — CONFLICT OF EVIDENCE AND OPINION. Interdiction. — By interdiction we are to understand the depriving of a person'laboring under mental disorder of his civil rights ; in other words, preventing him from exercising any control or man- agement over his affairs. It may be with or without restraint, for one condition does not necessarily imply the other, although there is a popular idea to the contrary. In Re Smith (June, 1862) an order for a jury was issued to try the question of sanity or insanity, and in affirming the order. Lord Justice Knight Bruce made the following statement : " It is desirable to remove the idea, but too 760 COMMISSIONS OF LUNACY. generally entertained by persons (common persons) in different stations of life, that the finding by a jury that the person is of unsoimd mind necessarily involves an interference with his per- sonal freedom: it does not. The court places no further restraint upon a lunatic than is necessary' for his protection, and I would refer to the fact that there are several lunatics living under the protection of the court who reside in their own houses, with large establishments." "When a person, from mental incompetency, is liable to be im- posed upon by others, or is guilty of foolish and extravagant acts, whereby his property is damaged, a Commission is commonly granted by the Court of Chancery, in order to determine whether he be "compos" or "non compos mentis." This writ is well known under the name of " de lunatico inquirendo." Before it can be issued it is necessary, among other matters, that there should be affidavits made by two or three physicians or surgeons, certifying to the in- sanity of the party. It has been already explained that the object of the Commission is to determine whether the incapacity to man- age affairs is owing to some mental defect or disorder, and not merely to want of education or bodily infirmity — otherwise all wealthy minors and infirm persons might be improperly deprived of the control of their property, formerly, Commissions were not issued unless it was evident that lunacy or idiocy existed — for weak- ness of mind or imbecility was not considered sufficient to justify legal interference. This is no longer the case, — "unsoundness of mind with incompetency" being all that the law requires to be established.. Thus, then, whether the case be one of mania, mono- mania, or dementia is not now the question, but whether the party be compos, or non compos mentis ; if the latter, whether it be to a degree to prevent him from controlling his property with careful and provident management. There was a strange contradiction in our system of jurisprudence some years ago. A person who had a delusion on a particular subject, although not affecting his social duties, was deemed a fit subject for a Commission, and deprived of his civil rights merely because his mental disorder would fall under the definition of lunacy. On the other hand, one who had no delu- sion, but great mental weakness, such as to incapacitate him from properly managing his affairs, was not deemed a fit subject for a Commission ; since weakness of mind and insanity were considered to be two entirely different states — the latter alone requiring inter- ference, although the injurious results were the same in both cases. It is unfortunate that these Commissions have been usually con- ducted on so expensive a scale as to render them applicable only to the wealthy classes of society: and even here the expenses attending such a simple inquiry as that for which the Commission is issued, have been often of the most ruinous kind, and the results by no means satisfactory. The Lord Chancellor has it now in his power to direct an inquiry to be made before one or two Commissioners, in which case a jury is dispensed with. Evidence may then be re- ceived, and the decision left with the commissioner or commissioners CONFLICTING MEDICAL EVIDENCE. 761 80 appointed. The costs of an inquiry by this regulation are greatly reduced ; and even under the amended law no tiommission of Lu- nacy can be had at a less expense than £60, and this only in uncon- tested cases. This form of proceeding is now adopted in the greater number of cases, so that out of 575 commissions in ten years only 21 were before juries. The Lunacy Regulation Acts are the 16th and 17th Vict. c. 70. (1853), and the 25th and 26th Vict. c. 86 (Au- gust, 1862). The last-mentioned Act has greatly improved pro- ceedings in lunacy, and has removed much of the injustice which formerly prevailed. In order to shorten these inquiries and lessen the expenses, the order under s. 3 is to be confined to the question whether or not the person is " at the time of unsound mind and incapable of managing himself and his aftairs." 'No evidence on his conduct is to be received as a proof of insanity unless it refers to a period within two years of the date of the inquiry. In cases of contested imbecility, this provision might exclude important evidence, but there is a discretionaiy power in the judge to admit it. Section 4 allows of the case being tried by a jury at common law. The alleged lunatic is to be examined before the taking of the evidence, and at the close of the proceedings, before the jury consult on their verdict. Under s. 12 power is given to the Chan- cellor to dispense with commissions in reference to persons who have but small property, and there are in this statute other strict rules regarding the visiting of lunatics confined in asylums. One source of difficulty on these occasions is, that medical wit- nesses are allowed to be separately sought out and summoned by those who are for and against the commission, and the opinions given by them often exactly neutralize each other. Under these circumstances they are converted into partisans in the cause as much as if they were counsel. It has been well remarked, that a man even unknown to himself, with the purest intentions and the most perfect rectitude, will insensibly lean to the side on which he has been consulted or employed. (Pagan, p. 301.) The public are apt to infer from such conflicting opinions emanating from men of equal experience, that the difference cannot depend essentially on the med- ical facts of a case, and that the question might as well or even bet- • ter be determined by non-professional persons. See the case of Mrs. Gumming (" Journal of Psychological Medicine" for April, 1852), in which the conflict of medical testimony was even greater than usual. A large portion of this lady's property was spent in deter- mining by a verdict that she was insane ; and there was an intention that the remainder should be expended in reversing the decision, when the unfortunate lady died! One remedy for this serious evil would be, that medical experts on such occasions should be selected and appointed by the Lord Chancellor, to examine an alleged lunatic and give evidence on his condition ; they should be in all cases made perfectly independent of both parties. At present, they rather occupy the position of medical counsel than medical witnesses, for it is quite clear that no one would be summoned whose views did not coincide with 762 EXAMINATION OP LUNATICS. those of the party summoning him ; and it is an opinion among some solicitors — for Avhich, unfortunately, there is apparent reason —that medical evidence on these occasions is a remarkable commo- dity, and may be purchased at graduated prices ! There are some medical men who appear to think that on these occasions they are justified in sinking the witness in the advocate, and that they are bound by a sort of duty to make the best of the case for the per- son who retains them ; but this is a mistaken view of their position. An advocate is not bound by an oath to state " the truth, the whole truth, and nothing but the truth ;" but a scientific witness is placed under this sacred obligation, and it is a duty which he owes to his profession and to society that he should lay aside all personal bias. ■It may appear an innocent matter to suppress some facts and to exaggerate the importance of others, in order to induce a jury to pronounce one whose mental soundness is in question to be perfectly sane and competent: but the same mercenary zeal which would thus lead to the civil freedom of an insane person, might on an- other occasion be employed in unjustly depriving a sane person of his liberty. The confidence of the public in medical opinions in reference to the insane person has been by recent events already much shaken ; and it would be altogether destroyed, and such opinions entirely dispensed with, if it were once known that a medical man on these occasions accepted a retaining fee not to speak the whole truth but, rightly or wrongly, to give his evidence in favor of the party who consulted him. Whatever may be the dif- ficulties of the case, experienced solicitors know that if they only search far enough they will generally fall upon some medical men who will adopt their views. (The reader will find some remarks on this subject in the " Medical Gazette," vol. 5, p. 719 ; vol. 11, p. 740 ; and vol. 17, p. 816.) Examination of alleged lunatics. — To determine whether a person is, or is not a fit subject for interdiction, or deprivation of civil rights, it is necessary to bear in mind that it is not enough to show there is delusion, as in the lighter cases of monomania ; but we are bound to ascertain bow far the delusion affects the judgment of the person, so as to prevent him, like other men, from managing his affairs with provident care and propriety. In many instances, however, some proof of delusion only is sought for : and if this be procured, it is hastily inferred that the person must be entirely indompetent to manage his property. The most diflicult cases are those which in- volve questions of imbecility. In conducting the defence of the Windham case (Dec. 1861), Sir Hugh Cairns was allowed by his medical adviser to make the following strange statement : " In a case of insanity accompanied by delusion, the mode of investigat- ing it so as to arrive at the truth is a matter of great difficulty and doubt : but in a case of imbecility, where there is either no mind at all or next to none, the task of coming to a right and just deci- sion is comparatively easy." Such a statement is the reverse of the truth, and must have been made under some hazy notion that the state of imbecility was identical with that of idiocy. One of his EXAMINATION OP LUNATICS. 763 own witnesses (Dr. Sutherland), in a subsequent stage of the pro- ceedings, corrected this error, by the admission in cross-examination, that " drawing the line between soundness and unsoundness of mind in cases of imbecility, is one of the most difficult questions of medical science." In conducting the examination of an alleged lunatic, we should compare his mind as it is with what it is proved to have been ; and if it be a ease of supposed imbecility, a proper regard must be had to age, society, education, and general conduct. We should also consider whether the person has been treated by his friends and re- lations as a hmatic or imbecile prior to the issuing of the commis- sion. A young person whose education has been much neglected, and who has never been intrusted with the care of money, cannot be expected to have much knowledge of the method of managing a large property. Questions are sometimes put on the moral respon- sibility of man and the attributes of Grod, to one who, perhaps, never heard of ethics or metaphysics. Again, mathematical and arith- metical questions, which would embarrass many persons who are set down as sane and competent, are sometimes put in cases of alleged imbecility. In one instance, a physician gave evidence on a commission that he found the alleged imbecile could not work the first proposition in Euclid, but this person admitted that he had always disliked mathematics. In a case, which occurred in Scot- land, one examiner asked the alleged imbecile, who said he had 1200^. in the Bank, and received 20^. for interest — How much was that per cent.? He said he could not tell ; he was no good hand at arithmetic. The counsel who appeared against the brieve or com- mission afterwards put the same arithmetical question to one of the medical witnesses who had deposed to the imbecility of the party ; and this witness, an educated man, confessed himself quite unable to answer it — a practical illustration of the impropriety of pronounc- ing a person to be imbecile or imcompetent merely because he is ignorant of that which he has never been taught ! (Case of David Yoolow.) If the capacity to manage affairs rested solely upon a knowledge of arithmetic, many now go free who ought to be imme- diately placed under interdiction. This is rather a commercial test of insanity: but it will be found that it has been applied in a very improper manner to determine the capacity of young and ill-edu- cated women. Unless the questions are confined to those subjects which the person has had either the opportunity or inclination to learn, a medical witness will always incur the risk of confounding mere ignorance with imbecility. One of the best tests of mental capacity will be found in deter- mining the degree to which, with ordinary opportunities, a person has shown himself capable of being instructed ; but too high a standard must not be assumed as a test of capacity. The mind of an alleged imbecile should not be compared with the most perfect mind, but with that of another person of average capacity, of the same age and station in society, and who has enjoyed like opportu- nities of instruction. It would be difficult to find two sane persons 764 TESTS OF CAPACITY. who were exactly equal in mental power : in some, one faculty is prominently developed, in others another. All that we have to look for in these cases of alleged unsoundness is an average degree of intellectual development, so as to qualify the person for performing the duties of his station. To win the confidence of an alleged luna- tic for the purpose of examination, we should not treat his observa- tions or delusions with levity, but rather seriously sympathize with him in his troubles ; we should listen attentively to all he has to say, for his suspicion will be excited by many questions being put to him. If we cannot agree with his conclusions, we should not con- tradict him abruptly, but endeavor to draw him out by asking for some corroborative evidence of his statements. Dr. Millar has properly advised that, before visiting the patient, we should make ourselves thoroughly acquainted with every particular connected with his history and condition, and treat him as much like a sane person as possible. The insane are exceedingly suspicious, and quick to detect any deceit practised on them. They are also jealous of the intrusion of strangers, and, unless great tact is employed, will look upon a medical man as an enemy. (" Hints on Insanity," p. 58.) The patient should be informed that his perceptions are merely the result of natural disease ; it is useless to tell him that he is under a delusion when his perceptions, although sometimes exaggerated, are too real to be doubted. (Op. cit. p. 36.) The conflicting medical evidence given on Commissions of Lunacy is in great part to be ascribed to the fact, that the whole of the mind of the person is not fairly examined. One physician tests one fac- ulty, another, another ; each has his own theory of insanity, and each his standard of competency. The witnesses in support of the commission do not go so much to test the actual state of mind of the person, as to discover what they deem proofs of insanity : those against the commission take an opposite course— they look only for some proof of soundness. It cannot therefore happen otherwise than that different conclusions should be drawn under such different modes of investigation. There is another point which requires at- tention in these cases. Persons laboring under a slight degree of imbecility are very soon irritated ; they are easily persuaded that they are ill used and persecuted ; and when they happen to be ques- tioned by parties who are represented as their enemies, they lose their self-command, and are no longer able to answer questions, which under their ordinary state of mind they would reply to with perfect accuracy. (Pagan, op. cit. p. 302.) A defective memory must not be hastily set down as a proof of legal unsoundness. This is more or less the natural result of age. A man may not have a good memory, and yet have a mind sound enough for the management of his affairs. A defective memory in an aged person, taken alone, proves nothing. (See "Ann. d'Hyg." 1836, vol. 1, p. 192.) A medical witness must not allow himself to be embarrassed by medical or legal definitions of insanity. The malady may not as- sume the form of lunacy or idiocy, in a strictly legal view — nor of CASES OF IMBECILITY. 765 mania, monomania, dementia, or idiocy, in a strictly medical view ; but still it may be a case of such mental disorder as to create an in- eajpadtyfor managing affairs. This is the point to which a medical examiner has to direct his attention. Cases of imbecility present the greatest difficulty, and create the greatest conflict of opinion among medical witnesses. Imbecility strictly implies a weak or feeble mind, and the terra is properly applied to one who has an intellect below par or below the normal average. The vagueness of these terms shows how difficult it is to draw a clear distinction between legal sanity and that degree of mental weakness implied by imbecility which would justify interdiction. Insanity in the common acceptation of the term cannot be proved in these cases : there will be no evidence of delusion, and there may be such an amount of self-control as to enable a person to maintain a conver- sation. Memory, judgment, and other faculties, although weak, are still present in a greater or less degree ; and from one or two interviews only, an examiner might be disposed to pronounce the person of sound mind and competent to manage his own affairs. There is a wide field for argument here; for it may be said with some truth in a defence, " that the doctors cannot put their fingers on a single point indicative of insanity." In short, each fact speci- fied by them may be frittered away by the remark that every one must have known some person who had either a bad memory or a weak judgment; who squandered money, who wasted it on un- worthy objects, who hoarded it and refused to pay just debts, or who lost it in foolish speculations, etc. All this may be true, and yet the person in question may be legally of unsound mind, and properly interdicted. As Dr. Pagan justly remarks, there is a facility of disposition in an imbecile or weak-minded person, which lays him open to be imposed upon by the artful and designing: and our conclusion regarding his competency must, therefore, be the result of a just appreciation of his general knowledge of affairs, derived from an examination of all his faculties. "We have to con- sider how far his imperfect mind would prevent him from attend- ing to his own interests, not in a manner which would insure their most profitable application, but in such a way as would prevent his affairs from being involved in ruin. His knowledge and under- standing may be so imperfect that his property would necessarily go to waste under his unassisted control. When it is proved that there has been habitual submission to the dictation of others, either from a long habit of being controlled, from indifference, or fear — when a man has allowed himself to be disobeyed or neglected by his servants, and to be openly cheated by tradesmen — these circum- stances furnish evidence of weakness of mind, and a justification of the, opinion that there should be interdiction. (Gp. cit. p. 203.) On the other hand, if a person when left to himself has managed his affairs with reasonable care and propriety, and has acted inde- pendently of others, there can be no stronger proof of his legal competency. [See the very able opinion of Patton, P. J., in Mc- Elroy's case, 6 W. & S. 451.— P.J 766 TESTS OF CAPACITY. The testamentary capacity of imbeciles may be tried by the same rules. A man who is of such an easy disposition as to be impro- perly influenced in the use of his property while living, may be equally influenced by fear or control to make an improper disposi- tion of it by his will; but in this case the terms of the will, if drawn up by himself, will allow a fair judgment to be formed of th^ mental soundness of the testator. There is on these occasions a method of testing the state of mind which has been suggested by Dr. ConoUy — namely, by inducing the patient to express his thoughts in writing, as in a letter addressed either to his physician, or to some confidential friend. This plan would probably often succeed in developing the existence of a latent delusion, when an examination would wholly fail ; the patient would not be led to suspect that he was being subjected to an examination for a hostile purpose. The current of his thoughts would be uninfluenced by the suspicion, that the act of writing was to test the state of his mind ; and as no man can long write in a connected manner who does not think collectedly, so we may expect to find ample evidence whether a delusion really exists in his mind or not. There are cases recorded in which the evidence of delusion has been derived from the terms of a will or deed written or dictated by the lunatic himself, when there was great difficulty in obtaining proof by an oral examination. In idiocy there is no capacity for writing. In dementia, as there is no memory, it commonly happens that the same word is written over and over again. 'No person in a state of dementia can write a connected sentence, because before the last part of the sentence is completed the first is entirely forgotten. In imbecility, we may meet with every variety of mental defect, but the state of the mind is pretty well shown by the expression of the thoughts in writing. This method, it must be remembered, cannot show whether or not a person is capable of managing his affairs : it is a mere index of a certain state of the mind, and must be coupled with general habits and conduct, before any conclusion is drawn from it relative to the propriety of interdiction. It will often serve to detect the existence of a delusion when other means fail. Dr. Forbes Winslow attaches some importance to handwriting as foreshadowing the occurrence of genera] paralysis with softening of the brain. This, however, refers, not so much to composition or style as correct writing and spelling. (Op. cit. p. 464.) The reader will find a complete essay on the writings of the insane, and the medico-legal conclusions to which they lead, by Dr. Marc^, in the " Ann. d'Hyg. Publique," 1864, vol. 1, p. 379. When a verdict of insanity is returned under a commission, it must always represent the party to be of unsound mind, and by reason of that unsoundness to be incompetent to manage his affairs. A date must be fixed at which the insanity first appeared, and this date should always be anterior to the issuing of the commission. If there be lucid intervals, the space of time occupied by these should also be defined. Among cases well calculated to show the conflict of medical THE WINDHAM CASE. 767 evidence is that of the late Mr. W. F. Windham (December, 1861). Fifteen of the relatives of this gentleman petitioned for an inquiry into his state of mind, on the ground that he labored under conge- nital deficiency of intellect, and this view was supported by strong medical opinions ; on the other side it was alleged that the mental condition of Mr. Windham, if below the normal standard, was merely the result of a neglected education. The inquiry lasted thirty-three days, during which 140 witnesses were examined — namely, fifty on the part of the petitioners, and ninety in favor of Mr. Windham, at a cost of about 30,000^. There was no proof of the want of the opportunity of education, but strong reason to believe that the alleged imbecile had not made use, like other boys of his age, of the advantages which he had enjoyed. He had been sent to Eton, but had derived little benefit from his connection with that great public school. It seems to have been admitted that as a boy he was wholly unlike other boys, and when he attained his majority, in August, 1861, his conduct was extrava- gant, wild, and wholly inconsistent with his social position. At the same time, he was not entirely deficient in business matters ; for it was proved that his uncle, one of the petitioners, had shortly before negotiated with him for the sale of a piece of land of the value of 1000^., thereby admitting his capacity to transact business. The evidence received on" this occasion was allowed to extend to the whole of his life, and it may be observed that in cases of al- leged imbecility it is not possible, without doing injustice, to pre- vent the reception of evidence from a long date. The result of this inquiry was that the jury, by a majority of fifteen to eight, returned the following verdict — " That Mr. Wind- ham is of sound mind and capable of taking care of himself and his affairs." After the verdict had been returned pronouncing him sane and competent, he was guilty of many extravagant acts, ex- hausted a splendid fortune and became a bankrupt ; showing that, whatever legal soundness of mind he might possess in the opinion of two-thirds of the jury, he practically did not evince that capacity which they declared him to possess of taking care of himself or his aft'airs ! A large section of the public joined in the view prominently put forward at the inquiry by his counsel. Sir Hugh Cairns, that this unfortunate young man had been made the victim of a charge the most cruel, unjust, and unjustifiable! Insanity, it was urged, in the ordinary acceptation of the word, did not exist in his case. There were no illusions, halluciations, or delusions ; but as these are never met with in the form of unsoundness imputed to Mr. Windham, namely, imbecility, their absence proved nothing for or against the existence of imbecility or weakness of mind. But what test is there for imbecility except conduct and conversation ? There was no incoherency of language, but there was strong evi- dence of habits such as we do not meet with among men of really reasonable mind; but opinions were divided on the question, whether these indicated unsoundness of mind, or a mixture of 768 CONFLICTING MEDICAL OPINIONS. eccentricity and moral depravity from deficient education. A majority of the jury took the latter view ; and Lord Chelmsford, in commenting upon this verdict in the House ■ of Lords (March, 1862) said : " The law as laid down by Lord Lyndhurst applied to cases short of insanity, but they must be cases of unsoundness of mind ; and mere extravagances or follies, which indicate imbecility, would not be sufficient unless the imbecility amounted to unsound- ness of mind." The legal test of the existence of this state of mind, as we are told by high authority, is " conduct." The lawyer means by madness "conduct of a certain character," while a phy- sician means by it " a certain disease one of the eft'ects of which is to produce such conduct." (" Grim. Law of England," by Fitz- james Stephen, p. 87.) The whole evidence against Mr. Windham bore upon conduct, and from the verdict we learn what sort of conduct does not constitute madness in a legal sense. The marry- ing of a woman of disreputable character— the squandering upon her of 14,000^. in jewelry, and settling upon her, without any reasonable grounds, 800^. per annum, with other extravagant acts of a similar kind, do not constitute "conduct of a certain char- acter " sufficient to render a man non compos mentis in the eyes of the law ; but if these acts evince soundness of mind and a compe- tency to manage affairs, what are the acts which indicate unsound- ness or incompetency ? On the other hand, we are told that the physician looks to the existence of a certain disease ; but a physi- cian can know nothing about the existence of disease of the brain during life in any case of imbecility, except in so far as its effects may be manifested by conduct. We therefore come round to the legal test of " conduct," which in Mr. Windham's case was con- sidered to be quite consistent with the provident management of a large estate and a splendid fortune. That the legal test was here a failure in affording protection from wastefulness is proved by the result — the loss of the whole property from reckless extravagance ! In reference to this and other cases, " doctors " have been strongly condemned for not agreeing among themselves on the subject of insanity, and it has been suggested that persons of common sense and a practical knowledge »f the world are more qualified to judge of soundness and unsoundness than medical men. In the Wind- ham case, which elicited these censures, the jury, consisting of twenty-three men with a " practical knowledge of the world," dif- fered from each other even more than the doctors — the number being fifteen in favor of a verdict of soundness and eight in favor of unsoundness of mind. The minority felt so strongly on the error of the verdict of the majority, that they specially signified their dissent from it to the Lords Justices who had directed the in- quiry. This great legal question was therefore decided arithmetic- ally by relative numbers, 16 to 8, as in the election of a Member of Parliament 1 The chief objections to the evidence of medical experts on these occasions would be removed, if they were nominated by the Lord Chancellor or the Lords Justices, and if they were thus made as COMMISSIONS OF LUNACY. 769 independent as special jurors. So strong was the public feeling in reference to medical evidence after this inquiry, that the Lord Chan- cellor actually proposed to exclude it altogether, in commissions of lunacy, except in so far as it was based on facts within the personal knowledge of the witnesses. It was suggested that the general scientific conclusions of experts should not be received as evidence. This proposition, which would have been most injurious to the in- terests of the insane, as well as the sane, did not meet with a favor- able reception. A Commission of Lunacy may be superseded, but the evidence must then be as strongly in favor of sanity, as it was before in favor of insanity. The onus of proof is then thrown on the person who has been found lunatic. [The Constitution of Pennsylvania vests in the Supreme Court and the several courts of Common Pleas, the care of the persons and estates of those who are non- compos mentis. In practice, however, original jurisdiction in these cases is nearly, if not exclusively, con- fined to the courts of Common Pleas. The act of 13th June, 1836, provides the manner of proceeding, in cases of interdiction, hy the issuing of a commission in the nature of a writ de lunatico inquirendo to inquire into the lunacy or habit- ual drunkenness of any person living within this commonwealth, or having real or personal estate therein. The commission is issued upon the application in writing, accompanied by affidavits, of a relation by blood or marriage, of the person named, or of a person interested in his estate : or (by act of 15th April, 1851), where there are no rel- atives, upon the application of any distinguished person of the same township, ward or borough, in which the alleged lunatic or habitual drunkard resides. There may be one or three commissioners, who are to " diligently inquire, by the oaths or affidavits of six good and lawful men of the county," whether the party is a lunatic, etc., how long he has been so, whether he has lucid intervals, what property he owns, and its value, etc. etc. ; and " the inquisition so to be made " to return to the court at a time specified in the commis- sion. The act (§ 67) defines the word " lunatic" as meaning " any person of unsound mind, whether he may have been such from his nativity, as idiots, or have become such from any cause whatever." By § 63, it is provided that upon petition of the party setting forth that he is restored to a sound state of mind, the court shall take proof of the facts, and if satisfied of the truth of the allegations of the petition, shall suspend, or as the court shall decide, altogether supersede and determine the commission, the inquisition, appoint- ment of a committee, and all subsequent proceedings. Though, in the main, governed by the principles applicable to similar proceedings in the Court of Chancery, the provisions of this act are much simpler and less expensive. Where there is a traverse of the inquisition, the question is not simply whether unsoundness of mind exists, but whether it exists to such an extent as to disqualify the traverser from conducting 43 770 COMMISSIONS OF LUNACY. himself with personal safety to himself or others, or from managing and disposing of his own affairs and discharging his relative duties. McMroy's case, 6 "W". & S. 451. The great object of the proceedings under a commission of lunacy is to afford security and protection. The fact that, as yet, the lunatic may not have squandered his pro- perty is no security that he may not do it hereafter. The act is precautionary in its design, and hence a disposition of mind or body, which might lead to the wasting of an estate is sufficient to justify the enforcement of its provisions. lb.; Sill v. McKnight, 7 W. & S. 245 ; Ludwick v. Commonwealth, 6 Harris 175. The same act (13th June, 1836) §§ 58-62, introduces the provi- sions of 39 and 40 Geo. III. c. 94, relative to the subject oi criminal proceedings against persons who were lunatics at the time of the commission of the offence, or who have become so since. These sections have been re-enacted by the new criminal code of 3l8t March, 1860. They provide that when a jurj^ shall acquit any person charged with crime or misdemeanor, on the ground of insanity at the time of the commission of the offence, or when he shall be found to be a lunatic upon arraignment, such jury shall find specially the fact of insanity and declare in their verdict that this was the ground of acquittal. The court may then order him to be kept in strict cus- tody, so long as he shall remain of unsound mind, or he may be de- livered to his friends, or to the guardians of the poor upon the entry of security that he shall be restrained by seclusion, or otherwise, from the commission of any offence. When the prosecutor fails to appear, and the prisoner would be otherwise discharged, if it appear to the court upon affidavit of any credible person that the defendant is insane, the court are required to order the district attorney to send a written allegation of such insanity to the grand jury, who shall make presentment of their finding to the court; and thereupon a jury shall be impanelled to try the insanity of such person. Similar statutory provisions exist in Massachusetts and Minne- sota, and perhaps in other States of the Union. See Bonfanti v. State, 2 Min. 123. The criminal courts of Pennsylvania may also upon petition in- quire into the insanity of, and commit to the State Lunatic Asylum persons unsafe to be at large, and those who are suffering unnecessary hardship of duress; Act of 14th April, 1845. This application may be made by a married woman. Shenango v. Wayne, 10 Casey 184. See also Brightly's Purdon's Dig., tit. " State Lunatic Asy- lum." Id., tit. "Lunatics and Habitual Drunkards." The act of. 1845 also gives the officers of the poor authority to send insane paupers to the State Asylum. These acts of course do not prevent the sending of persons to asylums by their friends, without the intervention of the courts. All such cases may, however, be brought before the courts upon habeas corpus. See Dr. Hartshorne's note, ante, p. 755. See also the case of Hinchman v. Ritchie, Bright. R. 144. — P.] RESPONSIBILITY IN CIVIL CASES. 771 CHAPTER LXIV. CIVIL RESPONSIBILITY. — TESTAMENTARY CAPACITY. — WILLS MADE BY THE INSANE. — TEST OF CAPACITY. — EVIDENCE OF DELUSION.— ECCENTRICITY IN WILLS. ResponsiUtity in civil cases. Insanity as an impediment to mar- riage. — Insanity is deemed in law to be a civil impediment to mar- riage, because it is considered that there cannot be that rational consent which is necessary to the validity of a contract. The marriage of a lunatic is therefore called a nullity, and is void ab initio. All that the law requires is that there should be good proof of insanity at, or about the time of the contract. If this be offered, and it be alleged that the contract was entered into during a lucid interval, then the party who would benefit by the allegation must prove it. The suitableness of the marriage, as well as the conduct of the party during or after its performance, will also be considered by the court. In Turner v. Myers, a lunatic who had recovered from his lunacy instituted a suit to set aside a marriage which he had contracted while in that state ! The marriage was declared void. (" Med Gaz.," vol. viii. p. 481.) The case of Baldry v. Ellis- (l!forwich Summer Ass., 1851) will be found of interest in relation to the matrimonial engagements of alleged lunatics. [But though marriage with an idiot or lunatic be absolutely void, and no sentence of avoidancy be absolutely necessary {Browning v., Peane, 2 Phillimore, 1969), yet, as well for the sake of the good order of society, as for the peace of mind of all persons concerned,, it is expedient that the nullitj'^ of the marriage should be ascertained and declared by the decree of a court of competent jurisdiction. 2- Kent, Com. 76.— P.] In Heed v. Legard (Court of Exchequer, May 30, 1851), a ques- tion arose whether a lunatic was responsible for necessaries supplied to the wife. The articles supplied were for the sole use of the wife, the husband being a confirmed lunatic, and the inmate of an asylum. . The court held that the fact of a husband being from the visitation of God unable to manage his affairs, did not absolve him from the obligation which he contracted when he married, to provide neces- saries for the support of his wife. He was then of sane mind, and although he had subsequently become insane, that obligation was not revocable under the circumstances. (See also a report of the case of Seaton v. Adcock, " Journ. Psychol. Med.," 1851, p. 297.) The validity of civil contracts entered into by lunatics will de- pend mainly on the circumstances which accompany the act. If there be nothing unreasonable in the conduct of the lunatic, and the 772 RESPONSIBILITY IN CIVIL CASES. party with whom he contracts has no knowledge or suspicion of the insanity, then the contract will be binding on the lunatic and his representatives. It was so held in Monckton v. Camerauz (Exchequer, June, 1848). This was an action by the administrator of a deceased person, to recover from the defendant, as secretary of an insurance office, the sum paid by him as the consideration for two annuities, the foundation of the action being, that at the time of the arrange- ment in question the deceased was not in a sound state of mind. At the trial before the Chief Baron it appeared that the negotiation had been conducted by the deceased with apparent prudence, sanity, and judgment, and that the arrangement entered into by him with the office was just such as any ordinary prudent person would have been expected to make with a view to his own interest. The deceased, who died very soon after the business had been arranged, was, both before and after, in an unsound state of mind. Under these cir- cumstances, this action was brought by his representatives, and a verdict recovered by them, subject to the opinion of the court on their right to recover as on the entire failure of consideration. The Chief Baron, in giving judgment in favor of the defendant, said it was sufficient for the purpose of this case to lay it down as a gen- eral rule, that when a person of apparently sound intellect enters into a contract such as any other ordinary person would enter into with others who act bondjide, and the parties cannot be restored to their former condition, it is no ground for setting aside the contract, that one of them was at the time non compos mentis. On appeal to the Exchequer Chamber this judgment was affirmed in May, 1849. (See also the case of Slaniland v. Willett, Vice-Chancellor's Court, Nov. 1848.) In the case of Donat v. Haniquet (Gruildhall Sittings, 1854), on an action to recover a sum of money, in which the defence was that the defendant was of unsound mind at the time of the con- tract, Crompton, J., held that unless it was shown that the plaintiff" had taken advantage of defendant's unsoundness of mind, he would be entitled to recover the amount claimed. [In the case of Leach v. Marsh, " American Law Reg.," vol. 2 (N. S.), p. 22, the Supreme Court of Maine decided that a judgment recovered on default, against a person admitted to have been non compos men^w at the time of the proceedings in the case, will' be reversed on a writ of etror brought by his administrators after his decease. The following is the note of one of the editors (Hon. I. E. E,edffeld) of the Register: "It seems well settled that contracts by lunatics and persons of unsound mind, as a general rule, are not binding." Lincoln v. Bv.chmaster, 32 Vt. R. 652, and numerous cases there cited. But there are many exceptions to this rule : — 1. "Where merchants, apparently sane, have purchased goods in the ordinary course of their business, and have disposed of them, in whole or in part, so that the goods cannot be restored to the seller, there is no question of the general liability upon such contracts, notwithstanding it should appear that the purchaser was in fact in- sane at the time of the purchase. Braes v. iee, 10 Ban- 56 ; Molton V. Camaraux, 2 Exch. R. 502 ; S. C. 4 Id. 17. And the same rule CIVIL RESPONSIBILITY OF LUNATICS. 773 extends to all cases where the seller has parted with his property in good faith, and it is not in the power of the lunatic to restore it. Even courts of equity refuse to interpose to set aside the contracts oi lunatics, unless the parties can be restored to their former condi- tion, or the sane party has taken some unconscionable advantage in the bargain. JVeil v. Morley, 9 Vesey 478. The parties are left to their legal rights. Sageron v. Leaky, 2 Atk. R. 412. The same rule extends to contracts made with infants. Farr\. Sumner, 12 Vt. E. 28 ; Tafty. Pike, 14 Id. 405 ; Weed v. Beebe, 21 Id. 495. But the recovery in both cases should be upon the quantum meruit, rather than upon the contract. 2. Contracts for necessaries for the lunatic or his family are bind- ing to the same extent, and much upon the same principles as similar contracts by infants. Thompson v. Leach, 3 Mod. R. 310 ; Seaver v. Phelps, 11 Pick. R. 304, 306. Some of the American cases go the length of holding that no recovery can be had against a lunatic, upon a contract express or implied, unless for necessaries. Seaver V. Phelps, supra; Fitzgerald y. Reed, 9 Sm. and Marshall ; Pearl v. McDowell, 3 J. J. Marsh. 658 ; 2 Greeul. Ev. § 369 ; Liiicoln v. Buck- master, supra. The rule in regard to instituting legal proceedings against a luna- tic is much the same as that which obtains in the case of infants ; and there would seem to be more reason for a strict enforcement of it in the former case than in the latter, since infants, long before they get out of their nonage, are entirely competent to select coun- sel, and conduct the defence of a suit. This subject is very elaborately discussed by Woodbury, J., in Lang v. Whidden, 2 S'. H. R. 435, where the authorities, prior to that date (1822), will be found very extensively quoted, and the subject very learnedly discussed, and satisfactorily disposed of by the court. It is here said the guardian must be notified, in all cases, or the judgment will be erroneous. The same rule has been adopted in many of the American States. Alhridge v. Montgomery, 9 Ind. R. 302 ; Snowden v. Banbury, 11 Penna. St. R. 522; 2 Barb. Ch. R. 387 ; Wright's Ap., 8 Barr 57 ; 6 B. Mon. R. 239. But if one who is a lunatic be arrested or im- prisoned in a civil suit, he is not entitled to his release on that ac- count. A guardian ad litem may be appointed, and the suit pro- ceed. Bush V. Pettibone, 4 Comst. R. 300 ; Aldrich v. Williams, 12 Vt. R. 413. There seems to be no good ground to question the decision in the principal case. The same rule has long been established in regard to judgments rendered against infants, without the appointment of guardians ad litem. 2 Saund. R. 212, 'E. H. ; Castlemain v. Moody, 4B&Ad. 90. See also Jfasow V. ileTimso?!, 15 Wendell 64 ; Wead V. Marsh, 14 Vt. R. 77; Crockett v. Drew, 5 Gray 399. In the case of Van Brunt v. Taylor, 3 Philadelphia R. 123, it was held by the District Court, that where an insane partner contracted loans, the firm was liable, whether the money was misappropriated by him or not. 774 TEST OF CAPACITy. By act of IStli June, 1836, § 44, no person, found by inquisition to be a lunatic, can in Pennsylvania, be arrested or imprisoned on menseor final process in any civil action, so long as he shall remain of unsound mind. — P.] Testamentary ca-pacity. Wills made by the insane. — Questions in- volving the testamentary capacity of persons are of very frequent occurrence, and medical evidence is commonly required for their solution. "When property is bequeathed by a testator out of the usual order of succession, it may be alleged by the relatives that he was wholly incompetent to understand the nature of the deed — either from actual insanity, the imbecility of age, or that natural failing of the mind which is so often observed to occur from disease, or on the approach of death. Bodily disease or intepacity does not affect the validity of a will, unless the mind be directly or indirectly disturbed by it. Some time since a case occurred in France, in which a will was contested on the ground that the testator, when he exe- cuted it, was laboring under hemiplegia. The opinion of Esquirol was required, and he said that hemiplegia might undoubtedly affect the brain — a fact clearly indicated by the sight, hearing, and other senses becoming weakened ; yet this, in his opinion, did not neces- sarily indicate an impairment of the intellectual powers. (" Ann. d'Hyg.," 1832, vol. 1, p. 203.) A man's mind, under these circum- stances, may not be so strong as in robust health, but still it may retain a disposing power. In Harwood v. Baker, decided by the Privy Council in 1841, a will was pronounced to be invalid owing to the general state of bodily disease in which the testator was at the time of making it. It appears that he was laboring under ery- sipelas and fever, and these diseases had produced a degree of drow- siness and stupor which rendered him incompetent to the act. In the case of Day (June, 1838), epilepsy was alleged to have affected the mind ; and in the case of ^fewe^i (March, 1833), paralysis was adduced as a ground of incompetency. In all cases of this kind, the law looks exclusively to the actual effect of the bodily disease upon the mind ; and this is commonly a question to be determined by a j ury from the testimony of those who have attended the deceased, as well as from the evidence of medical experts. Test of capacity. — A person is considered to be of a sane and dis- posing mind who knows the nature of the act which he is perform- ing, and is fully aware of its consequences. From some decisions that have been made, it would appear that a state of mind for which a party might be placed under interdiction or deprived of the man- agement of his affairs, would not render him incompetent to the making of a will. The validity of the will of a lunatic was once allowed, although made while he was actually confined in an asy- lum, because the act was rational, and it was such as the lunatic had announced his intention of making, some years prior to the attack of insanity. {Coghlan's case ; see Be Gard^en, "Law Times," July 6, 1844, p. 258 ; also the case of Cartwright, Mayo on " Medical Testimony," p. 44.) In Nichols and Freeman v. Binns (Probate Court, Aug. 1858), the question was whether the will of a Mr. Par- DELUSION IN THE WILL OR DEED. 775 kinson, made in a lunatic asylum near Norwich, was executed during a lucid interval. The jury found a verdict in favor of the will. The insanity of a person when not already found insane under a commission, must not in these cases rest upon presumption or pro- bability, but be established by positive proof. The act of suicide is often hastily assumed to be evidence of insanity ; but it would not be allowed as a proof of this state, even when a testator had de- stroyed himself shortly after the execution of his will. A case has been decided where the testator committed suicide three days after having given instructions for his will ; but the act was not admitted as a proof, or even as a presumption-of insanity at the time, and the will was pronounced to be valid. In another case, Edwards v. Ed- wards (Prerog. Court, Feb. 1854), it was proved that the testator had committed suicide three days after the execution of his will, and there was some evidence of eccentric habits almost amounting to insanity ; but the will was pronounced to be valid. Suicide is not deemed in law to be a proof of the existence of insanity. Delusion in the will or deed. — The validity of deeds executed by persons aftected with monomania is often a subject of dispute. The" practice of the law indicates that the mere existence of a delusion in the mind of a person does not necessarily vitiate a deed, unless the delusion form the groundwork of it, or unless the most de- cisive evidence be given that at the time of executing the deed, the testator's mind was influenced by it. Strong evidence is often derivable from the act itself, especially when a testator has drawn it up of his own accord. In the case of Barton (July, 1840) the Ecclesiastical Court was chiefly guided in its decision by the nature of the instrument. The testator, it appeared, labored under the extraordinary delusion that he could dispose of his own property to himself, and make himself his own legatee and executor! This he had accordingly done. The instrument was pronounced to be invalid. But a will may be manifestly unjust to the surviving relatives of a testator, and it may display some of the extraordi- nary opinions of the individual : yet it will not necessa|'ily be void, unless the testamentary dispositions clearly indicate that they have been. formed under the influence of a delusion. Some injustice may possilily be done by the rigorous adoption of this principle, since delusion may certainly enter into a man's act, whether civil or criminal, and it may not be always in our power to discover it; but, after all, this is perhaps the most equitable mode of construing the last wishes of the dead. According to Sir John JSTichol, it is not necessary in civil suits to connect the morbid imagination with the act itself; if the mind is proved to be unsound, the act is void. In Roberts v. Kerslake (Warwick Aut. Assizes, 1854), Lord Wens- leydale held that to vitiate a will, if it be a case of delirium, the act must be traced to delirious delusion, but if it be a case of lunacy it need not be traced to a delusion. Eccentricity in wills. — The evidence in these cases sometimes amounts to proof of eccentricity only on the part of the testator, or in the deed itself; but a clear distinction must be here drawn. 776 ECCENTEICITY IN WILLS. The will of an eccentric man is such as might always have been expected from him: the will of one laboring under insanity (delu- sion) is different from that which he would have made in an unaf- fected state — the instrument is wholly different from what it would once have been. It has been justly observed, that the insane are eccentric in their ideas, their language, or their conduct : but the merely eccentric have but a voluntary resemblance to the insane. (Jamieson's Lectures, " Med. Gaz.," vol. 46, p. 180.) Wills are sometimes contested more on the ground of eccentricity than of insane delusion ; but if eccentricity only be proved, a court will not interfere. In the case of Morgan v. Boys (1838), it was proved that the testator, by his will, had left a large fortune to his housekeeper. The will was disputed on the ground that it bore intrinsic evidence of the deceased not having been in a sane state of mind at the time of making it. After having bequeathed his property to a stranger, the testator directed that his executors should "cause some parts of his bowels to be converted into fiddle-strings — that others should be sublimed into smelling-salts, and that the remainder of his body should be vitrified into lenses for optical purposes !" He further added, in a letter attached to his will — " The world may think this to be done in a spirit of singularity or whim ; but I have a moral aversion to funeral pomp, and I wish my body to be converted into purposes useful to mankind." Sir H. Jenner, in giving judgment, held that insanity was not proved : the facts merely amounted to eccentricity, and on this ground he pronounced for the validity of the will. It was proved that the deceased had conducted his affairs with great shrewdness and ability ; that he not only did not labor under imbecility, but that he had been always treated during life as a person of indisputable capacity by those with whom he had to deal. The best rule to guide the court, the Judge re- marked, was the conduct of persons towards the deceased ; and the acts of his relatives evinced no distrust of his sanity or capacity while he was living. The deceased had always been noted for his eccentric habits, and he had actually consulted a physician upon the possibility of his body being devoted to chemical experiments after death. In the case of Mudway v. Croft (Prerog. Court, Aug. 1843), a will contested on the ground of insanity but defended on the plea of eccentricity. Sir H. J. Fust said — " It is the prolonged departure, without an adequate external cause, from the state of feeling and modes of thinking usual to the individual when in health, that is the true feature of disorder of the mind." The following case was the subject of litigation in Paris in 1864. A wealthy Portuguese gentleman named Machado died in 1861, having made a will with seventy-one codicils attached to it, some of them containing provisions impossible of execution. It was dis- puted on the ground of the insanity of the testator. One of the codicils was to this effect: "I leave for the Athenaeum of Paris 10,000 francs, the interest of which at 5 per cent, will be 500 francs. Half of this interest to be paid to a Professor of Natural History, who shall lecture on the colors and patterns of dresses, and on the WILLS IN SENILE DEMENTIA. ■ 777 characters of animals." Again: "My funeral shall take place at 3 P. M., the hour at which the rooks of the Louvre come home to dinner." The testator was especially fond of birds : he desired that many stuffed specimens should be placed in his coffin ; that his ser- vant should carry to the ceremony " one of my favorite birds in his cage ;" and that certain birds should be let loose on the day of his funeral. The testator had during his life erected his own tomb, on which were engraved a sun, a bird, an ox, and a dog, an egg "proper" surmounting them; beneath was incribed, "Here reposes the author of the ' Theory of Likeness.' " These and other facts of a similar kind were relied upon as proofs of insanity, but it was decided that the deceased was only vain, not insane, and therefore he had a right to will away his property as he pleased. It was proved in favor of his sanity, that in spite of these crotchets he had while living, managed his affairs with all the caution of a sane person. Wills in senile dementia. — Wills made in incipient dementia aris- ing from extreme age (senile imbecility) are sometimes disputed, either on the ground of mental deficiency, or of the testator, owing to weakness of mind, having been subjected to control and influ- ence on the part of interested persons. If a medical man be present when a will is executed, he may easily satisfy himself of the state of mind of the testator, by reqiliriug him to i-epeat from memory the mode in which he has disposed of the bulk of his property. A medical man has sometimes placed himself in a seri- ous position by becoming a witness to a will without first assuring himself of the actual mental condition of the person making it (case of the Duchess of Manchester, 1854). It would always be a good ground of justification, if, at the request of the witness, the testator had been made to repeat substantially the leading provi- sions of his will from memory. If a dying or sick person cannot do this without prompting or suggestion, there is reason to believe that he has not a sane and disposing mind. It has been observed on some occasions, when the mind has been weakened by disease or infimity from age, that it has suddenly cleared up before death, and the person has unexpectedly shown a diposing capacity. (" Ann. d'Hyg.," 1831, p. 360.) In Durnell v. Gorfield (Prerog. Court, July, 1844), a case in which an old man of weakened capacity had made a will in favor of his medical attendant. Dr. Lushington held that to render it valid there must be the clearest proof not only of the factum of the instrument, but of the testa- tor's knowledge of its contents. [In Greenfield's Estate, 2 Harris (Penna.) 489, where the decendent during her lifetime had at the age of eighty-six or eighty-seven, executed a deed to persons who were to hold in trust for her for life, and after her death, to admin- ister the property in the manner therein set forth, it was held, that a provision in the deed in favor of the counsel who drew or advised it, for his services to be formed as trustee, with the further provi- sions that such trustee might resign, without forfeiting his com- pensation, is void, at least unless it be proved that the grantor 778 RESTRICTION OF MEDICAL OPINIONS. knew of the particular provisions, and without influence from those interested, assented to them. If a douht exists in this respect the provision for compensation is invalid ; and the provision in favor of the other trustees who acted in the arrangement of the matter, through the counsel, or in connection with him, is also in- valid. The trustees may, however, be decreed compensation by the proper tribunal. — P.] ("Law Times," July 27, 1844.) In West V. Sylvester (Nov. 1864), Sir. J. Wilde, in pronouncing judg- ment against a will propounded as that of the deceased, an aged lady, said: "At the time she executed the will of October, 1863, although for many purposes she might be said to be in her right senses, she was nevertheless suffering from that failure and decrepi- tude of memory which prevented her from having present to her mind the proper objects of her bounty, and selecting those whom she wished to partake of it." "Wills made by persons whose capacity during life has never been doubted, while lying at the point of death, or, as it is termed, in extremis, are justly regarded with suspicion, and may be set aside according to the medical circumstances proved. Many diseases, especially those which affect the brain or nervous system directly or indirectly, are likely to produce a dulness or confusion of intel- lect, under which a proper disposing power is lost. Delirium sometimes precedes death, in which case a will executed by a dying person would be at once pronounced invalid. [By a statute law of Pennsylvania (Act of 26 April, 1855), bequests to public institu- tions are invalid, without regard to the testamentary capacity of the party making the bequest, if made within thirty days of death of testator. — H.] In examining the capacity of persons under these circumstances, we should avoid putting leading questions — namely, those which suggest the answers " yes " or " no." Thus, a dying man may hear a document read over, and affirm, in answer to such a question, that it is in accordance with his wishes, but without understand- ing its purport. This is not satisfactory evidence of his ha,viiig a disposing mind ; we should see that he is able to dictate the provi- sions of the document, and to repeat them substantially from memory when required. If he do this accurately, there can be no doubt of his possessing complete testamentary capacity. But it may be objected that many dying men cannot be supposed capable of such an exertion of memory ; the answer is then very simple ; it is better that the person should die without a will, and his property be distributed according to the law of intestacy, than that, through any failing of the mind, he should unknowingly cut off the rights of those who have the strongest claims upon him. Restriction of medical opinions. — In an important case {Bainbrigge V. Bainbrigge, Oxford Summer Ass., 1850), tried before Lord Camp- bell, in which the testamentary capacity of a testator was disputed, it was held that a medical witness, although conversant with cases of insanity, cannot be asked his opinion as to the insanity of a tes- tator founded upon the evidence given at the trial in his hearing. WILLS OF THE INSANE — ATTESTING WITNESSES. 779 (4 Cox, " Criminal Cases," 454 ; see also on this subject " Med. G-az.," vol. 46, p. 240.) In the case of the Duchess of Manchester, however, the opinions of Drs. Sutherland, Mayo, and ConoUy, on the compe- tency of the testatrix, were received by the court, although based upon the evidence given at the trial. [In general, every man is presumed to be sane until the contrary is proved ; and hence it has been held, that the burden of proving unsoundness or imbecility of mind in a testator, is upon the party impeaching the validity of a will for that cause. Especially, it is said, is this the case with reference to wills attested by subscribing witnesses, because it is the duty of the latter " to be satisfied of the testator's sanity before they subscribe the instrument " ( Werst- ler V. Custer, 10 Wright (Penna.) 502) ; and under the maxim " omnia prcesumuntur rite et solenniter acta donee probetur in contra- rium," it is to be presumed that they have not neglected this duty. Such is the rule in Pennsylvania, and in many of the other states in the Union ; Werstler v. Custer, supra ; Grabill v. Barr, 5 Barr 441; Barber v. McFerren, 2 Casey 214; Bees v. Stille, 2 Wright 138 ; Jackson v. Vand^eusen, 5 Johns. 144 ; Dean v. Dean, 1 Wil- liams (Vt.) 746 ; Trumbull v. Gibbons, 2 'Eqw Jersey 117 ; Hawkins V. Grimes, 13 B. Monroe (Ky.) 257 ; Berkins v. Perkins, 39 I^ew Hamp. 163; Stubbs v. Houston, 33 Ala. 555; McDaniel v. Crosby, 19 Ark. 533 ; Chandler v. Feeris, 1 Harrington (Del.) 454. But, on the other hand, in Harris v. Ingledeio, 3 P. Wms. 93, Sir Joseph Jekyll, M. E. said, " It must be observed that the proof of a will is attended with more solemnity than that of a deed : the for- mer being supposed to be made when the testator is in extremis : and therefore in equity, it is necessary to prove the sanity, which is all presumed in the case of the latter." See also Barry v. Batlin, 1 Curtis 637 ; Sutton v. Saddler, Com. B. 19 Law. Rep. N". S. 703 ; and this is said to be more particularly the rule where the statute relating to wills contains the provision (which indeed it generally does) that the testator must be of " sound mind." Cilley v. Cilley, 34 Maine 162 ; Comstock v. Hadlyne, 8 Conn. 261 ; Crovming shield v. Crowningshield, 2 Gray 524 ; Brooks v. Barrett, 7 Pick. 98, 99. The subject of testamentary capacity is very fully considered in Jarman on Wills, Perkin's Ed. vol. 1, p. 51, et seq. ; and in Wil- liams on Executors, vol. 1, p. 11, et seq. To the authorities there cited, may be added the recent cases of Vanpelt v. Vanpelt, 30 Barb. (N. Y.) 134 ; Dunham's Ap., 27 Conn. 192 ; Stubbs v. Houston, 33 Ala. 555 ; Bees v. Stille, 2 Wright 138 ; Aiman v. Stout, 6 ib. 114 ; Eckert v. Henry, 7 ib. 46 ; Daniel v. Daniel, 3 ib. 191 ; Werstler v. Custer, 10 ib. 502. In the case of Vanpelt v. Vanpelt, it was held that though a testator's capacity was slender, yet, if the evidence is sufficient to show that he fully understood, and intended to make the disposition which he has made, the will must stand, however unnatural and unjust may be its provisions. And in Stubbs v. Houston, it was held, that though a condition somewhat short of a 780 ATTESTING WITNESSES. total deprivation of reason will destroy testamentary capacity, yet that a person not competent to transact the ordinary business of life, may make a will. The existence of insane delusions was held in Dunham's Ap. not to incapacitate, if the testator has mind enough to know and appreciate his relations to the natural objects of his bounty, and the chai'acter and effect of the dispositions of his will. In Pennsylvania, mere weakness of intellect, however great, will not take away testamentary capacity, provided the testator at the time of executing his will, has a full and intelligent consciousness of the nature and effect of the act he is engaged in, a knowledge of the property he possesses, an understanding of the disposition he wishes to make, and of the persons and objects he desires to par- ticipate in his bounty. It is not necessary, however, that he should collect all these in one review. Daniels v. Daniels, Hees v. Stille, etc. It is the duty of every one called upon to attest a will, to first satisfy himself of the competency of the testator. If he has doubts, he should refuse to sign his name. Courts have spoken in the se- verest terms of persons who, having become witnesses to wills, have afterwards come forward to testify as to the insanity of the testator. The act of attestation solemnly testifies the testator's competency; so that the person who, believing that this does not exist, neverthe- less signs his name as a witness, becomes an instrument in what he himself considers a fraud. Should such witness afterwards attempt to impeach his own act, and to prove that the testator did not know what he was doing when he made what purported to be his will, though the evidence would not be positively inadmissible, very little credit is to be attached to it. Hees v. Stille, 2 Wright 140. The older cases go so far as to say that the testimony should not be re- ceived at all, upon the maxim of the civil law, nemo allegans suam turpiticdinem est audiendus ; and in Lowe v. Jolliffe (1 W. Blackstone's Eep. 365), where, notwithstanding the testimony of the subscribing witnesses against it, the will was supported. Lord Mansfield sent for those witnesses in order to have them committed for perjury : but, as the reporter states, they very prudently " had withdrawn themselves." It is now settled, however, that the question is one not for the court but the jury, who are to receive the evidence, but with the most scrupulous jealousy {Booth v. Blundell, 19 Ves. 504) ; bearing in mind as declared by Woodward, J., in Werstler^. Custer, 10 Wright (Penna.) 502, that " no honest man will subscribe as a witness to a will or other instrument, executed by an insane man, an imbecile, or an idiot." — P.] THE PLEA, OR DEFENCE OF INSANITY. 781 CHAPTER LXV. THE PLEA, OR DEFENCE OF INSANITY. — CIRCUMSTANCES UNDER WHICH IT IS ADMISSIBLE. — HOMICIDAL INSANITY. — MORAL INSANITY. — SYMP- TOMS. — LEGAL TESTS. — MEDICAL TESTS. — DELUSION. — TESTS OF IRRE- SPONSIBILITY. — MEDICAL EVIDENCE. The plea or defence of insanity. — Responsibility here signifies no- thing more than liability to punishment for crime, and a criminal act implies the existence of intention, will, and malice. (Stephen.) When insanity has reached a certain stage or degree, an act maybe perpetrated without malice ; and in this sense the person is con- sidered to be irresponsible in law. This is a question oi fact to be determined by a jury from the whole evidence set before them ; and the proof rests with those who make the allegation that the act in question, whether murder or arson, was not done wilfully and maliciously. " The sanity of a man's conduct," observes Mr. Ste- phen, " involves the presence of intention and will on all ordinary occasions ; and if the act is one of those which the law forbids, it is presumed to be malicious and wicked." (Criminal law of Eng- land," p. 89.) This subject is of considerable importance in a medico-legal view ; for should a plea of insanity be improperly ad- mitted in any criminal case, then punishment is made to fall un- equally on offenders ; and if, on the other hand, it be improperly rejected, punishment is administered with undue severity. The rule of law is that no man is responsible like a sane person, for any act committed by him while in a state of insanity. The plea may be raised for the smallest offence up to the highest crime — murder ; but it is rarely made a defence in smaller offences, because the close confinement to which an accused person, if found insane, would necessarily be subjected, would often be a heavier punishment than that which the law actually prescribes for the offence which he may have committed. In a case of felonious assault, it was urged by counsel in defence that the prisoner was insane; but the evidence on this point was not by any means conclusive — when it was inti- mated by the court that, if this plea were admitted, the party would probably undergo a much longer imprisonment than if on conviction he received the legal punishment for the offence ! (The Queen v. Reynolds, Bodmin Aut. Ass. 1843.) The judge is reported to have said that there was no proof of insanity. If the prisoner was pro- nounced insane, he might be imprisoned for life, and therefore he did not think that finding would benefit him ! A verdict of guilty was returned, and the man was sentenced to eighteen months' im- prisonment. This case shows that a defence of this kind may be 782 EESPONSIBILITY FOR CEIMINAL ACTS. sometimes indiscreetly put forward. Such a mode of dealing with the plea of insanity, i. e., of making it a question of expediency de- pendent on the amount of punishment for the offence, must be pro- nounced as unsafe and indefensible. Murder, incendiarism, and theft are the crimes for which the plea of insanity is commonly raised ; and it has been generally confined in this country to those cases in which persons have been charged with murder, or attempts at murder. Murder may be perpetrated by one who is obviously laboring under delirium or violent mania, or by an idiot or imbecile. Apart from the circumstances connected with the criminal act, there may be evidence of such a disordered state of mind in the person, as at once to exonerate him from that amount of responsibility which is exacted from one who is sane. The appearance of the accused, or the testimony of a- medical man, renders it unnecessary to go into the evidence, and a verdict is returned accordingly. The cases of difficulty are those in which insanity presents itself in a doubtful aspect, as in mania or imbecility. The mental disorder may be of so slight a nature as not legally to justify an acquittal for murder. In order to exculpate a person, it must be proved that insanity in a certain degree existed at the time of the perpetration of the act. Whether the prisoner is, or is not insane when placed on his trial, is immaterial in reference to the question of responsibility. In the case of Murray (tried before the High Court of Judiciary, Edin- burgh, ISTov. 1858), it was proved that the accused recovered his sanity eight hours after he had killed the deceased ; but he was acquitted on the ground of insanity at the time of committing the act. The proved existence of mental disease does not necessarily ex- empt a person from crimipal responsibility. Many a man whose mind is in an unsound state knows perfectly well whether he is doing wrong ; and so long as he knows that, he is considered to be subject to the criminal law. The existence of a morbid delusion cannot always be allowed to screen a criminal from the consequences of his own acts, while on the other hand there are instances in which a plea of insanity may properly be allowed, although no delusion can be proved. Each case must be taken with all its surrounding cir- cumstances, and legal theories of insanity are chiefly valuable, not as rigorous axioms of law, but as cautions to be observed by the The great difference of opinion which exists between physicians and jurists in reference to this plea, appears to me to consist in this : Most jurists aver that no degree of insanity should exempt from punishment for crime, unless it has reached that point that the person is utterly unconscious of the difference between right and wrong at the time of committing the alleged crime. Physicians, on the other hand, affirm that this is not a proper test of the existence of that de- gree of insanity which should exempt a man from punishment ; that those who are laboring under confirmed insanity, and who have been properly confined in asylums for years, are fully conscious of the EESPONSIBILITY FOE CRIMINAL ACTS. 783 difference between right and wrong, and are quite able to appreciate the illegality as well as the consequences of their acts. Again, those who have patiently watched the insane for years, agree that the legal test of utter unconsciousness of right and wrong in the perform- ance of acts would, in reality, apply only to persons who were suffer- ing from delirium, from a furious paroxysm of mania, or from con- firmed idiocy ; and that if the rule suggested — that a person, in order to be acquitted on the ground of insanity, should be first proved to be as unconsciovs of his act as a baby — were strictlj"^ carried out, there is scarcely an inmate of an asylum, who happened to destroy a keeper or attendant, who might not be executed for murder. Such a rule amounts to a reductio ad absurdum ; it would abolish all dis- tinction between the sane and the insane, between the responsible and the irresponsible ; and it would consign to the same punishment the confirmed lunatic and the sane criminal. This species of baby unconsciousness of action exists in idiots as well as in furious maniacs, but not in the majority of lunatics ; and it may be safely asserted that, if this criterion be the true one, acquittals on the ground of insanity have involved a series of gross mistakes for the last fifty years. It may be said that the consciousness of the insane is an in- sane consciousness, while the law implies the consciousness of a sound mind ; but this involves a peiitio principii. There have been numerous cases of acquittal in which, until the act of homicide was committed, there was no imputation either against the sanity or the sane consciousness of the accused. Having pointed out these incon- sistencies, it is only proper to acknowledge that in theory the Eng- lish law would punish a lunatic just as it would punish a sane man, provided the lunatic " had that degree of intellect which enabled him to know and distinguish between right and wrong, or what was lawful and unlawful ; if he knew what would be the effects of his crime, and consciously committed it ; and further, if with that con- sciousness he wilfully and intentionally committed it." In practice, however, it is placed beyond doubt that some who ought to be con- victed under these rules are acquitted on the legal fiction that they were at the time unconscious (or only insanely conscious) of the wrongfulness of their acts. Dr. Wood states, that of thirty-three men confined as lunatics in Bethlehem who had actually committed murder, not including those where an unsuccessful attempt was made to perpetrate the same crime, three were reported sane ; he feels quite satisfied that two of these were not insane at the time they committed the murders, and of the fifteen men who had actually committed murder, five were reported sane, and two of them ought, in his judg- ment, neverto have been acquitted on the ground of insanity. (" Plea of Insanity," p. 50.) According to Dr. Hood, in the six years from 1852 to 1858, 120 persons who were tried for murder, or attempt at murder, or acts of personal violence were acquitted on the ground of insanity. Of that number, 79 were received into Bethlehem Hos- pital, and in several instances they exhibited no symptoms of insanity while they were resident in the asylum. These facts, then, are sufli- cient to show that the rule of law generally adopted does not err on 784 HOMICIDAL INSANITY. the side of severity. The only complaint that can be made is that it operates with uncertainty. Of late years, some learned judges have admitted that there might be a consciousness that the act was wrong and illegal, and yet the person would be exempted from criminal re- sponsibility, provided it was proved by other circumstances, that he labored under a disease of the mind sufficient to prevent him from exercising a proper control over his actions. When the defence of insanity is set up, in a charge of murder, in order to warrant the jury in acquitting a prisoner, it must be proved affirmatively that he was insane in a certain legal sense, at the time of perpetrating the act ; if this be left in doubt, and if the crime charged in the indictment be proved, it is. their duty to convict him. {Reg. V. Stokes, 3 Car. and Kir. p. 185.) It is necessary to impress upon the mind of the medical witness, that it is not medical, but legal insanity which has to be proved on these occasions to the satisfac- tion of a jury. As no two medical men agree about what is mad- ness in a medical sense, and as some " mad doctors" have ever held that all great criminals are necessarily insane, it is obvious that the power to absolve from responsibility could not be placed in the hands of the profession with a due regard to the protection of society, or a safe administration of the law. The facts stated by Drs. Hood and Wood, in reference to the admission of alleged criminal lunatics into Bethlehem {supra), show that either by legal, or medical inge- nuity, or both combined, sane men are incarcerated as irresponsible lunatics ! Homicidal insanity. — Homicidal mania, or monomania, is com- monly defined to be a state of partial insanity, accompanied by an impulse to the perpetration of murder : hence it is sometimes called impulsive or paroxysmal mania. There may, or may not, be evidence of intellectual aberration ; but the main feature of the disorder is the existence of a destructive impulse which, like a delusion, cannot be controlled by the patient. This impulse, thus dominating over all other feelings, leads a person to destroy those to whom he is most fondly attached, or any one who may be involved in his delusion. Sometimes the impulse is long felt, but concealed and restrained : there may be merely signs of depression and melancholy, low spirits, and loss of appetite, as well as eccentric or wayward habits, but nothing to lead to a suspicion of the fearful contention which may be going on within the mind. As in suicidal mania, many of those who are in habits of daily intercourse with the patients have been first astounded by the act of murder, and then only for the first time led to conjecture that certain peculiarities of language or conduct, scarcely noticed at the time, must have been symptoms of insanity. Occasionally, the act of murder is perpetrated with great deliberation, and apparently with all the marks of sanity. These cases are ren- dered difficult by the fact that there may be no distinct proof of the existence, past or present, of any disorder of the mind, so that the chief evidence of mental disorder is the act itself : of the existence of insanity, in the common or legal acceptation of the terra, before and after the perpetration of the crime, there may be either no evidence SYMPTOMS OF HOMICIDAL INSANITY, 785 whatever, or it may be so slight as not to amount to proof. Such cases are regarded and described by some medico-legal writers as instances of insanity of the moral feelings only, and this condition has been called " Moral insanity" (p. 731). Its existence, as a state inde- pendent of a simultaneous disturbance of the reason or intellect, is denied by the great majority of lawyers, as well as by some eminent medical authorities. "Whether such a condition exists or not is a simple question of fact, to be established if possible by clear and conclusive evidence. Its existence in the case of a person charged with murder appears to have rested hitherto on a mere medical dic- tum. Intelligible reasons have not been assigned by those witnesses who have sought to satisfy a court of law that this has as distinct an existence as intellectual insanity ; in general, it is only alleged, and not proved to exist in a given case. If its existence were satisfac- torily established, it would, as Mr. Stephen observes, do away with one of the essential ingredients of crime — malice, and thus justify a jury In acquitting a person charged with murder. The accused on these occasions is assumed to have been an involuntary agent. As Mr. Stephen suggests, it might be a good defence to admit that a man loaded a pistol and pointed it at the head of another, but that it was fired by a sudden involuntary action of the necessary muscles, and not bj' the prisoner's will. The only difficulty is to get a jury to believe it ! The evidence given in support of the assertion that a man is morally insane is, generally speaking, at least as consistent with the theory that he is a great fool and a great rogue, as with the theory that he is the subject of a special disease the existence of which is doubtful. (" Criminal Law," p. 95.) There is no doubt that the unrestricted admission of such a theory would go far to do away with all punishment for crime, for it would render it utterly impos- sible to draw a line between (moral) insanity and moral depravity. What is crime but the perversion of moral feelings ? Moral insanity in a person of sound mind is a contradiction in terms ; whenever- • the mind is sound, a man's conscience and sense of right and wrong will always be sufficient to enable him to restrain evil desires and impulses. Symptoms. — Homicidal mania, in its more common form, may make its appearance at all ages, even in children ; it is occasionally periodical, and the paroxysm of insanity is preceded by symptoms of general excitement. The patient experiences colicky pains, and a sense of heat in the abdomen or chest, headache, restlessness, and loss of appetite, with lowness of spirits ; the face is flushed or pale, the pulse hard and full, and the whole body is in a state of convul- sive trembling. An act of violence is committed without warning, and the patient appears as if relieved from some oppressive feeling. He may be calm, and express neither regret, remorse, nor fear ; he may coolly contemplate his victim, confess the deed, and at once surrender himself to justice. In some rare instances, he may con- ceal himself, hide the weapon, and, like a sane criminal, endeavor to obliterate all traces of the crime — thus showing a perfect con- sciousness of the illegality or wrongfulness of the act, and a desire 50 ibb SYMPTOMS OF HOMICIDAL INSANITY. I to evade discovery. These are, however, the main features of crime, and UDless there is independent evidence of mental disorder, or of some bodily disease afiecting the brain and destroying the power of self-control, the conclusion must be that the person is sane and re- sponsible. The great problem to be solved on these occasions is — What are the plain practical distinctions between defective reason- ing power and perverted moral sense? The latter condition alone should not exculpate a person, or absolve him from punishment — or persons undeniably sane who have committed crimes, should be equally exculpated, and absolved from punishment. The symptoms above described have been observed to be more aggravated in proportion as the homicidal impulse was strong. The propensity to kill is sometimes a fixed idea, and the patient can no more banish it from his thoughts than a person afflicted with insanity can divest himself of the delusive ideas which occupy the mind. (Esquirol, vol. 2, p. 105.) It has been supposed that Esquirol here implies a state in which there is no perversion of intellect. The facts which he mentions, however, clearly prove the contrary ; for if a patient has not the power to banish from his thoughts this propensity to kill, he has passed beyond the bounds of reason, and is really insane. The admission of this fact proves that his mind must be unsound. Esquirol says — before the perpe- tration of the act there may be no sign of irrational conversation or conduct ; but he asks the question : because there is no proof of irrationality, are we to assume that these persons possess reason ? Is it possible to reconcile the existence of a rational state of mind with the murder of those who are most dear to them? (Op. cit. vol. 2, p. 102.) In Esquirol's view, therefore, it may be taken that mere perversion of feelings (insanity), irrespective of some latent aberration of intellect, does not exist, and moral insanity is a con- ventional term for a state in which the proofs of mental disturb- . ance are not so clear as in the generality of cases. An erroneous notion prevails in the public mind, that a homicidal lunatic is easily to be distinguished from a sane criminal, by some certain and invariable symptoms or characters, which it is the duty of a medical witness to display in evidence, and of a medico-legal writer to describe. But a perusal of the evidence given at a few trials will surely satisfy those who hold this opinion, that each case must stand by itself. It is easy to classify homicidal lunatics, and say that in one instance the murderous act was committed from a motive, i. e., revenge or jealousy; in a second, from no motive, but from irresistible impulse; in a third, from illusion or delusive mo- tive, i. e., mental delusion ; in a fourth, from perverted moral feeling, without any sign of intellectual aberration. This classification may comprise all the varieties of homicidal insanity', but it does not help us to ascertain, in a doubtful case, whether an act was or was not committed under any of these psychological conditions. It enables us to classify those who are acquitted on the ground of insanity, but it entirely fails in giving us the power to distinguish a sane from an insane criminal, or a reponsible from an irresponsible agent. SYMPTOMS OF HOMICIDAL INSANITY. 787 According to M. Esquirol, whose views, more or less modified, are adopted bj all writers on the medical jurisprudence of insanity, the facts hitherto observed indicate three degrees of homicidal mania: — 1. In the first degree, the propensity to kill is connected with absurd or irrational motives, or with actual delusion. The person would be at once pronounced insane. Cases of this description are not uncommon, and they rarely create any diiBculty. 2. In the second degree, the desire to kill is connected with no known motive. It is difficult to imagine a motive for the deed ; the person appears to have been led on by some impulse. There may have been delusion, but there is no evidence of the pre-existence of this. With respect to this class of cases, Mr. Stephen observes: " There are motives for all acts even the maddest, but it is fre- quently impossible to assign them specifi-cally. It is, however, generally impossible to form an opinion whether a given act was done from some unknown mad motive, or from some unknown sane motive." (Op. cit. p. 88.) 3. In the third degree, the impulse to kill is sudden, instanta- neous, unreflecting, uncontrollable (plus forte que la volonte). The act of homicide is perpetrated without interest, without motive, and often on persons who are most fondly loved by the perpetrator. (Esquirol " Maladies Mentales," vol. ii. p. 834.) It is this form, which has been called " impulsive insanity," which has given rise to so much contention on trials for murder in which insanity is set up as a defence, and therefore it will be well to consider this sub- ject in a legal aspect. Mr. Stephen thus comments upon it: "It is said that on particular occasions, men are seized with irrational or irresistible impulses to kill, to steal, or to burn, and under the in- fluence of such impulses may sometimes commit acts which would otherwise be most atrocious crimes. It would be absurd to deny the possibility that such impulses may occur, or the fact that they have occurred and have been acted on. Instances are given in which the impulse was felt and resisted. The only question which the existence of such impulses can raise in the administration of criminal justice, is whether the particular impulse was irresistible as well as unresisted. If it was irresistible, the person accused is en- titled to be acquitted, because the act would not then be voluntary and not properly his act. If the impulse was resistible, the fact that it proceeded from disease would be no excuse at all. If a man's nerves were so irritated by a baby's crying that he instantly killed it, his act would be murder ; it would not be less murder if the same irritation and corresponding desire were produced by some internal disease. The great object of the criminal law is to induce people to control their impulses; and there is no reason why, if they can, they should not control insane as well as sane impulses. The proof that an impulse was irresistible depends on the. circum- stances of the particular case. The commonest and strongest cases are those of women who, without motive or concealment, kill their 788 HOMICIDAL INSANITY. children after recovery from childbed" (puerperal mania). (Op. cit. p. 95.) The three forms in which a homicidal propensity may thus pre- sent itself in cases of insanity differ from each other only in de- gree — the first two being strongly analogous to, but lighter modifi- cations of, the third. All the cases which came before M. Esquirol had these features in common — an irritable constitution, great excitability, singularity or eccentricity of character ; and previously to the manifestation of the homicidal feeling, there M'as a gentle, kind, and affectionate disposition. As in other forms of insanity, there was some well-marked change of character in the mode of life; and this may be taken as a proof that there must have been some degree of intellectual disturbance. The period at which the dis- order commenced and terminated could be easily defined, and the attack could be almost always referred to some moral or physical cause. Attempts at suicide preceded, or followed the attacks ; all wished to die, and some desired to be put to death like criminals. In none of these cases was there any discovei-able motive for the act of homicide. ,M. Esquirol believes that there are well-marked distinctions be- tween this state and that of the sane criminal. Among these he enumerates : 1. The want of accomplices in homicidal mania. 2. The sane criminal has always a motive — the act of murder is only a means for gratifying some other more or less criminal passion, and is almost always accompa-nied by some other wrongful act ; the contrary exists in homicidal mania. 3. The victims of the crimi- nal are those who oppose his desires or his wishes — the victims of the monomaniac are among those who are either indifferent to, or who are the most dear to him. 4. The sane criminal endeavors to conceal, and if taken, denies the crime ; if he confesses it, it is only with some reservation, and when circumstances are too strong against him ; but he commonly denies it to the last moment ; — it is the reverse with the monomaniac. The exceptions to which these characters are open will be considered hereafter. They have, un- doubtedly, greater value in their combined, than in their individual application, and when in any case they coexist, there is strong reason to believe that the person accused of murder is laboring under a homicidal mania. The great difficulty in these cases, how- ever, is to distinguish moral depravity from insanity. I agree with a medico-legal writer on this subject, that " no hideousness of de- pravity can amount to proof of insanity, unsupported by some evi- dence of a judgment incapacitated, or of a will fettered by disease. In those cases in which the emotions are perverted, and where there is no clear proof of deranged intellect — cases which do from time to time occur — the presumption of insanity in regard to a criminal action has to be upheld by evidence of a suspension of the will from mental disease. If it can be proved that the act was not voluntary, this does away with its criminal nature." (Jamieson's Lectures on the Med. Jur. of Insanity, " Med. G-az.," vol. 48, p. 181.) But it is impossible in many cases to produce satisfactory LEGAL TESTS. 789 evidence of the suspension of the will as a result of disordered mind ; this suspension can in general be assumed only from the act itself — a dangerous assumption, and one that might lead to the crime of insanity, and to the exculpation of all criminals. Legal tests. — Admitting the existence of homicidal mania, as thus defined by Esquirol, it may become a question, how, when pleaded for one charged with murder, it is to be practically distin- guished from a case in which the crime has been perpetrated by a really sane person. Tests, both medical and legal, have been pro- posed. The legal test was explicitly stated in the following terms by the whole of the judges in conference, in answer to queries put by the House of Lords in the case of M'Naughten, who was tried and acquitted on the ground of insanity (June 19, 1843): — " ^Notwithstanding a party commits a wrong act while laboring under the idea that he was redressing a supposed grievance or injury, or under the impression of obtaining some public or private benefit, he is liable to punishment. The jury ought in all cases to be told that every man should be considered of sane mind until the contrary was clearly proved in evidence ; that, before a plea of insanity should be allowed, undoubted evidence ought to be ad- duced that the accused was of diseased mind, and that at the time he committed the act he was not conscious of right or wrong. Every person was supposed to know what the law was, and therefore nothing could justify a wrong act, except it was clearly proved that the party did not know right from wrong ; if that was not satis- factorily proved, the accused was liable to punishment. If the delu- sion under which a person labored were only partial, the party ac- cused was equally liable with a person of sane mind. If the ac- cused killed another in self-defence, he would be entitled to an acquittal ; but if the crime were committed for any supposed injury, he would then be liable to the punishment awarded by the law to his crime." (" Brit, and For. Med. Eev.," July, 1843, p. 273.) [See Dr. Bucknill's remark upon M'Naughten's case, and his criti- cism upon the dicta of the judges, in answer to the queries of the House of Lords. Bucknill's Essay on Criminal Lunacy (" Law Library," vol. 92), p. 44 et seq. — P.] It would appear that the law, as thus laid down, in order to render a man responsible for crime, looks for a consciousness of right and wrong, and a knowledge of the consequences of the act ; while the ad- ministration of justice rests on the principle that every one knows the law and fears its punishment. Thus, the complete possession of reason is not essential to constitute the legal responsibility of an oifender ; and it is also to be inferred, from the results of several cases, that a man may be civilly incompetent, but sufficiently sane to be made criminally responsible. The proofs required in the two cases are essentially distinct. It has been objected to this legal test, that it is insufficient for the purpose intended : it caniiot, in a large majority of cases, enable us to distinguish the insane homicide from the sane criminal. Many insane persons have committed acts which they knew to be wrong, 790 LEGAL TESTS. and of the criminality of which they were at the time perfectly con- scious. They have been known to murder others, in order to re- ceive the punishment of death at the hands of the law ; and there- fore they must have been conscious of the wrongfulness, or rather of the illegality, of the act which they were perpetrating, and have known that they were committing an offence punishable by the law of man. In short, the criminal nature of the act has often been the sole motive for its perpetration ! (" Ann. d'Hyg.," 1852, vol. 1, p. 363.) It has been suggested, with some truth, that it is rather the imperfect or defective appreciation of the motives to right, or against wrong action which leads to crime among the insane, and not the mere ignorance of right and wrong. Most lunatics have an abstract knowledge that right is right, and wrong wrong ; but in true in- sanity, the voluntary power to control thought and actions, and to regulate conduct by this standard, is impaired, limited, or overruled by insane motives. A lunatic may have the power of distinguishing right from wrong, but he has not the power of choosing right from wrong. A criminal is punishable not merely because he has the power of distinguishing right from wrong, but because he volun- tarily does the wrong, having the power to choose the right. (Jamie- sou's Lectures on Insanity, " Med. Gaz.," vol. 46, p. 827.) [Dr. Forbes Winslow, in speaking of the defence of insanity in criminal cases, uses the following language : " When such ques- tions have come before the judicial tribunals of the country, the presiding judge, in his charge to the jury, has invariably referred to the dicta of preceding administrators of the law, and has quoted their definition or description of insanity as an unerring test of the presence of mental derangement in any ease in which the malady is alleged to exist. "How absurd, upon reflection, must such a course'of procedure be. Has not our knowledge of the disorders of the mind advanced during the last fifty years ? Do we not know more of insanity than our professional brethren did who lived in the days of Coke, Mans- field, and Erskine ? If so, how ridiculous it is to cite their opinions or to bind us down to the authority of men whose information on this subject must of necessity have been extremely limited and cir- cumscribed. The judges of the land appear to have had no settled or clear views on the subject of insanity." * * * " After an examination of the cases which have been brought forward in this work, it must be evident that the capability of ' distinguishing be- tween right and wrong,' is not an unerring test to which to appeal. A person may be perfectly competent to draw a correct distinction between right and wrong, and yet labor under a form of insanity which ought unquestionably to protect him from legal or moral responsibility." ("Plea of Insanity," p. 73.) "The knowledge attained by men, of a subject which they have grappled all their lives," says Chief Justice G-ibson, in Smith v. Kramer^ 1 Am. Law. Eeg. 3/)3, " ought surely to prevail against knowledge gleaned from the hornbooks of a profession to which the gleaners did not belong." LEGAL TESTS. 791 The same eminent judge, in the case of Gom. v. Mosler, 4 Barr 266, admitted that moral insanity, if established, would relieve the defendant from criminal responsibility. " There may be," said he, in his charge to the jury, "an unseen ligament pressing on the mind, drawing it to consequences which it sees but cannot avoid, and placing it under a coercion, which, while its results are clearly per- ceived, isincapable of resistance. The doctrine which acknowledges this mania is dangerous in its relations, and can be recognized only in the clearest cases. It ought to have been shown to have been habitual, or at least to have evinced itself in more than a single in- stance. It is seldom directed against a particular individual ; but that it may be so, is proved by the case of the young woman who was deluded by an irresistible impulse to destroy her child, though aware of the heinous nature of the act. The frequency of tliis con- stitutional malady is fortunately small, and it is better to confine it within the strictest limits. If juries were to allow it as a general motive, operating in cases of this character, its recognition would destroy social order as well as personal safety. To establish it as a justification in any particular case, it is necessary either to show, by clear proofs, its contemporaneous existence, evinced by present circumstances, or the existence of an habitual tendency developed ~ in previous cases, becoming in itself a second nature." The defence was not established in this case, and the prisoner was convicted. The objection to adhering to the old decisions with reference to the test of criminal responsibility, in the face of the great advance which has taken place in the last fifty years in the scientific know- ledge of the subject of insanity, is that juries rather than sufter an insane criminal, whose unsoundness does not come up to the anti- quated standard, to be punished in the same manner as if he were sane, acquit him altogether. He is thus turned loose : if his insanity has not been real, a criminal escapes ; if it has, then society is again exposed to the dangerous freaks of a madman. Even if they con- vict, notwithstanding the actual existence of moral insanity, the lunatic is restrained only during the period of his sentence, and the same result ensues. If judges, instead of " moving in the ruts" of their predecessors, would, as it is the boast of the common law they do, keep pace with the advance of science ; if juries were required, as they are in some States, to find the fact of insanity whenever they acquit on this ground ; or, if, what would perhaps be still better, the jury, as it has been suggested (Whart. & Still6, " Med. Jur.," § 277), were permitted simply to pass upon the mere fact of the commission of the act, leaving the consideration of the prisoner's sanity for a commission or jury of scientific men, competent to decide so difficult a question ; if whenever the prisoner is acquitted because of insanity, the court should in all cases commit him to a proper asylum, there to remain until proved before the same tribunal to be entirely restored ; the plea would be much less frequently set up, and would be much more apt to be properly decided, if it should be. Criminals would thus be surer of punishment, the really insane have an opportunity of being restored by proper treatment, and society have the protec- 792 MEDICAL TESTS. tion which, under the " right and wrong" test, it so often loses. Where the offence is homicide, as Dr. Taylor very properly remarks, the confinement of the prisoner acquitted on the ground of moral insanity, should, for the reasons he mentions, be for life. — P.] Medical tests. — The tests which have been proposed by medical jurists for detecting cases of homicidal mania are as follows : — 1. The acts of homicide have generally been preceded by other striking peculiarities of conduct in the person— ^often by a total change of character. 2. Those persons who are affected with it have in many instances previously or subsequently attempted suicide — they have expressed a wish to die or to be executed as criminals. These supposed cri- teria when tendered as medical proofs of insanity in courts of law, have been repeatedly, and very properly rejected. They are of too vague a nature for practical use, and apply as much to cases of moral depravity as of actual insanity ; in short, if these were ad- mitted as proofs, they would serve as a convenient shelter from pun- ishment for many sane criminals. 3. Motive for crime. — The acts are without motive ; they are in opposition to all human motives. A man known to have been ten- derly attached to his wife and children murders them — -a fond mother destroys her infant. It is hereby assumed, or implied that persons who are sane never commit a crime without an apparent motive, and that in the perpetration of a criminal act an insane per- son either never has a motive, or has one of a delusive nature only. If these propositions were true, it would be easy to distinguish a sane from an insane criminal ; hut the rule wholly fails in practice. In the first place, the non-discovery is here taken as a proof of the non-existence of a motive ; while it is undoubted that motives may exist for many atrocious criminal acts without our being able to dis- cover them — a fact proved by the numerous recorded confessions of criminals before execution, in cases in which, until these confessions were made, no motive for the perpetration of the crime had appeared to the acutest minds. [Com. v. Mosler, 4 Barr 266. — P.] 4. Confessions. — The subsequent conduct of the person ; he seeks no escape, delivers himself up to justice, and acknowledges the crime laid to his charge. This is commonly characteristic of homicidal mania ; for by the sane criminal every attempt is generally made to conceal all traces of the crime, and he denies it to the last, or until he sees that denial can be no longer serviceable to him. 5. Accomplices. — The sane murderer has genemlly accomplices in vice or crime ; the homicidal monomaniac has not. Upon this it may be observed that some of the most atrocious murders com- mitted in modern times have been proved to be the acts of persons who had neither accomplices, nor any assignable inducements lead- ing to the commission of the crimes. It is, however, a fact so far in favor of the existence of homicidal insanity, that the insane never have accomplices in the acts which they perpetrate. These criteria can hardly be described as medical ; they are circumstances upon MEDICAL TESTS — SUMMARY. 793 ■which a non-professional man may form just as safe a judgment as one who has made insanity a special study. 6. Delusion in the act. — The presence of delusion has been said to characterize an act of homicidal monomania, while premeditation, precaution, and concealment have been considered to be the essen- tial features of the act of the sane criminal. Some medical men think, if they discover anything resembling a delusion in the mind of an accused person, that he is necessarily irresponsible for the act, but the theory of the law, as laid down by the judges in M' Naughten' s case, is that notwithstanding a person labors under a delusion, if he commits an act which he knows to be contrary to law he is liable to punishment; if the delusion he 'partial., the party accused is still responsible ; and if the crime were committed for an imaginary in- jury, he would be held equally responsible. (See ante, p. 789.) Much stress was formerly laid upon the delusion being connected with the act in cases of alleged insanity ; but it must be remembered that, except by the confessions of insane persons during convalescence, it is not easy for a sane mind to connect the most simple acts of a lunatic with the delusion under which he labors. Every act of homicide perpetrated by a really insane person is doubtless con- nected with some delusion with which he is affected ; but it is not to be supposed that one who is sane can always make out this con- nection. It may be further observed that premeditation, precaution, con- cealment, and flight are met with in crimes committed by both sane and insane criminals, although these acts are certainly strong char- acteristics of sanity. It should be a question for a jury whether, when they are proved to have existed in any criminal act, there might not have been such a power of self-control in the person, al- though in some degree insane, as to justify a conviction. It is not the presence of a slight degree of mental aberration which necessa- rily indicates a loss of power of controlling actions. Are such per- sons less beyond the influence of example than one half of the sane criminals who are punished ? 7. A number of murders perpetrated at once. — In the acts of sane criminals one person, or at the most two, may be destroyed ; but, in cases of homicidal mania, it is not unusual to find a wife and several children killed by the husband, or four or five children at once de- stroyed by the wife. In these cases, no motive but that which is based on some insane delusion can be suggested for such a series of murders. Thus, four infants may be found murdered by a mother, who admits the act but endeavors to account for it by asserting that she wished to convert them into angels, or to save them from desti- tution and exposure to worldly temptations. It would be wrong, however, to infer from this statement that, because a man has heaped crime upon crime, he is therefore insane. This would be equal to making the atrocity of the crime or crimes a test of insanity. Summary. — The foregoing considerations lead to the inference that there are no certain legal, or medical tests whereby homicidal mania can be demonstrated to exist. Each case must be determined 791 SUMMARY — INCONSISTENCIES. by the circumstances attending it; but the true' criterion of irrespon- sibility, in all ambiguous cases, appears to be whether the person, at the time of the commission of the crime, had, or had not a sufficient •power of self-control to govern his actions ; or, in other words, whether he knew the act was wrong, and could avoid the perpetration of it. This involves the consideration, not only whether insanity existed in the accused, but whether it had reached a degree to destroy, not merely a consciousness of the nature of the act, but volition— the will to do, or not to do it. If, from circumstances, it can be inferred that an accused person had this power, whether his case falls within the above rules or not, he should be made responsible and rendered liable to punishment. If, however, he was led to the perpetration of the act by an insane impulse, or, in other words, by an impulse which his mental condition did not allow him to control (l&ion de volont^, Esquirol), he is entitled to an acquittal as an irresponsible agent. The power of controlling an act appears to me to imply the existence of such a state of sanity as to render the party re- sponsible : and when there is this want of control, it may be fairly concluded that there is no sane intention, and that the person is irresponsible. A test somewhat similar to this is constantly applied bj' juries, under the directions of our judges, to distinguish murder from manslaughter : and it is quite certain that sanity and homi- cidal mania are not more nicely blended than those shades of guilt whereby manslaughter passes into murder. The manner and cir- cumstances under which a crime is committed will often allow a fair inference to be drawn as to how far a power of self-control ex- isted or was exercised. A man in a violent fit of mania or delirium rushes with a drawn sword into an open street, and stabs the fii'st person whom he meets ; another, worn out by poverty and destitu- tion, destroys his wife and children to prevent them from starving, and then probably attempts to murder himself: these are cases in which there is a fair ground to entertain a plea of irresponsibility. But when we find a man not showing any previous intellectual disturbance, lurking for many days in a particular locality, having about him a loaded weapon — -watching a particular person who frequents that locality — not facing the individual and shooting him, but coolly waiting until he has an opportunity of discharging the weapon unobserved by his victim or others — the circumstances appear to show such a perfect adaptation of means to ends, and such a power of controlling actions, that it is difficult to understand on what principle an acquittal on the ground of insanity could have been allowed. I xefer here to the case of M'Naughten, tried for the murder of Mr. Drummond, January, 1843. The acquittal in this case was the more remarkable because there was no proof of general insanity, and the crime was committed for a supposed injury. According to the rules laid down by the fifteen judges, from questions submitted to them in connection with this case, this man should certainly have been convicted. These acquittals on the ground of insanity, contrary to public opinion, are often errone- ously ascribed to the crotchets of medical experts. They are, I ACQUITTALS ON THE GROUND OF INSANITY. 795 believe, more commonly due to the powerful and impassioned addresses of counsel, who in civil as well as in criminal cases simply . fight for victory, wholly irrespective of any abstract ideas of truth or justice. Medical opinions are brought forward, or suppressed in order to complete a sensational picture, which is intended to show to an ignorant jury, either that a lunatic is perfectly sane, or that a sane man who has committed a deliberate act of murder, is beyond any reasonable doubt insane. Every artifice or argument which may raise a doubt in the minds of the jury is resorted to on these occasions, and the last words of the last eloquent speaker have a far greater influence on the verdict than the opinions of " mad doctors" in the witness box. These admit of being misrepresented and turned into ridicule without any power of reply on the part of those who gave them. [Dr. Bucknill (Criminal Lunacy, 98, 99) mentions the case of Margaret Garrety, who was tried in 1851, at Newark, Ifew Jersey (see "Am. Journ. Ins.," January, 1852) for " the assassination with a carving-knife, of a young man who had seduced her and afterwards married another woman. This trial," he says, " presents a remarkable instance of perversion of the plea by the jury, in order to avoid the condemnation and execution of an ill-used woman. The jury were sixty-two hours in deliberation ; their verdict of ' not guilty on the ground of insanity,' was greeted with applause in the court-house, and with universal congratulation and rejoicing in the city. The celebrated Hampshire verdict, ' Served him right,' would perhaps have been more consistent, if not with the facts of the case, at least with the temper of the pub- lic. After the trial, the court appointed a commission consisting of six physicians, to examine her case, and decide whether she should be sent to the asylum or set at liberty. They unanimously reported, that after careful investigation, they found existing no evidence of unsound mind." — P.] In cases of alleged homicidal mania, very vague meanings have been sometimes assigned to the term delusion. In Reg. v. Burton (Maidstone Lent Assizes, 1863), the prisoner, a 3-outh of 18, was indicted for the murder of a boy at Chatham. There was no mo- tive; but it was argued by his counsel in defence, that he labored at the time under a delusion — the delusion being a desire to be hanged. Mr. Joy, the surgeon of the prison, stated that he had had frequent opportunities of examining the prisoner while in gaol, and in his opinion he was perfectly sane ; so far as witness could judge, he was under no delusion. The jury returned a verdict of " guilty." If the youth had believed that he had been already hanged for murder, this might have been considered a delusion ; but a desire to be hanged, or to die from any violent cause cannot be so regarded. The remarks of the learned judge (the late Mr. Justice Wightman) upon this kind of defence contain all that is necessary to show its fallacy. In passing sentence upon the pri- soner he said : " It is stated that you labored under a morbid desire to die by the hands of justice, and that for this purpose you com- mitted the murder. This morbid desire to part with your own 796 ACQUITTALS ON THE GROUND OF INSANITY. life can hardly be called a delusion : and, indeed, the consciousness ■ on your part that you could eftect your purpose by designedly de- priving another of life (for which you would have to suffer, as you knew, the punishment due to the greatest of crimes) shows that you were perfectly able to understand the nature and consequences of the act which you were committing, and that you knew it was a crime for which by law the penalty was capital. This was, in truth, a further, and I may say a deeper, aggravation of the crime ; for you designedly intended to compass your own death by the murder of another." It has been a disputed question whether a medical witness on a trial in which a defence of insanity is raised, can be asked his opin- ion from the evidence, respecting the state of a pi-isoner's mind at the time of the commission of the alleged crime, i. e., whether the accused was conscious at the time of doing the act that he was doing something contrary to law, or whether he was then laboring under any and what delusion. It has been decided, by fourteen judges out of fifteen, that facts tending to lead to a strong suspicion of in- sanity must be proved and admitted, before the opinion of a medical witness can be received on these points. (See " Med. Gaz.," vol. 46, p. 240.) In forming a judgment of the mental condition of an accused person, it is no part of the province of a witness to modify his opinion according to the iiunishment which may follow if the plea be rejected, but simply according to the medical facts of the case. The legislature only is responsible for the punishment ad- judged to crimes. Dr. Mayo has justly observed, that a medical witness is summoned to a court of justice in order to enable the judge and jury to arrive at certain practical conclusions. The question proposed to him involves a simple fact, and not its conse- quences; and if the latter consideration be entertained by him, it will be liable to bias his evidence on the fact, which is his legiti- mate topic. The definition of insanity becomes very expansive when its expansion may become protective to a criminal with whom we may happen to sympathize. The question whether the accused is a responsible agent is of a judical nature: our evidence should be confined to the question whether the accused' is insane in a certain sense or meaning in which it is understood and defitied by law. ("Medical Testimony and Evidence in Cases of Lunacy," 1854, p. 9.) A medical witness in these cases generally moulds his evidence to a foregone conclusion on the criminal responsibility of the ac- cused,. and he thus lays himself open to a remark from the judge that he must not encroach on the functions of the jury. It is cer- tainly a great evil that, under the present mode of laying this question before a jury, the law operates unequally. One case be- comes a subject of prominent public interest, and every exertion is made to construe the most trivial eccentricities of character into proofs of insanity, and to magnify the effects of an hereditary tendency by proving that a maternal grandmother's sister or some remote relative had been confined as a lunatic: an acquittal follows. THE DEFENCE OF INSANITY. 797 Another case may excite no interest — it is left to itself; the accused is convicted, and either executed, or otherwise punished, although the evidence of insanity, had it been as carefully sought for and brought out, would have been perhaps stronger in this, than in the former instance. Probably no case in modern times has produced greater excite- ment in the public mind, or so strongly directed attention to the modern defence of insanity in trials for murder, as that of G-eorge . Victor Townley, who was charged with the murder of a young lady to whom he was engaged to be married {Reg. v. Townley, Derby Winter Assizes, 1863). In this case there was a clear and distinct motive; there was a full consciousness of the nature of the act and of its penal consequences, as well as an absence of any delusion or of anything indicative of intellectual insanity in the conduct of the prisoner up to within a short time of the act, or in the numerous letters which he wrote. There was no proof that he had lost self- control, or that he was fettered in his actions. The prisoner had entered into an engagement with the deceased (Miss G-oodwin). Shortly before the murder she had written to him, requesting to be released from her engagement ; she candidly told him that she had formed an attachment to another man. In his correspondence with her, he requested a last interview, to hear (as he said) her determi- nation from her own lips. The prisoner went to her house on the 21st August, 1863, induced the deceased to take a walk with him; and in about an hour she was found bleeding from severe wounds in the throat, from the effects of which she soon died. No sane murderer intending to destroy another would have pursued a dif- ferent course. Townley, it is true, made no attempt to escape : he admitted that he had stabbed her, and assisted in carrying her dead body to Wigwell Hall, where she resided. At the trial there was no answer to the charge of murder, except that the prisoner was insane when he perpetrated the act ; that he was maddened partly by the refusal of the deceased to marry him, and partly by the knowledge that she was engaged and would probably be married to another man. This theory found some medical support, but the jury returned a verdict of guilty. An attempt was afterwards made to rescue this criminal from punishment, but it failed. He was condemned to penal servitude, and subsequently destroyed himself. Tested by the rules respecting criminal responsibility assigned by Mr. Fitzjames Stephen, the evidence in Townley's case showed clearly intention, will, and malice. There was an absence of proof of delusion, and the allegation that the act arose from an irre- sistible impulse was a mere assumption, without any fact in the previous or subsequent conduct of the prisoner to give to it sup- port. It may well be inquired of those who adopt the theory of irresponsibility in this case — If this is insanity, what is crime ? If Townley was irresponsible for an act thus coolly perpetrated, in which the motive was so clear, no person should hereafter be con- victed of murder who stabbed a woman from jealousy, revenge, or lyii IKRESISTIBLE IMPULSES TO CRIME. mortified pride. There was no doubt that Townley had a con- sciousness of right and wrong — that he knew the act was illegal and punishable by the law of the land ; but his guilt did not rest upon these judicial tests of criminal responsibility. He had this knowl- edge in common with all sane, and some really insane persons. In his case, however, insanity was neither proved nor rendered even probable, while it was disproved by his conduct and all the circum- stances connected with the act of murder. It may be wrong to convict all men who come -up to this judicial standard, i. e., who^ know right from wrong, because insanity may coexist with such knowledge : but it would be a reductio ad absurdum to contend that, in the absence of any clear proofs of insanity, a man is to be ac- quitted of crime when he knew that the act was wrong, and had well calculated the legal consequences. One medical defender of Townley, in order to account for the absence of symptoms of insan- it}'^, suggested that the duration of the homicidal impulse was short, and did not extend beyond the period of the commission of the act to which it impelled ! There would be no difficulty on these prin- ciples in making out that every act of murder was the result of impulsive insanity, and that all murderers while stabbing others are morally insane, and therefore, although they may show sanity afterwards, they are irresponsible for their acts ! The legal test of a consciousness of right and wrong is much complained of, but in practice it certainly cannot be said to err on the side of harshness or severity ; for it is much more common to find that sane persons are acquitted on the ground of insanity, than that one who is really insane is convicted and punished as a sane criminal. But the med- ical assumption here suggested to extenuate Townley's crime would go far to exculpate every criminal who committed murder. The doctrine of " irresistible impulse" and the theory of impul- sive insanity, have been strained in recent times to such a degree as to create in the public mind a justifiable distrust of medical evidence on these occasions. It is obviously easy to convert this into a plea for the extenuation of all kinds of crimes for which motives are not at once apparent, and thus medical witnesses often expose themselves to severe rebuke. They are certainly not justi- fied in setting up such a defence, unless they are prepared to draw a clear and common-sense distinction between impulses which are " unresisted" and those which are irresistible. As a learned judge once remarked in his address to a jury : " What is the meaning of not being able to resist an impulse ? Every crime is committed under an impulse, and the object of the law is to compel persons to control or i-esist these impulses. If it is made an excuse for a person who has committed a crime, that he was goaded to it by some impulse which medical men might choose to say he could not control, such a doctrine would be fraught with very great danger to society." While the truth of these remarks is obvious, it must be ad- mitted that the ordinary legal test for responsibility is not satis- factory. In addressing the jury in Heg. v. Coc/ccroft, involving a IRRESISTIBLE IMPULSES TO CRIME. 799 trial for murder (Leeds Autumn Assizes, 1866), Mr. Justice Mellor made the following observations on the defence of insanity which had been set up : " It would be dangerous if the idea went abroad that persons committing crime under sudden impulses were there- fore to be excused. At the same time, he thought that the defini- tion of insanity which would excuse from criminal responsibility, as given in M'Naughten's case, hardly went far enough. He was of opinion that a man might know that he was doing an act which was wrong, and still he might belaboring under such disease of the mind as not to be able to restrain his impulse to do that act, and he should therefore not be amenable to the criminal law. The mere fact, however, of the prisoner being ignorant, and of a low type of mind would be no excuse. If the jury thought that the prisoner knew at the time when he committed the act that he was doing wrong, and was not laboring under such a disease of the mind as incapacitated him for controlling his impulses, he was not entitled to acquittal on the ground of insanity. The doctrine of uncontrollable impulse, as laid down by some writers, was a very dangerous one, and required to be watched with the utmost care. Passion arising from provocation , however trivial, oftered to a mind however ill regulated, did not relieve the person from criminal re- sponsibility." Hence it follows that a man might know that he was doing wrong and committing an act against the law of God and man, yet if with this consciousness of the illegality of the act, there was a diseased condition of the mind which prevented him from control- ling his actions, he will be entitled to an acquittal on the ground of insanity. With this admission, it appears to me unnecessary to occupy space with metaphysical discussions regarding criminal re- sponsibility ; for however objectionable the theory — if the practice of the law be in any one case in conformity with that which has been advised by writers on the Medical Jurisprudence of Insanity, although it may be even adverse to the theory on which it is pro- fessedly based, this is all with which we have to concern ourselves : the principle is admitted. The great defect in the English law is, not that it will not go even to the full extent of exculpating a per- son who has committed a crime with the full knowledge of its ille- gality, and under what is called an "uncontrollable impulse," or an impulse which owing to mental disease his reason was not sufficient to control, but the uncertainty of its amplication. There are many cases reported which show that an acquittal on the ground of in- sanity is frequently a mere matter of accident. 800 SUICIDAL MONOMANIA. CHAPTER LXVI. SUICIDAL MANIA. — SUICIDE NOT NECESSARILY AN INDICATION OF IN- SANITY. — SUICIDE A FELONY. — IN RELATION TO LIFE-INSURANCE. — HEREDITARY TAINT. — EROTOMANIA.— PUERPERAL MANIA.— PYROMANIA. — KLEPTOMANIA.— DIPSOMANIA. — RESPONSIBILITY OF DRUNKARDS. — DELIRIUM TREMENS. — SOMNAMBULISM. — DEAFNESS AND DUMBNESS. Suicidal monomania, or suicidal mania, is the name given to that form of insanity which is marked by the prominent idea of self- destruction. Its approach is insidious : it is foreshadowed by im- paired appetite and sleeplessness arising from some cause of mental anxiety too trivial to create alarm. It may proceed either from sudden impulse or be the result of long deliberation ; it may be committed with, or without, apparent motive ; it may proceed either from a delusive or a real apprehension of poverty, disgrace or ruin. Suicide from sudden impulse is not uncommon ; persons have been known to destroy themselves who had not previously manifested any symptoms of intellectual disorder. Sir Charles Bell relates that one of the surgeons of the Middlesex Hospital was in the habit of going every morning to be shaved by a barber in the neighborhood, who was known as a steady industrious man. One morning the surgeon was conversing with the barber about an attempt at suicide which had recently occurred, and the surgeon observed that the man had not cut his throat in the right place. The barber then inquired, casually, where the cut should have been made ; the surgeon pointed on his neck to the situation of the carotid artery. The barber in a few minutes retired to the back of his shop, and there cut his throat with the razor with which he had been shaving the surgeon ; he had wounded the carotid artery in the place indicated by the surgeon, and died before any assistance could be rendered to him. Although this act was quite sudden and unexpected, it may have been only the final result of a delusion which had long existed, concealed from others, in the mind of this man — j ust as the sight of a weapon has often led to its use for the purpose of suicide. Dr. Forbes Winslow remarks "that a person is often impelled to self-destruction by the overpowering and crushing influence of a latent delusion that has for weeks, and perhaps months, been pressing like an incubus on his imagination. Patients sometimes confess that they have been under the influence of monomaniacal ideas and terrible hallucinations for a long period without their existence being suspected even by their most intimate associates. " For six months," writes one patient, " I have never had the idea of suicide, night or day, out of my mind. Wherever I go an unseen demon SUICIDAL MONOMANIA.. 801 pursues me, impelling me to self-destruction ! My wife, friends, and children observe my listlessness and perceive my despondency, but they know nothing of the worm that is gnawing within. Is this not a type of cases more generally prevalent than we imagine ?" (" Obscure Diseases of the Brain," p. 265.) The want of power to shake off this delusion shows clearly that the mind is not in a healthy state — that the person is not sane. Men who are thus mentally affected generally retain a certain control over their actions ; thus they will voluntarily give up pistols, razors, or other weapons by which suicide might be perpetrated. A friend suffering from an attack of suicidal mania, while residing with me in Paris in 1830, delivered to me one night his razors, with a request that I would lock them up and keep them out of his sight, as otherwise he feared that he might destroy himself at any moment. Although he recovered from this attack, he had a relapse, and sub- sequently destroyed himself by taking prussic acid. Persons labor- ing under this form of monomania, may go to bed perfectly collected, and suddenly awake in the night and destroy themselves by hanging, drowning, or precipitating themselves from a window. These cases probably depend on the persistence of some horrible halluci- nation which may have occurred in dreaming, and in the reality of which they cannot at the time disbelieve. Some years ago I saw a case of this kind in a man who was a patient at Guy's Hospital. The man attempted to strangle himself in the dusk of the evening with the cord of his bed ; he was fortunately saved, and he recovered after having been nearly strangled. On asking him what led him to the attempt, he told me that he suddenly saw a large black figure round his bed (the devil), which by signs and words compelled him to try and bang himself. It appeared that this man had previously shown symptoms of suicidal monomania. When the impulse to suicide is checked by any great moral shock, it may suddenly disappear. My friend, to whose case I have above referred, recovered under the shock from the sudden outbreak of the French Revolution in 1830. The danger to which he was exposed, while residing with me in Paris in the early days of the revolution, for a time at least dispelled the idea of self-destruction. Pinel men- tions the case of a man who while hurrying to one of the bridges of Paris to throw himself into the river, was suddenlj"^ attacked by robbers ; he made a desperate resistance, and escaped from them. He could not then account for his being where he was, and quietly walked home, having abandoned" the intention of destroying him- self There is but little doubt that many acts of suicide would be prevented if circumstances only gave a slight opportunity for re- flection ; the mind would then be diverted from the dominating idea of self-destruction. Suicidal mania is susceptible of being spread by imitation, espe- cially when the mode of self-destruction adopted is accompanied by circumstances of a horrible kind, or by such as excite great notoriety. The sight of a particular spot where an act of suicide has been al- ready committed will often induce a person, who may hitherto have 51 802 IS SUICIDE A PROOF OF INSANITY? been unsuspected of any such disposition, at once to destroy himself. Thus, a second and a third- suicide took place from the Monument near London Bridge, soon after the first had occurred. Acts of incendiarism have been also observed to lead to arson in the same, or in a neighboring district : but there is here a criminal as well as a monomaniacal imitation, and experience has clearly shown that there is no check so eft'ectual for this as the rigorous application of the law. Does the act of suicide necessarily indicate the existence of insanity ? — Suicide is often set down as furnishing positive evidence of in- sanity ; a doctrine which commonly finds expression in the verdicts of coroners' juries — not so much from the fact of insanity being thereby established, as that any verdict but this would weigh heavily, not on the deceased, but on his surviving relations and friends. In the opinion of Dr. Davey, the suicidal propensity is, in all cases and under all circumstances, a positive sign or symptom of disor- dered mind (insanity). ("Journal of Mental Science," April, 1861, p. 110.) This, however, is not in accordance with the views of many psychologists. In one case, a person will fancy that he is constantly watched — that he is oppressed and persecuted by all around him, and that his prospects in life are ruined when, on the contrary, his affairs are known to be flourishing ; he destroys himself under this delusion, in order to avoid imaginary evils. In cases of this descrip- tion, whether arising from a momentary insane impulse, or from delusive reasoning, there cannot be a doubt that the act is one of insanity. It is very different, however, when a real motive is obviously present — as when a person destroys himself to avoid actual disgrace or impending ruin. The motive is here based on a reality — on a real estimate of the man's position ; the results are clearly foreseen, and the suicide calculates that the loss of life would be to him a smaller evil than the loss of honor and fortune. It may be urged that a motive of this kind is itself delusive, and will appear insufficient to the minds of most men ; but what known motive is there sufficient to account for parricide, infanticide, or any other crime of the like horrible nature ? It appears to me, we must allow either that all crime is the offspring of insanity, or that suicide, like infanticide, may be the deliberate act of a sane person. To affirm that suicide is always per se evidence of insanity is to affirm, sub- stantially, that there is no criminality in self-murder ; for it is im- possible to regard that act as a crime which is committed under a really insane delusion. (See " Ann. d'Hyg.," 1831, vol. i. p. 225 ; for some additional remarks on this subject see Lectures by Dr. Jamieson, " Med. Gaz.," vol. 46, p. 523, and " Jour. Psychol. Med.," 1850, p. 19.) The law of England very properly treats suicide as a felony ; those who have attempted and failed in its perpetration are held to be . sane and responsible agents, unless there should be clear evidence of their (intellectual) insanity from other circumstances ; and it is cer- tain, that the evidence required to establish this must be much stronger than that sometimes admitted in cases of homicide. IS SUICIDE A PROOF OF INSANITY? 803 Some singular medico-legal cases have occurred, involving the question how far the act of attempting suicide is indicative of in- sanity. In the case of the Queen v. Rumhall (Cent. Grim. Court, May, 1843), a woman was charged with attempting to drown her child. It appeared in evidence that she had fastened her child to her dress, and thrown herself into a canal with the intention of de- stroying herself. She was rescued, and was subsequently tried and convicted of the felony of attempting to murder her child by drown- ing. Had she not been rescued, and had she succeeded in her pur- pose of self-destruction, it is probable that the verdict of a jury would have been, as it so frequently is on these occasions — " Tempo- rary insanity." In Meg. v. Furley (Cent. Crim. Court, April, 1844), the prisoner was convicted of murder under similar circumstances, but the sentence was subsequently commuted. In Reg. v. Gathercole (1839), a man was charged with manslaughter, under the following singular circumstances: The prisoner threw himself into a canal for the purpose of drowning himself; the deceased, who was passing, jumped in and rescued him, but by some accident he was himself drowned in the humane attempt. The defence was, that the prisoner was at the time insane, and therefore not responsible for the death of the person who attempted to save him ; but this was negatived, and the prisoner was convicted. So if a man intending to shoot himself fails, and by accident shoots a bystander, he will be held responsible, unless there be a clear proof of intellectual insanity ; the act — the attempt itself, taken alone, will not be admitted as evidence. If two persons agree to commit suicide, and one only dies, the survivor is guilty of murder. In Beg. v. Fisher (Taunton Spring Assizes, 1865), the prisoner was indicted for the murder of his wife by poison. It appeared from the evidence that they had been mar- ried fourteen years, and had lived happily together. The man was well-conducted and industrious ; but he fell into a desponding state- of mind, and thought that by the introduction of machinery into his trade of a shoemaker, he and his wife would be reduced to poverty. He communicated this feeling to his wife ; they pondered over it together, and they both agreed to destroy themselves. The man procured a quantity of laudanum, and shared it with his wife ; they took about an ounce each. The wife died, but owing to early vom- iting the prisoner recovered. It was proved that before marriage the prisoner had been confined in a lunatic asylum ; still he had perfectly recovered, and just before this occurrence it was observed that both husband and wife were low and dispirited. There was then no indication of intellectual insanity about him : and the only delusion appeared to be that machinery would ruin his trade. In answer to the charge he said, " According to my notion I am not guilty of murder." The case is like that of many others — of two poor, weak-minded, infatuated people agreeing to commit suicide. Under the direction of the judge, the jury returned a verdict of" guilty. 804 SUICIDE IN EELATTON TO LIFE-INSURANCE. Suicide in relation to life-insurance. — It is well known that ac- cording to the rules of some English offices, a policy of life-insur- ance is forfeited by the act of suicide ; but supposing it to have been really an act of insanity, it has been doubted Avhether the policy would be legally forfeited. In an equitable view the policy should not be forfeited under these circumstances, any more than if the party had died accidentally by his own hands. The condi- tion equitably implies that the assurred party puts himself to death deliberately and not unconsciously through a delusion as a result of a fit of delirium or an attack of insanity. This question was raised in the case of Borradaile v. Hunter (Dec. 1841). An action was brought to recover the amount of a policy of insurance effected on the life of a clergyman who threw himself into the Thames from Vauxhall Bridge, and was drowned. The whole case turned upon the legal meaning of the words '■'•die by his own hands" which formed the exception in the proviso to the payment of the policy. At the trial of the case, Erskine, J., directed the jury, that if the deceased threw himself into the river knowing that he should destroy himself, and intending to do so, the policy would be void ; they had further to consider whether the deceased was at the time capable of distinguishing between right and wrong, or in other words, whether he had sufficient knowledge of the consequences of the act to make him a felo-de-se. The jury found that the deceased threw himself into the water intending to destroy himself, and that previously to this act there was no evidence of insanity. They were then directed to take the act itself with the previous conduct of the deceased into consideration, and say whether they thought he was at the time capable of knowing right from wrong. They then found that he threw himself from the bridge with the intention of destroying himself, but that he was not then capable of judging between right and wrong. The jury were here evi- dently perplexed with the strict meaning of the words right and wrong ; the first part of the verdict made the case one of felo-de-se, the last part made it one of insanity. The verdict was entered for the defendants, i. e., that the diseased was a felo-de-se, and that the policy was therefore void. This case was subsequently argued before the four judges in the Common Pleas (May, 1843). It was then contended for the plain- tiff, that according to the terms of the policy there must have been an intention by the party assured to " die by his own hand," and that an insane person could have no controllable intention. The judges differed ; three thought there was no ground for saying that the deceased was affected by an uncontrollable impulse; on the contrary, the jury had found that he threw himself into the river knowing that he should destroy himself, and intending to do so. In their opinion the act was one of felo-de-se, and the policy was void. Tindal, C. J., considered, that the verdict should be for the plaintiff", thereby leading to the inference that the act of suicide was in this case the result of insanity, and not of a felonious kill- ing, to which alone he considered the exception in the proviso SUICIDE IN RELATION TO LIFE-INSURANCE. 805 should apply. It is probable if the term " suicide " had been in- serted in the policy, instead of the words " die by his own hands" that the decision would have been in favor of the plaintiffs ; for to vitiate a policy from an accidental result depending on an attack of insanity a.nd flowing directly from that attack, is virtually vitiating it for the insanity itself! In this respect, it appears that the learned Chief Justice took a sound and equitable view of the ques- tion, so important to the interests of those who have insured their lives. It is impossible for a man to enter into a. contract against an attack of insanity, any more than against an attack of apoplexy ! The jury found that the deceased was irresponsible for the act, and it is clear that the insurers and insured intended no more by using the terms " die by his own hands," than the act of suicide. By this decision, therefore, the insurers received the benefit of a wider in- terpretation of the terms than that which either party could have foreseen or contemplated. The question was again raised in the case of Schwabe v. Clift, Liverpool Summer .Assizes, 1845. ("Med. Gaz.," vol. 36, p. 826.) The deceased, whose life was insured, destroyed himself by taking sulphuric acid : there was clear evidence of his being at the time in a state of insanity. The jury bere, under the direction of Cres- well, J., returned a verdict for the plaintiffs, thereby deciding that the policy was not vitiated by the mere act of suicide. The learned judge held that to bring the case within the terms of the exception, the party taking his own life must have been, at the time of the act, an accountable moral agent and able to distinguish right from wrong. In this instance the term used in the policy was " suicide," which according to the learned judge meant " a felonious killing." Supposing that the insured party was killed by voluntarily precipi- tating himself from a window while in a fit of delirium from fever, this would be an act of suicide, or dying by his own hand ; but it surely cannot be equitably contended that his heirs should lose the benefit of the insurance in consequence of an event depending on an accidental attack of a disease, which no one could have foreseen, and against which no one could guard ! If this principle be not admitted, the decision which must necessarily follow would appear to be against all equity ; if it be admitted, then it must apply equally to every case of mental disorder, the proof of the existence of this resting with those who would benefit by the policy. On an appeal, the judgment in this case was however reversed, the judges again differing. It was argued for the insurers, that if a man retained just enough of intelligence to produce death by com- petent means, but was deprived of all moral sense, the policy was void. Against this view it was urged by one of the judges, that whether the intellect was destroyed altogether, or only partially, it could make no difference. If death was the result of disease, whether by affecting the senses, or by affecting the reason (thus leading to suicide), the insurance office was liable under the policy. If the act was not the act of a sane and reasonable creature, it was not an act of suicide within the meaning of the proviso. Those judges who SUICIDE IN RELATION TO LIFE-INSURANCE. adopted the opposite view held that the meaning of the words, as introduced into the exception, was — if the party should kill himself intentionally : the words were considered to include all cases of vol- untary self-destruction. If a party voluntarily killed himself, it was of no consequence whether he was sane or not. The majority of the court held this view, and a new trial was granted. Had all the judges been present to give their opinions, the decision might have been different; for five had expressed themselves at various times in favor of the view that the term suicide in policies applies, as it ought to do, only in cases in which there is no evidence of insanity ; while four had declared their opinion to be, that it includes all cases of " intentional" self-killing, whether the person be sane or insane. It is difficult to understand how a man in a fit of delirium or insanity can be said to kill himself voluntarily or intentionally. "Will and intention imply the judgment of a sane man in regard to civil and criminal acts, but a delirious or really insane person acts under a delusion ; and as the law would hold him irresponsible in regard to others, his representatives should not suffer for an act which he was himself incapable of controlling. (See " Law Times," July 18, 1846, p. 342.) The decision in this case is of great importance to persons whose lives are insured, for it may be made to govern others ; and on this principle, a man attacked with delirium, and who during the fit pre- cipitated himself from a window and was killed, would be declared a suicide within the meaning of the proviso, and a policy of insur- ance on his life would be ipso facto void. It will be perceived that the law, as interpreted by a majority of the judges, is that whenever a person destroys himself intentionally, whatever may be the state of his mind, the policy becomes void. It also appears that, according to this legal view of the question, a person may have and exercise his intention, although undoubtedly insane. Whether he has been found so under a commission, or a verdict to this effect has been returned by a coroner's jury, is therefore unimportant. It must be proved by those who would benefit by the policy, that the party died from his own act without intending to destroy himself. If a man take poison, or shoot himself, or commit any other act leading to his own death, it must be shown that it was the result oi accident, and not of design on his own part. Some Insurance offices now insert in the contract a proviso by which, whether the person be S-OMnA. felo-de-se or not, the policy shall be forfeited ; but they reserve to themselves the power of returning a part or the whole value of the policy, calculated up to the day of death. In the mean time they have the power of taking the full benefit arising from an act of suicide committed during a fit of delirium or insanity, in which, as medical men know, there can exist no controllable intention, no freedom of judgment, and no real exercise of will. (See case " Prov. Med. Journ.," Aug. 9, 1818, p. 428.) [See chap, on Life Insurance, post.] There is a form of suicide not unlikely to present itself for con- sideration, namely, where a man, in the habit of using a powerful PUEBPEEAL INSANITY. 807 drug for medicinal purposes, takes a large dose while in a state of intoxication, and dies. In May, 1857, a Mr. George Fife died from an overdose of morphia, and it was proved to the satisfaction of the jury that this must have been taken while he was intoxicated. In such a case, a man may have no sane intention of destroying himself, yet he dies by his own hands. As drunkenness does not excuse or justify any act of homicide, so it would not probably be allowed to affect the question of suicide ; and death under such circumstances would probably be held to be a felonious killing. From these cases one fact is clear — the act of suicide is not treated by the law as a necessary proof of insanity ; and therefore the in- genious arguments which have been held on this subject have but little interest for a medical jurist, in a practical view. It has been elsewhere stated that acts of suicide have been mistaken for homi- cide, merely because the deceased had expressed no intention of destroying himself, and had manifested no disposition to the act by his previous conduct. This, however, is a fallacious view of the subject, since suicide from sudden impulse is by no means unfrequent ; and even when the act bears about it marks of delib- eration, it is not to be expected that a person should previously announce his intention, for this would be a sure way of defeating his object. If, as it is alleged, the act of suicide was in all cases the offspring of insanity, suicide should be frequent among the insane. Experi- ence, however, is not in favor of this assumption. The Report of the Commissioners of Lunacy for 1850 shows that there were then confined as lunatics 15,079 persons, while the suicides for the year among this large number amounted to only eight, of which six were perpetrated by strangulation. As mechanical restraint is either abolished, or considerably diminished in most asylums, lunatics have now much more liberty than formerly, and yet suicides among them are comparatively rare. This favorable result must be in part as- cribed to active superintendence and watching. The tendency to suicide seems to be in some cases hereditary. Dr. Burrows relates an instance in which this propensity declared itself through three generations : in the first, the grandfather hanged himself; he left four sons: one hanged himself, another cut his throat, and a third drowned himself in an extraordinary manner, after having been some months insane: the fourth died a natural death, — which, from his eccentricity and irregularity of mind, was scarcely to be expected. Two of these sons had large families : one child of the third son died insane, two others drowned themselves, another became insane, and made the most determined attempts on his life. Several of the progeny of this family, being the fourth generation, when they had arrived at puberty, showed a tendency to the same fatal propensity. Puerperal insanity. — Mania may present itself in other forms than those hitherto considered. Women who have been recently delivered are liable to sudden attacks, in which a disposition to 808 PUERPERAL INSANITY, murder their offspring is the most marked symptom. This has been long known and recognized by physicians as " puerperal mania." The disorder seldom attacks a woman before the third day — often not for a fortnight, and in some instances not until several weeks after delivery. Out of ninety-two cases, Dr. Simpson observed that the attack occurred in twenty-one, between the fifth and the fifteenth day. (" Med. Times and Gaz.," Sept. 1, 1860, p. 201.) The most frequent period is at or about the commencement of lactation, and between that and the cessation of the uterine discharges (lochia). According to Esquirol, it is generally preceded or attended by a suppression of the lochia and milk. The late Dr. Ashwell remarked that undue lactation might give rise to an attack of mania under which the murder of the offspring might be perpetrated. (" Diseases of Women," p. 732. See the case of Reg. v. Lacey, !N"ottingham Summer Assizes, 1858.) It may also come on after forced, or volun- tary weaning. The symptoms do not differ from those of mania generally but it may assume any of the other forms of insanity : and in one-half of the cases, it may be traced to hereditary tendency. There is a childish disposition for harmless mischief. The woman is gay and joyous, laughing, singing, loquacious, inclined to talk obscenely, and careless of everything around. She imagines that her food is poisoned ; she may conceal the suspicion, and merely avoid taking what is offered to her. She can recognize persons and things ; and can, though perhaps she will not, answer direct questions. Occa- sionally there is great depression of spirits with melancholia. These facts are of some importance in reference to cases of alleged child- murder. This state may last a few hours, or for some days or weeks. The murder of the child is generally either the result of a sudden fit of delirium, or a sudden impulse, with a full knowledge of the wickedness and illegality of the act ; so that the legal test of re- sponsibility of a knowledge of right and wrong cannot be applied to such cases, except on the assumption that insanity already exists, and taints the consciousness of the individual, (p. 789.) A woman has been known to request her attendants to remove the child, but she has afterwards taken an opportunity to destroy it. Such cases are commonly distinguished from deliberate child-murder by there being no motive, no attempt at concealment, nor any denial of the crime on detection. There is in general a full consciousness of the illegality of the act, but apparently an entire want of power to con- trol the murderous feeling. Women in the pregnant state have been known to perpetrate murder apparently from some sudden perversion of their moral feelings: there has been probably latent intellectual disturbance, but not suflacient to attract the notice of friends. There is a great sympathy between the uterine organs and the brain, which may account for the occurrence of such cases ; but I am not aware that irresponsibility on the ground of insanity has been admitted in this country, under these circumstances. PYROMANIA — KLEPTOMANIA. 809 Fyromania. Propensity to incendiarism. — This is described as a variety of monomania in which there is a morbid disposition of mind leading to impulsive acts of incendiarism without any mo- tive. It is a condition not specially recognized by English jurists or in English courts of justice. It has been said to occur in girls about the age of puberty, and is supposed to be connected with disordered menstruation. The case of Jonathan Martin has been frequently quoted as an instance of pyromania. He had, however, merely a delusion that he was deputed by God to burn down the Cathedral of York, in order to do away with the heresies which he supposed to exist in the Church. There was no doubt of his in- sanity ; he had been already twice confined in an asylum. Never- theless, as the late Baron Alderson (who was counsel for the prose- cution) remarked, the act was perpetrated with much method. It seems that Martin remained behind after the afternoon service in the cathedral, and when left alone he went up into the belfry, cut off about eighty or ninety feet in length of the prayer-bell rope, which, being usually rung from below, had been drawn up and coiled up to that length there. With this rope he succeeded in knotting a sort of ladder, and throwing it over the iron gates of the choir, he climbed over by means of the knots. Being in the choir, he struck a light with a flint and his razor, lighted a candle which he had brought, collected the prayer-books, and set fire to the paper, close to the carved work at the archbishop's throne, in two piles. He then cut away a silk curtain, gold fringe, etc., which he stole ; and getting back by his rope-ladder into the body of the cathedral, he escaped through a window on the north side, — the most unfrequented part. He had provided himself with a pair of pincers, by which he forced the window, and let himself out by his rope-ladder to the ground. A sane criminal could hardly have devised a better method of perpetrating the act, or of escaping after its perpetration. The defence, as in most of these cases, was in- sanity at the time of perpetrating the act, and not specially Pyro- mania. Kleptomania. Propensity for thieving. — This term has been ap- plied by Marc to that form of monomania which is said to manifest itself by a propensity to acts of theft. It is alleged by him and others that this propensity has often shown itself in females labor- ing under disordered menstruation, or among those who were far advanced in pregnancy — the motive being the mere wish of posses- sion. Pregnancy, according to him, should be a good exculpatory plea when a well-educated woman, of strictly moral conduct, steals some unimportant article of no value compared with her worldly means and position in society. There are several instances on re- cord showing that well-educated persons moving in a respectable sphere' of society have been guilty of petty acts of theft. The arti- cles taken have been valueless compared with their means. Instances of this kind have been brought before our Police-courts, and this motiveless impulse to theft has been occasionally pleaded ; but in .810 EROTOMANIA — DIPSOMANIA. most of them the following facts have been clearly established by evidence : 1. A perfect consciousness of the act and of its illegal- ity. 2. The article, though of trifling value, has still been of some use to the person — thus women have stolen articles either adapted to female use, or on which money could be raised. 3. There have been art and precaution in endeavoring to conceal the theft ; and 4, either a denial of the act when detected, or some evasive excuse. When circumstances of this kind are proved, either the parties should be made responsible, or theft should be openly tolerated. The evidence of a disordered state of mind should not be allowed to depend on the nature of the act, or every morally depraved per- son might bring forward a plea of insanity for any crime or offence. When the plea of insanity is raised in respect to other cases of stealing, the rule appears to be (per Tindal, C. J.), that there should be proof that the prisoner was incompetent to know that the par- ticular act in question was a wrong one. {Reg. v. Yaughan, Mon- mouth Sum. Ass., 1844.) Erotomania. Aidoiomania. — Erotomania has been described by M. Esquirol as a chronic affection of the brain leading to mental disorder, in which amorous ideas are as predominant and as uncon- trollable as religious ideas in some cases of religious melancholia. It occurs in both sexes, and in his opinion it differs from nympho- mania and satyriasis in the fact, that it has its origin in a primary disturbance of the functions of the brain from disease. In nympho- mania, however, the female sexual organs, and in satyriasis the male sexual organs, are at fault. These two mental conditions he re- gards as depending on morbid changes in the sexual organs. Dr. Marc has suggested that the term aidoiomania (from ai&oiov, puden- dum) is more appropriate ; it signifies furor genitalis, and includes both nymphomania and satyriasis. ("De laPolie," vol. 2, p. 182.) It cannot be denied that, from sympathy between the genital organs and the brain, mania may sometimes show itself by exces- sive sexual desires leading to attempts by one on the other sex. This is the very difficulty to the admission of such a defence. Ex- cessive amorous propensities may exist in sane and responsible persons, and if unresisted by due moral control, they may in a cer- tain sense be described as irresistible ; but this Will hardly satisfy a court of law that a man could not help perpetrating a rape when time and circumstances were especially favorable for such an assault on a woman. The sane ravisher will generally seek his opportu- nity — the maniac will attack any woman openly and indiscrimi- nately. Such a defence is rarely set up in a case of rape, for the reason, no doubt, that all the circumstances of the case would be adverse to it. Dipsomania. Drunkenness. Civil responsibility of drunkards. — This state, which is called in law frenzy or " dementia affectata" is regarded as a temporary form of insanity. Jurists and legislators have differed widely respecting the degree to which drunkards CRIMINAL RESPONSIBILITY OF DRUNKARDS, 811 should be made responsible for their acts. "When the mind of a man is completely weakened by habitual dvankennesa, the law infers irresponsibility, unless it plainly appears that the person was at the time of the act, whether of a civil or of a criminal nature, endowed with full consciousness and reason to know its good or evil tend- ency. Any deed or agreement made by a party when drunk is not invalidated by our law, except in a case in which the intoxication has proceeded so far as to deprive him of all consciousness of what he is doing ; and a court of equity will not interfere in other cases, unless the drunkenness was the result of collusion by others for the purposes of fraud. When the drunkenness has occasioned a tem- porary loss of the reasoning powers, the person is incapable of giving a valid consent, and therefore cannot enter into a contract or agreement; for this implies aggregatio meniium, i. e., a mutual assent of the parties. Partial drunkenness therefore, provided the person knew what he was about, does not vitiate a contract or agreement into which he may have entered. Thus the law appears to define two states in drunkenness : one in which it has proceeded to but a slight extent, and it is considered that there is still a power of rational consent ; another in which it has proceeded so far that the person has no consciousness of the transaction, and therefore can give no rational consent. The proof of the existence of this last state would render all the civil acts of a person void. A confession made by a man 'while in a state of drunkenness is legally admissible as evidence against him and others, provided it be corroborated by circumstances. In a case tried a few years since the prisoner con- fessed, while drunk, that he had committed a robbery and murder which had taken place some time before, but of which he had not been suspected. He mentioned a spot where the property of the murdered person had been concealed by him, and the whole of the circumstances of the murder. The property was found as he had described it, and the case was clearly brought home to him, chiefly by collateral evidence from his own confession. He was convicted. In a case tried at the Central Criminal Court, in October, 1849, a man pleaded his drunkenness at the time of his first marriage as a defence to a charge of bigamy. There was some evidence to show that he was partly intoxicated when the cei-emony was performed : it was proved, however, that he was sufficiently conscious of the whole of the proceedings, and he was convicted. (" Med. Q-az.," vol. 44, p. 762.) Criminal responsibility of drunkards. — "When homicide is committed by a man in a state ol drunkenness, that is held to be no excuse for the crime. If voluntarily induced, whatever may be its degree, it is not admitted as a ground of irresponsibility, even although the party might not have contemplated the crime when sober. {Heg. v. Beeves, Derby Winter Assizes, 1844.) Thus it appears that when the state of drunkenness is such that any civil act would be void, a person may still be held legally responsible for a crime like mur- der. Some judges have admitted a plea of exculpation when the crime has been committed in a state of frenzy arising from habitual 812 CRIMINAL RESPONSIBILITY OF DRUNKARDS. drunkenness ; but even this is not general. The question whether the person was or was not drunk at the time of committing a crime may be, however, occasionally of some importance. It was held by Patteson, J., that although drunkenness is no excuse for any crime whatever, yet it is of very great importance in cases in which there is a question of intention. A person may be so drunk as to be utterly unable to form any intention at all, and yet he may be guilty of very great violence. {Reg. v. Cruse., 8 0. & P. p. 546.) If the drunk- enness has produced a diseased state of the mind, then a criminal act perpetrated by the person, might admit of exculpation either on the ground of insanity, or of the want of sane consciousness at the time of the act ; but the difficulty is to prove in such cases the ex- istence of actual disease to a sufficient degree to render the person irresponsible in a legal sense. When it is a question whether the accused was actuated by malice or not, a jury may under certain circumstances be required to take the fact of drunkenness into their consideration, and this may have some influence upon their verdict. While, then, drunkenness does not furnish any excuse for a crime, it may become material with reference to the intent with which an act has been perpetrated. ("Law Times," Sept. 27, 1845, p. 542.) It is obvious that if drunkenness were to be readily admitted as a defence, three-fourths of the crimes committed in this country would go unpunislied ! In cases in which the head has sustained any physical injury, as among soldiers and sailors, drunkenness, even when existing to a slight extent, produces sometimes a fit of temporary insanity, leav- ing the mind clear when the drunken fit is over. The law makes no distinction between this state and ordinary drunkenness, although juries occasionally show by their verdicts that some diflerence ought to be made. (See cases in Alison, p. 653.) Hallucinations and illusions are a common eifect of drunkenness, and may lead to the commission of criminal acts. Marc relates a case where two friends being intoxicated, the one killed the other under an illusion that he was an evil spirit. The drunkenness of the accused was held to have been voluntary ; and he was con- demned to ten years' imprisonment with hard labor. A case of this description {Reg. v. Patteson) was tried at the Norfolk Lent Assizes, 1840. A man while intoxicated killed his friend, who was also in- toxicated, under the illusion that he was some other person who had come to attack him. It is reported that the guilt of the prisoner was made to rest upon the fact, whether, had be been sober, he would have perpetrated the act under a similar illusion ! As he had voluntarily brought himself into a state of intoxication, this was no justification ; he was found guilty of manslaughter, and sen- tenced to two montbs' imprisonment. The proof of drunkenness may fail, but still, if the person charged with the death acted under an illusion, he will be acquitted. In Reg. V. Price (Maidstone Summer Assizes, 1846), it was proved that the prisoner, who had been on friendly terms with deceased, was going home at night, having previously been in company with deceased at CRIMINAL RESPONSIBILITY OF DRUNKARDS. 813 a public house. According to the prisoner's statement, a man sprang upon him from the hedge by the roadside, and demanded his money and his watch, or else he said he would have his life ; the prisoner closed with,, and beat him severely, inflicting such injuries that he died shortly afterwards. The supposed robber turned out to be his friend, and it was believed that he had made an attempt to rob the prisoner jokingly ; the result, however, was that the attempt had ended in this fatal manner. The prisoner throughout told the same story, and there did not appear to be the slightest ground for sug- gesting that it was untrue. Coltman, J., after hearing the evidence of the witnesses, said it appeared to be quite clear that the prisoner had acted under an impression that he was protecting his own life from the attack of a robber, and under such circumstances he could not be held to be criminally responsible. The jury accordingly returned a verdict of not guilty, and the prisoner was discharged. .An excessive indulgence in the habits of drinking does not necessarily derange the mind, but it practically renders a person unfit for the control of himself and the management of his pro- perty. It is therefore a question whether it would not be for the benefit of such persons and of those dependent on them, if the law interfered and placed them under the same restraint as those whose minds had been actually rendered unsound by this pernicious habit. [The law does so interfere in Pennsylvania — vide note to p. 769 ante. — P.] Intoxication is simply poisoning by alcohol, a light form of nar- cotic poisoning. A medico-legal question may arise in reference to the responsibility of persons for acts perpetrated while they are under the infiuence of other narcotics of a more powerful kind. Thus, a person may have lost his self-control from the eflects of opium or any of its preparations — Indian hemp, datura, chloroform, or substances of the like nature. If we except Indian hemp (bhang or gunja) and datura (in which muscular power may be excited), the general efl'ect of other narcotics is to produce only a short stage of excitement, which is speedily followed by drowsi- ness, stupor and muscular weakness. As a result of taking any of these drugs, a man may have halluciations or illusions, and in this state commit murder like an insane person, who may fancy that he sees a hideous spectre, or the devil before him. Dr. Che- vers, in his " Medical Jurisprudence for India," describes several instances in which murders have been perpetrated by persons who had taken preparations of hemp (op. cit. pp. 541 et seq.). The legal test of irresponsibility for such acts he states as follows : " ISTo person can be acquitted unless it can be proved that, by reason of unsoundness of mind not wilfully caused by himself, he was uncon- scious, and incapable of knowing, in doing the act, that he was doing an act forbidden by the law of the land" (p. 566). Persons who voluntarily place themselves in such a condition as to be deprived of all self-control are therefore held responsible; and whether the drug be alcohol, opium, or Indian hemp is immaterial. Restraint. Interdiction. — Drunkenness, even when habitual, is 814 CRIMINAL RESPONSIBILITT OF DRUNKARDS. not a sufficient ground for the imposition of restraint or interdic- tion, in the English law. Thus, on a Commission in I^ovember, 1836 (^e Holden), the jury returned that the party was of weak mind and given to habits of drunkenness, but that he was not of unsound mind. On application, the Lord Chancellor refused to interfere. This part of our law requires revision. Delirium tremens. — This is a disordered state of mind which pro- ceeds from an abuse of intoxicating liquors. Habitual drunken- ness appears to be the predisposing, while abstinence from drink is the immediately exciting cause. Thus, the disorder frequently does not show itself until the accustomed stimulus has been with- drawn for a certain period. It commences with tremors of the hands, by which it is known from ordinary delirium and restless- ness ; and the individual is subject to hallucinations and illusions, sometimes of a horrible kind, referring to past occupations or events. The patients are often violent, and prone to commit suicide or murder — more commonly the former; hence they require close watching. Persons laboring under this disorder are incompetent to the performance of any civil act, unless the mind should clear up before death ; they are not responsible for criminal acts com- mitted while they are laboring under an attack. Acquittals have even taken place on charges of murder, when there was delibera- tion as well as an apparent motive for the act. Thus then, although the disorder may have been voluntarily brought on by habitual drunkenness, the law admits it as a sufficient plea for irresponsi- bility, while in a case of confirmed drunkenness it rejects the plea. In delirium there is a formed disease of the brain, while volun- tary drunkenness merely produces a temporary disturbance of its functions. In one trial the evidence showed that homicide had been committed by the accused while he was laboring under an attack of delirium tremens. {Jieg. v. Simpson, Appleby Summer Assizes, 1845.) The prisoner's mind had become unsettled from this dis- order, brought on by habitual drunkenness. In another case the plea was also admitted by the jury, although it was scarcely sup- ported by the medical evidence. {Beg. v. Watson, York Winter Assizes, 1845.) [Many of the States of the Union have statutes defining murder, and dividing it into degrees. Where this is the case the existence of intoxication and its effect upon the mind of one charged with homicide, becomes of much importance, upon the question of in- tent and premeditation. The " American Law Journal," for Oc- tober, 1848 (p. 145), contains the following admirable article upon this subject. " The mental status produced by drunkenness is frequently deter- mined by the testimony of physicians. But the effect of that state of mind, voluntarily produced, in relieving from responsibility for crime, is to be determined by the courts. Sir William Blackstone quotes the language of Sir Edward Coke, who declares that ' a drunkard who is voluntarius daemon, hath no privilege thereby ; but CRIMINAL RESPONSIBILITY OF DRtrNKARDS. 815 what hurt or ill soever he doth, his drunkenness doth aggravate it.' And Sir "William adds, that ' the common law of England, con- sidering how easy it is to counterfeit this excuse, and how weak an excuse it is, though real, will not suffer any man thus to privilege one crime by another.' (Plow. 19, 4 Bl. 26, 1 Inst. 247.) The effect of this severe rule of the common law is frequently to fix upon the accused the legal guilt of a crime of much greater enormity than he ever intended to commit. But the great value of the com- mon law is that it is founded upon far-reaching views of policy, which look beyond the justice of the particular case, for the pur- pose of protecting the higher interests of society. It seems to be conceded as a principle of the common law that a man who wil- fully perpetrates an unlawful act is responsible for all its conse- quences. Hence, a man who accidentally kills another by dis- charging a gun at a sheep, or a domestic fowl, for the purpose of stealing it, is guilty of murder at common law, although his mind never in fact assented to the enormity of taking the life of a fel- low being. On the same principle, it would seem that a man who voluntarily puts himself in a state of mind which causes him to take the life of another is guilty, by construction, of the common law crime of murder. " The hardship of this rule has sometimes caused the scales of justice to vibrate in its application to capital cases. In 1819, Mr. Justice Holroyd, in jRex v. Grindley, under the influence of his feelings, held that ' though voluntary drunkenness cannot excuse from the commission of crime, yet where, as upon a charge of murder, the material question is whether the act was premeditated, or done only with a sudden heat and impulse, the fact of the party being intoxicated is a circumstance proper to be taken into con- sideration. (Lewis's Grim. L. 602 ; 1 Spear's 384.) This decision has doubtless had its influence elsewhere. The error of Mr. Justice Holroyd consisted in supposing that at common law it was always ' a material question ' in murder ' whether the act was premeditated ' or not. We have seen that premeditated killing was not always essential to constitute the crime ; otherwise it never could have been held murder to kill a human being accidentally in the pre meditated perpetration of larceny. There is some reason to believe that subsequent reflection brought the mind of that enlightened judge to an acknowledgment of his error. In 1835, in the case of Rex V. Carroll, Mr. Justice Parke, after citing the case of Rex v. Grindley, decided by Mr. J ustice Holroyd, remarked that ' highly as I respect that late excellent judge, I differ from him, and my brother Littledale agrees with me. He once acted upon that case, but afterwards retracted his opinion, and there is no doubt that case is not law. I think that there would be no safety for human life if it were to be considered as law.' (7 Car. and Payne, 145 ; 32 Eng. Com. Law, 471 ; Lewis's Crim. Law, 602, note.) " Mr. Justice Story, in the United States v. Drew, took a distinction on the effect of intoxication which, on account of its humanity, has received general commendation. That learned judge held that in- 816 DECISIONS IN THE UNITED STATES. sanity, of which the remote cause is habitual drunkenness, is an excuse for an act done by the party while so insane, but not at the time under the influence of liquor. The crime (to be punishable) must take place during a fit of intoxication, and be the immediate result of it, and not a remote consequence superinduced by the antecedent drunkenness of the party. In cases therefore of delirium tremens or mania a potu, the insanity excuses the act, if the party he not intoxi- cated when it is committed. (5 Mason, 28 ; Am. Jurist, vol. 3, p. 5 to 30 ; Burnet v. The State, Martin & Yerger, 138 ; Comwell v. The State, ib. 147 ; Lewis's Criminal Law, 602, note.) " In Virginia, where there is a statute dividing murder into de- grees, like that of Pennsylvania, it is believed that a similar view of the law prevails. {Com. v. Jones, 1 Leigh, 612.) " In Tennessee, Mr. Justice Reese, in 1843, in delivering the opin- ion of the Supreme Court upon a similar statute, has explained the law on this interesting question in language so clear and for- cible as neither to be misunderstood or refuted. In the case of Swan V. The State, 4 Humphreys, 136, the judge makes the follow- ing remarks : — " The characteristic quality of murder of the first degree, and that which distinguishes it from murder in the second degree or any other homicide, is the existence at the time of the death of the as- saulted, of a settled purpose and a fixed deliberate design on the part of the assailant that his assault should produce death. The length of time which the assailant deliberates on his intention is not material. Drunkenness is no excuse for or justification of crime. But although drunkenness in point of law constitutes no excuse or justification for crime, still, when the nature and essence of a crime is made by law to depend upon the peculiar state and condition of the criminal's mind at the time, and with reference to the act done, drunkenness as a matter of fact affecting such state and condition of the mind, is a proper subject for consideration and inquiry by the jury. The question in such a case is, what is the mental status f Is it one of self-possession, favorable to the forma- tion of a fixed purpose by deliberation or premeditation ? or did the act spring from existing passion, excited by inadequate provocation, acting it may be on a peculiar temperament, or upon one already excited by ardent spirits ? In such case it matters not that the provocation was inadequate, or the spirits voluntarily drank. The question is, did the act proceed from sudden passion, or from delib- eration and premeditation ? To regard the fact of intoxication as meriting consideration in such a case, is not to be held that drunk- enness will excuse crime, but to inquire whether the very crime which the law defines and punishes has in fact been committed. If the mental state required by law to constitute the crime be one of deliberation and premeditation, and drunkenness or other cause excludes the existence of such mental state, then the crime is not excused by drunkenness, or such other cause, but has not in fact been committed." Of course it is not to be understood from the foregoing article SOMNAMBULISM. 817 that drunkenness is any defence to the factum, of guilt. It is only with reference to the question of intent, and with the view to reduce the degree of guilt from murder in the first degree, which in most of the States is punishable with death, to murder of the second degree or to manslaughter, the punishment of which is only im- prisonment more or less extended, that evidence of intoxication is receivable. Commonv)ealth v. Kilpatrick, 7 Casey, 203 ; Com. v. Miller, 17 Legal Intel. 276 (Ludlow, J.). I^or will it be sufficient even for this purpose, unless the intoxi- cation be so great as to render the prisoner unable to form a wilful, deliberate, and premeditated design to kill, or incapable of judging of his acts and their legitimate consequences. {Keenan v. Common- wealth, 8 Wright 65 ; Com. v. Miller, lb. v. Kilpatrick, supra). — P.] Somnambulism. — This term applies to sleep-walking ; but the medico-legal facts are chiefly confined to acts of violence perpetrated unconsciously during the state of sleep, in which it is presumed that malice and intention, the chief ingredients of crime, are want- ing. It has been a contested question among medical jurists, how far a person should be held responsible for a criminal act perpetrated in that half-conscious state which exists when he is suddenly roused from sleep. There is no doubt that the mind is at this time subject to hallucinations and illusions, which may be more active and per- sistent in some persons than in others ; but it is difficult to suppose, unless we imagine there is a sudden access of insanity, that a person should not recover from the delusion before he could perpetrate an act like murder. A remarkable case of this descrijatiou, that of Bernard Schedmaizig, will be found reported by Marc. (Op. cit. vol 1, p. 56.) This man suddenly awoke at midnight, and saw, as he believed, a frightful phantom. He twice called out, " Who is that?" and receiving no answer, and imagining that the phantom was advancing upon him, he seized a hatchet which was beside him,, attacked the supposed spectre, and it was found that he had mur- dered his wife. He was charged with the murder, but pronounced " not guilty" on the ground that he was not at the time conscious- of his actions. A trial involving this question occurred in England. A peddler in the habit of walking about the country armed with a sword-stick, while lying asleep on the high road, was roused by a man accidentally passing, who seized and shook him by theshoulders. The peddler suddenly awoke, drew his sword and stabbed the man, who soon afterwards died. The peddler was tried for manslaughter. His irresponsibility was strongly urged by his counsel, on the ground that he could not have been conscious of an act thus perpetrated while in a half-waking state ; and this defence was supported by the opinion of a medical witness. The prisoner was, however, found guilty. Under such circumstances, it was not unlikely that an idea had arisen in the prisoner's mind that he had been attacked by robbers and therefore had stabbed the man in self-defence. {Bex V. Milligan, Lincoln Autumn Assizes, 1836.) In Beg. v. Byron (Winchester Winter Assizes, 1863), it was proved that a blow 52 818 RESPONSIBILITY OF THE DEAF AND DUMB. struck by a drunken person during sleep had caused death. The man was charged with manslaughter under the following circum- stances: The prisoner and deceased were soldiers in the same regi- ment, at Aldershot. The prisoner was in the street drunk, and deceased seeing this, took him in to prevent his being arrested for drunkenness, and placed him on his bed. In this state he lay for some time quite drunk and insensible. In the course of the after- noon, deceased went up stairs to see him ; he tried to awaken him, when the prisoner suddenly kicked out, and his boot came violently against the lower part of the abdomen of deceased. The prisoner did not awake, but appeared then to be quite insensible. The de- ceased died, and it was found that the blow had caused rupture of the intestines. As in order to constitute the crime of manslaughter, it must be shown that the person charged did something knowingly, and the prisoner was not in a state to have known anything, it was held that there was no case against him, and he was acquitted. The act was committed during sleep, but the sleep appears to have been the sleep of drunkenness. Somnambulism may become a subject of discussion under a con- tested policy of life-insurance, in which it may be provided that it shall be vitiated by suicide. If a man falls from a height and is killed while in a state of somnambulism, would this be considered an act of suicide within the meaning of the policy? The proviso against suicide has been held to include only intentional killing (case of Borradailev. Hunter^ "Med. Gaz.,"vol. 36, p. 826), and in death under these circumstances the killing cannot be said to be inten- tional ; it can only be regarded as an accident — therefore it is rea- sonable to infer that the policy would not be void. It is impossible, however, to lay down any general rules relative to cases of this description ; since the circumstances attending each case will suffi- ciently explain how far the act of murder or suicide had been committed during a state of somnambulism, or under an illusion continuing from a state of sleep. THE DEAF AND DUMB. It was formerly laid down in the old law-books, that a person born deaf and dumb was by presumption of law an idiot, but in modern practice, want of speech and hearing does not imply want of capacity either in the understanding or memory, but only a difficulty in the means of communicating knowledge ; and when it can be shown that such a person has understanding, which many in this condition reveal by signs, he may be tried and suffer judgment and execution. (Archbold.) A deaf and dumb person is not incompetent to give evidence, unless he is also blind ; he may be examined through the medium of a sworn interpreter who understands his signs. This condition does not justify restraint or interdiction, unless there is at the same time mental deficiency. A deaf and dumb person who has never been instructed, is'altogether irresponsible for any action, civil or criminal. Such a person cannot even be called on to plead to a FEIGNED DEAFNESS AND DUMBNESS. 819 charge, when there is reason to suppose that he cannot understand the nature of the proceedings. A deaf and dumb woman wascharged with cutting off the head of her child. By signs she pleaded "not guilty," but she could not be made to understand the nature of the other proceedings against her. Upon this she was discharged, and subsequently confined as a criminal lunatic. In Reg. v. Goodman (Staftbrd Summer Assizes, 1841), a deaf and dumb man was con- victed of theft and sentenced to imprisonment. He was made to comprehend the proceedings by signs and talking with the fingers. In Reg. v. Brook (Buckingham Summer Assizes, 1842), the prisoner could read and write well. He was charged with feloniously cutting and stabbing. The proceedings were reported to him in writing. He was convicted, and the judge(Alderson, B.) having sentenced him to a year's imprisonment, handed down his judgment in writing, which he recommended him to read and ponder over in prison! In Reg. v. Jackson (Bedford Summer Assizes, 1844), Alderson, B., held that before the evidence of a dumb witness can be received, the court must be satisfied that he understands the obligation of an oath. It has been decided in the ecclesiastical courts that the consent of a deaf and dumb person given by signs, renders a matrimonial con- tract valid, provided the person has a full and proper understanding of their meaning. An incompetency to enter into contracts or un- soundness of mind, must not be inferred to exist merely in conse- quence of a person being deaf and dumb. In the case of Harrod V. Harrod, (Vice-Chancellor's Court, June, 1854), an attempt was made to deprive the plaintifi' of his rights on the ground that he was an illegitimate child. The marriage of his parents took place thirty years previously, but the marriage was said to be void by reason of the alleged incapacity of his mother to enter into the con- tract ; the mother was deaf and dumb, and of more than ordinarily dull intellect. Sir "W. P. "Wood said there was an important difler- ence between " unsoundness of mind" and " dulness of intellect." The presumption in such cases was always in favor of sanity, and the fact of a person being deaf and dumb did not raise a presump- tion the other way. Experience in asylums showed, that the deaf and dumb were not necessarily of unsound mind. The woman had_ assented to the marriage in form and substance, and with a perfect knowledge of what she was doing. In the ceremony of marriage it had never been held that the repetition of the words was necessary. The woman conducted herself with great propriety before and after the marriage, and a child was born in due course. There was no ground for an issue. Feigned deafness and dumbness. — From these statements it will be perceived that medical evidence is of but little importance in rela- tion to the deaf and dumb. Indeed, there arc only two cases in which this kind of evidence is likely to be called for — 1st, when there is accompanying mental deficiency, in which case the general rules elsewhere given are applicable ; and 2dly, when there is a 820 FEIGNED DEAFNESS AND DUMBNESS. suspicion that the deafness and dumbness are feigned. There will be no great difficulty in detecting an imposition of this kind. It may be found that the alleged deafness and dumbness did not come on until a motive existed, and that there was no apparent cause but the very suspicious one of evading responsibility for some of- fence committed. The use of ether or chlorofoi'm-vapor may be occasionally resorted to with advantage for the detection of such an imposition. In one instance, a strong shock of the induced cur- rent from a large magneto-electrical apparatus, by means of moist- ened conductors applied over the larynx, brought out after a few minutes the power of speech in a lad who had successfully imposed on many persons. ("Med. Times and G-az.," March 30, 1861, p. 339.) It requires great skill to maintain an imposture of this kind. Such persons are immediately thrown off" their guard by addressing them in a voice a little above, or a little below the common conver- sational tone ; a change in the eye or the features will at once indi- cate that they hear and understand what is said. An ignorant impostor may be dealt with on the principle of " artis est celare artem" by seriously proposing in a low voice to a medical friend who may be present, the necessity for the performance of some formidable surgical operation. The production of amputating instruments has been known to have a wonderful effect ! In Beg. v. Yaquierdo (Herts Summer Assizes, 1854) the prisoner, who was charged with wilful murder, was found by the jury to be wilfully mute. The man refused to plead, although it was obvious that he was well aware of the nature of the proceedings, itfo counsel could be assigned to him, as this could not be done without the prisoner's consent. He was convicted and sentenced. Dr. Wilson mentions the case of an impostor who had succeeded in convincing all around him that he was completely deaf. His medical attendant prescribed for him daily extra wine and other articles of diet, but in reality he ordered that none of them were to be supplied. The consequence was that while the patient was nominally living on the fat of the land, he was actually suffering from hunger. At. last the surgeon remarked aloud that he could not understand why the patient seemed to be losing flesh with such a diet. This proved too much, and the pretended deaf man, in an 'unguarded moment, indignantly exclaimed to the nurse, "You know I have never had any of those good things." (" Lancet," 1872, 1, p. 93.) On one occasion, a pauper feigning deafness and dumbness, was detected by the production of a case of surgical instruments during a consultation between two surgeons as to the performance of an operation upon him at once. If the impostor can write, he may perhaps be detected by the ingenious plan adopted by the Abb^ Sicard. When the deaf and dumb are taught to write they are taught by the eye. The letters are only known to them by their form, and their value in any word can be understood only by their relative position with respect to each other. A half-educated impostor will spell his words, or di- FEIGNED DEAFNESS AND DUMBNESS. 821 vide them incorrectly: and the errors in spelling will always have reference to sound — thereby indicating that his knowledge has been acquired through the ear, and not alone through the eye. A man who had defied all other means of detection wrote down several sentences, in which the misspelling was obviously due to errors produced by the sound of the words, thereby showing that he must have heard them pronounced. The Abbd concluded that the man was an impostor without seeing him, and he subsequently confessed the imposition. 822 PRINCIPLES OF LIFE INSURANCE. LIFE INSURANCE. CHAPTER LXYII. PRINCIPLES OF LIFE INSURANCE. — QUESTIONS TO PERSONS WHO INSURE THEIR LIVES. — MEDICAL QUESTIONS. — WHAT DISEASES HAVE AND WHAT DISEASES HAVE NOT A TENDENCY TO SHORTEN LIFE? — LEGAL DECISIONS RESPECTING THE MEANING OF THESE WORDS. — CONCEALMENT OF DISEASES. — WHAT IS MATERIAL CONCEALMENT? — CONCEALMENT OF HABITS. — WHAT IS INTEMPERANCE? — PROXIMATE AND REMOTE EF- FECTS. — DELIRIUM TREMENS. — EPILEPSY. — PHTHISIS. — -ABSTINENCE. — VEGETARIANISM. — OPIUM-EATING. — INVETERATE SMOKING. — INSAN- ITY. — -VOIDANCB OF POLICIES BY SUICIDE. — SECRET POISONING OF PER- SONS WHOSE LIVES ARE INSURED. The subject of Life Insurance in a medico-legal view is almost peculiar to the medical jurisprudence of Great Britain. This arises from the extent to which insurances on lives are effected in this country, and from the peculiar nature of the provisions which regu- late contracts of this description. The insurance of a life is a contract whereby the insurer, in con- sideration of a certain sum of money, called a premium, either in a gross sum or in periodical payments — proportioned to the age, sex, profession, health, and other circumstances of the person whose life is insured — ^undertakes to pay to the person for whose benefit the in- surance is made, a stipulated sum or an equivalent annuity, upon the death of the individual whose life is insured, whenever this event shall happen, if the insurance be for the whole life ; or, in case this shall happen within a certain period, if the insurance be for a limited time. The deed by which this contract is made is called a policy, and it is concerning the stipulations of the policy, and the meaning to be put upon certain medical terms used in it, that litigation commonly arises. The amount of premium payable will be regulated by the mean expectation or duration of life of the individual ; and this it is well known is not only different at different ages, but is greater at certain periods of life in women than in men. One fact, however, is certain, — the most successful Insurance Offices have considerably underrated the probability of expectation of life among adults, and thus have derived enormous profits by demanding higher premiums on the insured than a fair view of the rate of mortality would jus- PRESUMPTION OF DEATH. 823 tify. The calculations of some of the older offices were based on what is called the IsTorthampton Table, which represents in an ex- aggerated degree the mortality not only of the class of persons who commonly effect insurances, but of the entire population. This table has been thus improperly applied to determine the mortality of men in the middle classes, holding the most durable tenure of life. Besides this, as Mr. Edmunds has shown, some of the offices have entirely excluded from insurance the sick class, out of which the greater part of the mortality indicated in the table necessarily takes place. By excluding the sick, and requiring strong medical certificates respecting the condition of healthy applicants, it follows that the mortality among the insured falls immeasurably short of that which is indicated by the ordinary Tables of Mortality, from which the amount of premium is reallj'^ calculated. The sum for which a person's life has been insured cannot be re- covered until after the death of the person, and distinct proof of death. Those who would benefit by the death must prove the fact of death, when this is open to doubt. A case is reported in which a claim was made on an insurance company for the amount of a policy on the life of a man who suddenly disappeared, while at Brighton, within a week after the insurance of his life had been effected. The man's clothes were found on the beach, and the jury were asked to infer from this fact that the man was drowned, and that his body had been carried out to sea. E^o one had seen him go into the water. The jury were discharged without a verdict. It was quite possible that the clothes had been designedly placed there, and that the man had gone off in another direction, and was still living. [A case is mentioned in Angell on " Fire and Life Insurance," p. 379, note 4, where the defence of want of proof of death was set up, but not successfully. In the winter of 1848, Rev. Thomas Waring very mysteriously disappeared near Elizabethtown, Hardin Co., Kentucky, and was then, and still believed by his relatives and friends to have been murdered. Some years before his death he had eftected an insurance on his life, in favor of his wife, in the Nautilus Mutual Life Insurance Co. of ISTew York, for $5000. In January, 1853, suit was instituted in Jefferson Circuit Court by Mrs. Waring, for the recovery of the sum named. One of the points relied upon by the defence was that he was, not dead, but had absconded. The whole case turned upon this. The case was submitted to the jury upon the evidence, and a. verdict rendered for plaintiff" for the amount of the policy with interest. The law applicable to such cases is thus stated by Mr. Angell ("Fire and Life Insurance," § 351): "In order to render the in- surers upon a life liable, the event of death may (must) happen within the time prescribed by the policy, and as a doubt may exist whether the person upon whose death the liability depends is dead, a question of fact may be raised to be determined by the jury. All the authorities concur in stating the rule of the common law to be that the presumption of life with respect to persons of whom no 824 PRESUMPTIOIT OP DEATH. account can be given, ends at the expiration of seven years from the time they were last known to be living ; and that, after such a period of time, the burden of proof is devolved on the party insur- ing the life of the individual iu question. The issue in such case being an issue of fact, the jury are at liberty to find the fact of death within the period of seven years, upon the circumstances proved in the case. The circumstances which have been stated to be material to this issue, are the age of the party, his situation, habits, employment, state of health, physical constitution, the place or climate of the country, whether he went by sea or land, the facilities of communication between that country and his former home, his habit of correspondence with his relatives, the terms of intercourse upon which he lived with them, in short, any circumstances tending to aid the jury in finding the fact of life or death — -all these circumstances have been stated by Prof. Greenleaf as material. There must also be evidence, that learned author pro- ceeds to say, of diligent inquiry at the place of the person's last residence in this country, and among his relatives, and any others who would have probably heard from him, if living ; and also at the place of his fixed foreign i-esidence, if he was known to have any. In Loring v. Steinman, 1 Met. (Mass.) R. 204, Shaw, C. J., in giving the judgment of the court, says : " It is a well settled rule, that upon a person's leaving his usual home and place of resi- dence for temporary purposes of business or pleasure, and not being heard of, or known to be living, for the term of seven years, the presumption of life then ceases, and that of his death arises. The presumption is greatly strengthened when the departure of an indi- vidual was from his native place, the seat of his ancestors, and the home of his brothers and sisters, and family connections ; and still further when it was to enter upon the perilous employment of a seafaring life." Upon this subject, see also Best on Presump., 59-61 ; Whiteside's Ap., 11 Harris 114 ; Campbell v. Head, 12 lb. 498 ; Holmes v. John- son, 6 Wright 159 ; Windship v. Conner, 42 B". H. 341. When the person whose life is in question has gone to sea, the presumption of death may arise much sooner than seven years. Thus in Patterson v. Black, Park on Ins. 433-34 (2 Am. Ed.) the question was whether the assured died before the 30th January, 1778. It appeared that about the 20th November, 1777, he sailed from the Cape of Good Hope, in the sloop of war Swallow, which ship, not being afterwards heard of, was supposed to have been lost in a storm off the Western Islands. The plaintiflF proved the de- parture, and also called several captains who sailed at the same time who swore that the vessel must have been as forward in her course as they were on the 13th or 14th of January, the period of a most violent storm, in which she was probably lost ; and that the Swallow was much smaller than their vessels, which with difficulty weathered the storm. Lord Mansfield, who tried the cause, left it to the jury to say whether, under all the circumstances, they thought the evi- dence sufficient to convince them that the assured died before the SURVIVORSHIP. 825 time limited ; adding, that if tKey thought it so doubtful as not to be able to form an opinion, the defendants should have their ver- dict. They found for the plaintiiF. The rule is stated to be that where a vessel is missing and no in- telligence of her has been received within a reasonable time after she sailed, it is presumed that she foundered at sea. Thus, where a ship was insured in 1739, from ]S"orth Carolina to London, an action was brought against the underwriters. The only evidence was that she had sailed on her intended voyage, and had never since been heard from. The defendant objected that as captures and seizures were excepted by the policy, it lay in the assured to prove a loss by sink- ing, etc. The Chief Justice (Lee), however, said that it would be unreasonable to expect evidence of that, for as everybody on board was presumed to be drowned, the plaintiff had given the best proof the nature of the case admitted of. The case being left to the jury, they found for the plaintiff. G-reen v. Brown, 2 Strange 1199. In order to raise this presumption, however, it must be distinctly shown that the ship left the port bound on her intended voyage ; and although her not being heard of for many months or years, raises a presumption of her crew having perished, it affords none as to the precise time of the death of any person on board. This must be collected bv the jury from the circumstances of the case. Watson V. King, 1 Stark. R. 121 ; Sillick v. Booth, 1 Y. & C. N. C. 117 ; Best on Presump. 145-6. Where two or more persons perish by the same calamity, the question sometimes arises, when the circumstances of their deaths are unknown, which one is to be presumed to be survivor. By the Roman law, if it were the case of father and son, where the latter was under the age of puberty, he was presumed to have died first; but if above that age, the presumption was the other way. By the French code, if the persons perishing are under the age of fifteen, the eldest is presumed to have survived ; if above the age of sixty, the youngest. If between those ages and of different sexes, the male is presumed to have survived ; if of the same sex the presumption is in favor of the younger. (Grreenleaf 's Ev. vol. 1, § 29.) But in the common law, no rule on the subject has been laid down ; and the better opinion is that the presumption is that all perished together. lb. § 30. However, in the case of Moehling v. Mitchell, 1 Barb. Ch. (N. Y.) 264, where a married woman procured an in- surance on the life of her husband, for her own use, the money to be paid to her, unless she died before him, and in that case to her child, pursuant to the act of 1840 (2 E,. S. 3 ed. 207, §§ 60, 61), and sailed with her husband and child in a ship which was never heard of again ; held, there being no presumption that the child survived her, or that she survived her husband, that the case did not fall within the act, and that the insurance money was part of the per- sonal estate of the husband. " If any circumstances of the death of either party can be proved, there can be no inconvenience in submitting the question to a jury, to whose province it properly belongs." 1 Greenl. Bv. § 30. Thus 826 EXPECTATION OF LIFE. in the case cited by Blackstone, from Gro. Bliz. 503 (2 Black. Com. 132), upon the question of what constituted a sufficient seisin on the part of the husltand to entitle the wife to dower, where a father and son were both hanged in one cart, but the son was supposed to have survived the father by appearing to struggle longest ; the jury found that he was the survivor, whereby he became seized of an estate in fee by survivorship, in consequence of which seisin his widow had a verdict for her dower. See also upon this subject, Best on Presump. 190-202.— P.] Different rules have been given by actuaries for calculating the expectation or duration of life at different ages. It is difficult to test their accuracy, except in reference to large numbers of persons liv- ing under similar circumstances, and for these groups of the popu- lation statistics do not fairly provide. Age is the point from which nearly all the Tables of Mortality start, without reference to health, trade, occupation, or social position. One of the most simple of these rules for calculating the duration of life from 6 to 60 years has been given by Willich ; he considers it to be equal to two-thirds of the difference between the age and 80. Thus, in a man 20 years of age the difference is equal to 60, and two-thirds of this are equal to 40, the probable duration of life for a person of average health at 20. Each office has its own rules for calculating the amount of premium to be paid by the person who effects an insurance. As insurance offices are very numerous and their profits are large, it is obvious that their calculations must be very much in their own favor. The expectation of life in the insured is ordinarily much greater than they assign to it ; at the same time, the amount payable in the form of premium is kept down by competition. With respect to the influence of profession, a higher premium is demanded by some offices for the insurance of the lives of persons whose occupations expose them to great risk — as, for instance, of persons actually engaged in military or naval service. The rule adopted with respect to professions in one of the best London offices is as follows: "No extra premium is required from any person in the army or navy unless on actual service, but the assurance will be void if the party whose life is assured enter into any naval or military service whatever, unless by consent of the Directors, en- dorsed on the policy." Above all other conditions, the general state of health of the person is likely to have a most important influence on the mean duration of life ; and it is here that medical science lends its aid — Ist, by showing how far a contract may be safely entered into when the person is affected with disease ; and, 2dly, by showing whether a diseased state of the body really existed in the person insured, although at the time of insurance it may have been alleged that he was healthy, and free from disease. By improved methods of diagnosis, the existence of disease under a proper examination is easily made known, or it may be at once inferred from symptoms described by non-professional persons. Then, again, the influence of particular diseases in shortening life QUESTIONS CONNECTED WITH LIFE INSURANCE. 827 are now so much better understood than formerly, that the numer- ous offices have of late years been especially established for the in- surance of diseased, as well as of healthy lives, the amount of pre- mium being of course regulated by the nature of the disease, and the degree to which it may have advanced. In these cases, lives are insured as if the persons had reached a greater age, the amount paid being calculated on the theory that the person is ten, fifteen, or twenty years older than he is. As in the case of all civil contracts, the law requires that there should be a strict compliance with the conditions by each party, it follow that, if any fraud has been committed by the insured — if he, or those to whom he trusted in his dealings with the office, have concealed from the insurers the existence of any disease under which he was at the time laboring, or any symptoms indicative of a pro- bable attack of disease ; or if he or they have knowingly and wil- fully misrepresented or misdescribed his actual bodily condition, then the contract will be void, and the amount of the premiums forfeited. This forfeiture is a usual condition in the policy. Ac- tions on policies of life insurance are not unfrequent; and, unfortu- nately, the medical evidence given on these occasions, as in cases of insanity, is of a very conflicting character. This is by no means creditable to the profession, for it either proves the existence of great bias in the witnesses, or that medical rules are devoid of all certainty, and are therefore practically useless. A writer, in com- menting upon these professional conflicts, says: "One of the most unsatisiPactory parts of our law of evidence is that which relates to the testimony of experts. It is impossible to shut out such evi- dence altogether, but there is nothing which brings more discredit upon the administration of justice. There is one consequence of its admission which is common to all cases in which it occurs. It is, that no difficulty has ever been found in obtaining any amount of evidence of this description on either side of any point at issue." It will be, therefore, necessary to enter into an examination of the circumstances under which medical men are called upon to appear. An action is never likely to be brought for the recovery of the amount of a policy, except in those cases where there is reason to suspect that a wilful fraud has existed in the contract. Juries always regard such actions with disfavor; and while judges inter- pret the law strictly, the onus of proof is entirely thrown upon the offices. Hence the insured are placed in a very advantageous posi- tion. These actions, in nine cases out of ten, depend upon the con- struction put on the medical terms of the contract ; hence, it is our duty to see how medical defects are likely to arise in reference to the policy. The conditions of insurance vary in different offices. The following are taken from the papers isstied by one of the prin- cipal London offices : — Questions. — The name, residence, and profession of the party whose life is to be assured ? Place of birth ? Date of birth? The — daj^ of — . Age next birth day — years'? {Proof should he fur- nished.) Married or single? Sum to be assured, £ — . Term for 828 QUESTIONS PROPOSED TO THE MEDICAL ATTENDANT. which the assurance is required? Have you ever been afflicted with gout, rupture, asthma, fit or fits, spitting of blood, or any other disease or disorder which tends to shorten life? Have you had the smallpox, or been vaccinated? Have any of your relatives died of consumption ? Are you now, and have you always been, of temperate habits of life? Are you employed in any naval or military service? State if there be any other material circumstance touching your past or present state of health or habits of life to which the foregoing questions do not extend? Name and resi- dence of your usual medical attendant? Has attended me — years. Name, residence, and profession of two friends well acquainted with your health and habits of living? Has known me — years. Has known me — years. Has a proposal ever been made on your life at any other office or offices? If so, where ? Was it accepted at the ordinary premium ? or at au increased premium ? or declined ? I, the above named , do hereby declare that the foregoing statements, and the answers and replies made by me to the several above-men- tioned questions and requisitions, and each and every of them, is and are true in substance and matter of fact. And that I have not omit- ted or concealed any fact, matter, or thing in anywise touching or aftecting my state of health, constitution, or habits of life. And I also declare, that it is expressly understood and agreed between myself and the Company, that the foregoing particulars, statements, and this declaration are to be considered and taken as the basis of the contract of assurance between me and the Company, for this assurance. And in case the foregoing particulars, statements, and declaration be untrue, or contain any untrue averment, the policy of assurance effected in pursuance thereof shall, in any or either of such cases, be absolutely null and void, and the premiums paid thereon shall become and be absolutely forfeited to the Company, and not be receivable or recoverable by rae or by my representa- tives. Dated the — day of — , 186-. Signature of the person. [Statements in an application for life insurance, "upon the faith of which the policy is expressed to be made, with a stipulation that, if they shall be found in any respect untrue, the policy shall be void," are warranties, and if untrue, even in a point immaterial to the risk, avoid the policy. Miles v. Connecticut Mutual Co., 3 Gray (Mass.) 580 ; Cazenove v. Bis. Co., 6 C. B. (N. S.) 437.— P.] The following questions are submitted to the usual medical atten- dant of the person whose life is proposed for insurance : 1. How long have you known him ? 2. Are you his usual medical atten- dant? and have you seen him with reference to this report? 3. "When was he last ill ? and what have been the nature and duration of the complaints for which you have attended him ? 4. Has he to your knowledge, or have you reason to believe that he has had, any giddiness, or affection of the head, or any particular determi- nation of blood to the head; or has he suffered from apoplexy, palsy, epileptic or other fits, or other disease of the brain, or from insanity? 5. Has he ever suffered from pulmonary disease? from habitual cough, shortness of breath, spitting of blood, asthma, in- REFEREES. 829 flanimation, or other disease of the lungs, or from disease of the heart? 6. Has he ever had dropsy, inflammation, or severe disease of the bowels, disease of the liver, of the kidneys, or other urinary organs, or any aftection of the alimentary canal ? 7. Has he had gout or rheumatism? If so, in what form? and have the attacks been frequent? 8. Has he ever been affected with hernia? If so, in what situation? Is it reducible? And does he wear a truss? 9. Has he had any serious wound, hurt, or other accident, causing any bodily infirmity? 10. Do you consider he is now in perfect health ? 11. Has he been, and is he now, habitually sober and temperate ? 12. Is he of active or sedentary habits ? 13. Does his occupation expose him to the chances of disease? 14. Have his parents been healthy and long-lived, or otherwise? 15. Have any of his near relatives died of consumption or any hereditary disease ? 16. State any material circumstance touching his health or habits, to which the foregoing questions do not extend, which may affect the eli- gibility for life assurance? Dated this — day of — , 186-. Signed In oi-der to show the searching nature of these inquiries, and how one set of answers is made to act as a check upon another, it is only necessary to refer to the following list of queries which are put to private individuals acquainted with the person. This paper is to be filled up and transmitted with a proposal for life-insurance: — State whether you have been acquainted with the person whose life is proposed to be insured, and how long. Whether you have ever heard or known of his being ill, and, if so, state the time of the illness and nature of the complaint. Whether he is at this time to the best of your knowledge and belief, in perfect health. Whether his habits and manner of living are temperate and regular. (You will be pleased to direct your particular attention to this subject of inquiry.) Whether his appearance indicates health and a good con- stitution. Whether there is any, and what, apparent defect in the formation of his person. When you last saw him. Whether he is in person thin or middle-sized, stout or bloated. Whether his com- plexion is pale, sallow, brown or florid. Whether he is married or single. Whether he has had any brothers or sisters. If so, how many; the number now living; the ages at which the others have died, and the cause of their decease. Ascertain and state whether his parents are living, and if not, the age at which they have died, and the causes of their death ; communicate all the information you can acquire as to the health and longevity of his other relatives ; also whether any of them have died of consumption, or have been subject to fits or mental derangement. Whether the persons referred to, respecting the life to be insured, are worthy of credit ; and whether the medical referee is the usual medical attendant of the party. Whether you consider the life in question in all respects safe and proper to be insured by the company upon ordinary terms, and whether you recommend the same to the Directors as such. Ascer- tain if the life has been proposed in any other office, and if so, whether declined or taken. If the insurance is proposed by one 830 MEDICAL BEFEKEES. party on the life of another, endeavor to learn and state' the object for which it is intended. ^o one can blame insurance offices for acting thus rigorously. Frauds of the worst description have been frequently attempted upon them, and it is only by the adoption of a system of this kind that they can protect themselves. The chapter on life-insurance in the first edition of this work has been translated by M. Tardieu with numerous editions. ("Ann. d'Hyg." 1866, 1, 383, and 2, pp. 120 and 382.) Among them he gives copies of the questions to which answers are required by many French, German, and Spanish offices. They do not materially differ from those above given, but the more recent offices have evi- dently profited in this respect by the experience of the older insti- tutions in Great Britain. Dr. Gmelin, of Stuttgart, has collected the formularies of questions put by fifteen different offices, chiefiy German, to the medical attendant of the intending insurer. He finds that they vary from a minimum of ten to a maximum of thirty-two questions. He divides them into superfluous, indiscreet, irrelevant, and misleading. (Eulenberg, "Vierteljahrs." 1872, 1, 271.) From the minuteness of some of these inquiries it appears that a much more difficult duty is thrown upon German than upon English medical practitioners. According to M. Tardieu, some French companies act upon a much more reasonable plan, and leave the medical attendant perfectly free to draw up a certificate according to his own views. ("Ann. d'Hyg." loc. cit.) ITie relations of medical men with insurance offices — Medical re- sponsibility. — The practice with some offices in obtaining a certificate gratuitously from the medical attendant of the person proposing to insure his life is one great source of litigation. The responsibility of causing the life to be accepted or rejected is thus thrown entirely upon the usual medical attendant of the person ; for, as we shall see hereafter, an application for a certificate from a medical practitioner who is a stranger, is very likely to be treated as a fraud, and to lead to the disputing of the policy. The medical attendant of the person, it is true, is the only individual who can properly certify to the real state of health, and therefore to him an application is generally made. He is sometimes expected to furnish an important certificate of this kind gratuitously ; and should it happen to be unfavorable, he is exposed to the risk of losing what may probably be a lucrative portion of his practice : for I shall not suppose that any member of the profession would certify to what he knew to be untrue, in order to retain a patient. The question is, whether an insurance office has a right to place a medical man in such a responsible position as this. In the issuing of a policy, the insurers and insured are equally benefited, for the contract would certainly not be made except upon a supposition of reciprocal benefit. The medical attendant, without whose sanction the policy could not be properly effected, not only derives no benefit, but is actually exposed to the risk of loss for performing in an honorable and conscientious manner an invidious duty thus forced upon himi Such a state of things ought not to be. MEDICAL EEFEREES. 831 Many actions for the recovery of disputed policies have shown most clearly that the practice leads to great carelessness and indifference on the part of medical men in drawing up these certificates ; and this produces, in the end, a more serious loss to the representatives of the insured, than if the life had not been accepted. It must be remembered that the insurers do not suffer by any misconduct on the part of a medical man who signs such a certificate, but the repre- sentatives of the insured ; hence, the offices show no disposition to amend this vicious system. It is always professed that such com- munications are confidential ; but in more than one instance medical men have found that the contents of their certificates have become known to their patients, and have even been publicly used as evi- dence in courts of law. A partial remedy would be, that the medical attendant of the party should not be called upon to sign a certificate at all, but that this should be done only by a medical referee of the office, after a regular professional consultation with the medical attendant, and a proper examination of the person. If the life were rejected, the onus of rejection would be on the proper person — the appointed referee ; and if accepted, he would be properly made responsible to the office for any gross negligence in the performance of his duties. It is true that there are few insurance offices which have not consulting physicians and surgeons attached to them ; but the weight of responsibility in contested suits does not rest with these officers so much as with the medical attendants of the insured. In the event of a medical practitioner being called upon to sign a certificate of this kind, it appears to me that the safe plan to be adopted would be that he should decline the proposal, except upon a professional consultation with the medical officers appointed by the insurers. If, however, from private considerations, he is com- pelled to sign the certificate, it is his duty to use the greatest caution, not merely in returning answers to the formal questions on the paper, but in detailing all particulars knoxon to him respecting the state of health of the person. In acting otherwise, he would be doing the greatest possible injury to the representatives of the insured, and probably damage his own reputation. There is no intermediate course ; the duty must either be performed carefully, conscientiously, and hono- rably, or it must be declined altogether. [The practice of sending blank certificates to be filled up by the regular medical attendant of the applicant, gratuitously, has become as great a nuisance in the United States as in Great Britain. We are clearly of the opin- ion that it is not the physician's duty to comply with such requests ; it is optional with him to do it, or not. In the first place, the company has no right to the service without an adequate compen- sation ; and secondly, there may be cases in which the family phy- sician would have serious doubts as to the propriety of divulging professional secrets connected with his patient's former health, e. g., in the case of syphilis; or of certain habits, as of occasional drunk- enness or opium eating. Of course, all such points must be known to the applicant himself, and on him alone must devolve the risk of any concealment. — K.] » 832 DISEASES TENDING TO SHORTEN LIFE. Diseases tending to shorten life. — Let us take the case, however, that this preliminary duty has been properly performed ; important medical questions may arise respecting the alleged infringement of the conditions of the policy. The list of diseases specified com- prises a great variety — affections of the head, apoplexy, palsy, epi- leptic or other fits, disease of the brain, insanity, disease of the lungs, spitting of blood, asthma, inflammation, disease of the heart, dropsy, diseases of the bowels, liver, kidneys, or urinary organs, gout, rheumatism, hernia, phthisis, or any hereditary disease. In the proposals of some offices, the mysterious word ." fits " occupies a very prominent position, but it is difficult to say what this word thus isolated actually means. It -appears to have been borrowed from the vocabulary of the ancient searchers under the bills of mortality in the reign of Charles II. Thus it may comprise, apoplexy, epi- lepsy, paralysis, syncope, convulsions from any cause, and even asphyxia. The word is too indefinite for a certificate, and should be expunged. In the mean time, a court of law will not allow in- surers to benefit by the use of ambiguous terms in the contract, and it has therefore commonly restricted the meaning of the word "fits," to attacks of epilepsy. The main condition, however, is in- volved in the terms — " any other disease or disorder tending to shorten life." Upon the meaning of these words litigation commonly turns, and the opinions of medical experts are required. It is impossible to lay down any general rules for determining what diseases have, and what diseases have not a tendency to shorten life. Any deviation from health might be so interpreted ; but the law puts a proper limitation here upon the meaning of the words, considering them to apply to those diseases only which, in a medical view, are regarded as of a serious nature, and, as a general rule, are likely either directly or indirectly to affect the duration of life of any person laboring under them. This question was brought to an issue in the case of Watson v. Mainwaring, in which payment of the amount of a policy was refused, because the in- sured had labored at the time under what was called organic dyspep- sia J and this fact was kept concealed from the insui-ers. It was left as a question of fact to the jury, whether the malady with which the deceased was afflicted, and of which he ultimately died, was an ordinary or organic dyspepsia at the time of the insurance. The judge (Chambre) in charging the jury said : " All disorders have more or less a tendency to shorten life, even the most trifling ; as, for instance, corns may end in mortification ; but that is not the meaning of the clause. If dyspepsia were a disorder tending to shoi'ten life within this exception, the lives of half the members of the profession of the law would be uninsurable." We learn then, from this case, that a person may die from a disease under which he was laboring at the time of insurance; and yet if it be not the common course of that disease to shorten life, the representatives may recover the amount of the policy. This is an equitable inter- pretation of the terms ; for the insurers have no right to give a forced meaning to the words of the policy, and to take advantage INFLUENCE OF GOUT. 833 of what must be regarded as an accidental result. From other decisions we learn that, in order to render a policy valid, these words do not imply that the insured must have been at the time entirely free from all the seeds of disorder or latent disease. Such a condi- tion is impossible. A man may be laboring under some insidious disease — ulceration of the stomach or intestines, for instance — lead- ing to perforation ; but if this be, as it commonly is, unknown both to himself and his medical attendant, the insurers are bound to take the risk. Lord Mansfield in the case of Sir James Boss, held that the warranty was sufficiently true, if the person were at the time in a reasonable good state of health. A life may be a good life, although the person may be at the time laboring under some bodily infirmity. [The assured, who effected a policy on his life in February, 1855, signed a declaration stating, among other things, that he was then in good health, and did ordinarily enjoy good health ; and that he was not aware of any disorder or circumstance tending to shorten his life, or to render an insurance on his life more than usually haz- ardous, unless anything stated in answer to certain questions which preceded the declaration might be so considered. In an action upon the policy, it appeared that in 1853 and 1854, the deceased had had two severe bilious attacks. Medical men had expressed different opinions as to the effects of these attacks upon his health ; but it did not appear that the unfavorable opinions had ever been com- municated to the assured. It was held that it was proper to in- struct the jury that " if the assured honestly believed at the time he made the declaration, that the bilious attacks had no effect upon his health, and did not tend to shorten his life, or render an insur- ance upon it more hazardous, the fact that he was aware that he had had these attacks, even though (without his knowledge) they had such a tendency, would not defeat the policy." — Jones v. Pro- vincial Ins. Co., 3 C. B. (]Sr. S.) 65.— P.] On the other hand, a disease tending to shorten life must not be taken to signify only one of those maladies which have commonly a rapid and fatal course — as phthisis and scirrhus; it may apply to dropsy, gout, asthma, insanity, and many diseases of a chronic cha- racter. When the existence of these diseases, or even a well-marked tendency to them, is concealed from the insurers, or omitted to be stated through mistake, even without fraudulent intention, the policy in the event of death becomes void, because the risk incurred is really different from the risk understood and intended at the time of the agreement. Such diseases are not necessarily fatal, but this is not the question ; their tendency is to diminish the expectation of life, and if medical evidence establish this with regard to any dis- order intentionally concealed, whether chronic or acute, the contract is at an end. G-out. — In December, 1862, a case was tried in which it was alleged that there had been concealment of the existence of gout. {Excrs. of Fowkes V. The Manchester and London Assurance Company.) The deceased, Fowkes, a commercial traveller, aged 49, in the year 1860 53 834 CONCEALMENT OF HABITS. eflected a policy on his life for lOOOZ. He died in June, 1861. Pay- ment was refused on the ground that the answers of deceased were untrue, and that there had been suppression of a material fact. It seems he was asked whether he had ever been afflicted with gout, and he answered "N"o." He was asked whether the life had been offered at any other office, and, if so, whether it was accepted ; and he answered that it had been proposed, and had been accepted at the ordinary rate. These were the answers which it was alleged were false. On the part of the company, a surgeon stated that in May, ISftS, deceased was suffering from suppressed gout. He had an " extremely slight attack," which lasted only about forty-eight hours ; he did not tell the deceased that it was gout ; he believed that he died of suppressed gout in an aggravated form. A pro- posal of the deceased to another company, which had been declined, was put in evidence. On the part of the plaintiffs it was contended that there was no evidence that deceased had ever been " afflicted with gout." The Lord Chief Justice left it to the jury — first, whether the answers of the insured were untrue ; and next, whether they were false to his knowledge. .First, had he been "afflicted with gout?" The question must be considered with some reason- able latitude, and it was not because a person had some passing symptoms which a far-seeing medical man might ascribe to the presence of suppressed gout in the system, but whether there was gout in a sensible appreciable form? This certainly was stated before the proposal, to have been " the slightest possible case" of gout, according to the medical evidence. As to the other question — whether the life had been proposed at any office and accepted or declined — it appeared that the life had been proposed at two offices, and accepted by one, but declined by the other. Had the assured answered truly in simply saying that he had proposed and been accepted ? The question no doubt was not in the most compre- hensive form, but was it answered fully and fairly, and according to its obvious meaning and effect, by saying nothing of the proposal which had been declined ? He thought not ; but left it to the jury. He, however, thought further that it was not strictly true that the life had been " accepted" in the sense in which the word was used — for it had not been accepted by any office on a proposal for assurance, but merely approved .by the medical man. It was for the jury to say whether either of the answers was untrue, and, if so, whether either was untrue to the knowledge of the assured. The jury found that the assured had not been afflicted with gout at the time of the proposal ; also that the answer to the other question was untrue, but not to his knowledge. The Lord Chief Justice directed a ver- dict for the plaintiff", subject to a point reserved for the court whether the knowledge of the untruth was material. Habits. — Again, a person may be laboring under no actual disease at the time of affecting the insurance, but his habits may be such as to produce general injury to health, and to have a tendency to shorten life. Concealment of habits, the effect of which on health CONCEALMENT OF HABITS. 835 must, or ought to be known to all medical men, may be just as fatal to a policy as the concealment of a serious disease. Although they may not always be included in the questions put by the office, yet the law will equitably hold that the insurers should be made ac- quainted with all circumstances which might reasonably affect the risk.^ Concealed habits of drunkenness -have thus given rise to medical questions of considerable importance; and in one remarkable instance which will be mentioned hereafter, a question arose as to whether the practice of opium-eating, which had been concealed from the insurers, had or had not a tendency to shorten life. Some recent exposures, partly of a civil, and partly of a criminal nature, have rendered insurance offices much more strict in their in- quiries. In the rules already quoted, special information is de- manded upon the existence of material circumstances touching health or habits of life, and whether the person is, or is not of temperate habits. Any facts bearing upon these questions, if known to the medical attendant, must of course be stated. The existence of such habits must be known to the person himself, and the declaration which he signs is so explicit that, if intentionally concealed by him, no individual can reasonably complain of the voidance of the policy and the forfeiture of the premiums. The case of Von Lindenau v. Desborough, tried in the Court of King's Bench before Lord Tenterden in October, 1828, shows that medical men are bound, at the risk of invalidating the policy, to state the exact bodily condition, so far as it can be obtained by ob- servation, of the person whose life it is proposed to insure. It appears that on the 16th June, 1824, a policy for 3208?. was effected, in the Atlas office, on the life of the Duke of Saxe Gotha, at the time he was residing abroad. The Duke died on the 17th Febru- ary, 1825, within nine months of the time of effecting the insur- ance ; and the payment of the amount of the policy was refused on account of a material concealment of the exact condition of the insured from the insurers. It appeared in evidence that for some time prior to the insurance, the Duke had been an invalid, and that at the time it was effected he was childish, and had not spoken for two years. He had labored under some affection of the brain, did not improve in health after the insurance, and ultimately died from an attack of paralysis. The certificate upon which the in- surance was granted had been signed by two German physicians,, Drs. Dorl and Ziegler. It was to the effect that the general health of the Duke was good ; but that he was " hindered," (gehindert,. had an impediment) in his speech, and had an affection in his left eye. It was also stated that he was perfectly free from disease, or symptoms of disease. On inspection of the head, a tumor of large- size connected with the inner table of the skull was found pressing upon the brain. This tumor was evidently of long standing, and had probably been the cause of the symptoms and death. Ten. ounces of serum were found effused in the brain. It appears that before the insurance was effected, an agent in Germany had informed the insurers that the Duke had led a disso- 836 MATERIAL CONCEALMENT. lute life, by which he had lost the use of his speech, and, accord- ing to some, of his mental faculties also ; and on this the Office required a payment of nearly double the usual premium. The case of the insurers was that there had been material concealment of the Duke's r6al condition at the time of effecting the insurance. The late Mr. J. H. G-reen, who appeared as a witness for the plain- tiff, the claimant under the policy, considered, from the history of the case, that there were no symptoms of organic disease, although the symptoms mentioned would lead to a suspicion of disease in the head. In reply to a question by Lord Tenterden, he said if, as a medical man, he had been asked by an Insurance Company con- cerning the state of a man's health, who was unwilling to move, who was subject to control and influence, and who had lost his speech, he would have considered it his duty to mention these cir- cumstances. Lord Tenterden then left it to the jury whether there had been any concealment of material facts relative to the Duke's health. The plaintiff" was nonsuited, and a new trial subsequently refused. There can be no doubt that the answer here given by Mr. Grreen was such as every conscientious man must have given under the circumstances. A medical expert appears in court to speak the whole truth, to the best of his judgment, and not to make out rightly or wrongly the particular case of the person who summons him. On the other hand, it is obvious that Drs. Dorl and Ziegler gave a most improper certificate. They might not have been able to ex- press any opinion respecting the existence of a tumor in the brain, but they were wrong in suppressing the real state of the Duke. If they knew his actual condition, their conduct was censurable; if they did not know it, they were not justified in signing a certificate at all. Because a man may enjoy at the time tolerable bodily health, facts of this nature, showing great disease of the nervous system, ought not to be kept from the knowledge of the insurers. Imbecility, depending on whatever cause, should always be men- tioned. Material concealment. — Some medical practitioners entertain the opinion that, provided they can certify that the person is in good health at or about the time of the insurance, that is all that the insurers need know. The same opinion is commonly entertained by the insured ; and the latter, after having been attended by one medical man for an illness, will apply to another, a comparative stranger, to certify to his condition of health for insurance. We must not lend ourselves to this system, which is based sometimes upon a mistake, at others upon fraud. If medical men would de- cline signing the papers under such circumstances, they would not ■ only save themselves from censure, but be actually conferring a ■benefit upon the applicant, by preventing him from obtaining a policy upon terms which on his death may render it invalid, and entail a forfeiture of the premiums. Prom what has already been . said, it will be understood that the exact state of health of the per- MATERIAL CONCEALMENT. 837 son at the time of the insurance does not represent the whole of the risk incurred by the Office. The restoration to health, as in a case of diseased lungs, may be only temporary ; it may be speedily fol- lowed by phthisis, and the insurers therefore ought to be informed of the previous condition, as well as present state of the applicant. The conditions in the declarations are so explicit upon this point, as to render it scarcely necessary to refer to the propriety of making this addition to the certificate. The disease under which the in- sured had labored may have been of a trivial kind, and not likely to aifect the risk ; nevertheless the safest plan is to state it. The option will then lie with those who are to incur the risk. When facts of this kind are either concealed, or not plainly stated, the question of how far they were or were not material to be laid before the insurers is always left to the jury, who are guided in their ver- dict by their own common-sense, as well as by medical opinions. It would appear, also, from a decision of the House of Lords in Anderson v. Fitzgerald, that the truth of the answers given, and not their materiality, should govern the verdict of a jury. In a case tried in December, 1856, Lord Campbell held that a suppression of the truth on the part of the person whose life was insured, would not avoid the policy, if the party effecting the insurance was inno- cent and ignorant of the suppression. Some medical men have adopted the plan of signing certificates, but have declined to make any written reply to certain queries : as, for instance, the general query — Can you give any, and what information respecting the habits of the applicant ? If nothing be known concerning these, it should be so stated ; if, however, the existence of any habits affecting health be known to us, we shall do an injury to the applicant and ourselves by withholding infor- mation on the subject. It may be the means of causing a heavier premium to be demanded for insurance than if the facts were known ; and if this should not happen, the omission is very likely to give rise to future litigation. Thus, in the case of the Earl of Mar, the payment of the policy was refused on the ground that the Earl had been addicted to opium-eating. His medical referee replied favorably to the special questions in regard to habits, whether sedentary or active, temperate or intemperate ; but he neglected to reply to the general question regarding habits ; and on the Earl's death it was found that he had been an opium-eater for many years before effecting the insurance. This fact might not have been known to the medical referee, but it is always better to fill in the reply either affirmatively or negatively, if the certifi- cate be signed at all, than to leave the Office to draw an unfavor- able inference, or to render the policy afterwards open to dispute. In the case of a Mrs. Elgie payment of the amount of a policy was refused under the following circumstances: The insured had been for some time prior to the insurance in a delicate state of health, and in the year 1821 it was thought that the symptoms were those oi -phthisis. In October, 1822, she was twice alarmingly ill. In December of that year, wishing to insure her life, she called 838 CONCEALMENT OF PHTHISIS. in a medical friend, who had not been in attendance upon her, to examine her and certify as to her state of health. It appears he examined particularly the state of her lungs and liver, and finding them, as he thought, sound, certified that the ordinary state of her health was good. On the 19th March, 1823, he gave another certificate to the same eftect, upon which the insurance was effected in April, 1823. Mrs. Elgie died of disease of the lungs in April, 1824. Payment was refused, on the ground that there had been concealment of material facts as to the state of health of the in- sured. It appears that, unknown to the medical gentleman who had given the certificate, the insured had been attended between December, 1822, and the 19 th March 1823 (the date of the certifi- cate), by a medical practitioner residing in her neighborhood for a cough, and that she had become much emaciated. This gentleman, however, thought that there was no structural disease — an opinion confirmed by the examination made for the certificate in March. The fact of the deceased having labored under this illness was, however, concealed from the insurers. The jury thought that, although there had been concealment, it was not material, and a verdict was returned against the defendants. A new trial was granted, but a verdict was again returned against them. The truth is, it is not the concealment of every slight attack of illness that will vitiate a policy ; although the contract being one, as it is termed, uberrimce Jidei, it is in the highest degree unwise either in the insured, or, if it be known to him, in the medical man signing the certificate, to conceal from the insurers any previous illness or medical attendance from another quarter. It may always be fairly urged that a knowledge of the facts might have led to the rejection of the life, or have made a difference in the amount of the annual premiums. One part of our duty therefore, if we sign a certificate upon a careful examination, is to ascertain whether the applicant has, or has not been previously attended by another medical practi- tioner. A case was tried at the "Warwick Summer Assizes, 1844 {Geach V. Ingall), in which it was alleged that the existence of phthisis (pulmonary consumption), or phthisical symptoms, had been con- cealed from the office. On the side of the plaintiff", the medical attendant of the insured was called, and he certified that in May, 1840, when the policy was issued, he considered the deceased to be in good health, and an insurable life. A physician who examined the deceased in February of that year stated his belief that the chest of the deceased was sound, and he considered him to be a very good life. For the defence two medical men were called, who deposed that deceased had had spitting of blood before effecting the insurance, and that he had labored under decided symptoms of consumption in 1840, which it was inferred must have existed at the time of the insurance. There was evidence of a general con- sumptive tendency in the family ; the father died of it, and there was no doubt whatever that the insured had died of it in December, 1843, three and-a-half years after the policy was issued. The medi- CONCEALMENT OF HERNIA. 839 cal evidence was conflicting, but the existence of the disease at the time of the insurance rested upon presumption and not upon proof ; hence the jury returned a verdict for the plaintiiF. A second and a third trial were had upon this case, on the ground of misdirection by the learned judges; but verdicts were again returned on both these occasions in the plaintiff's favor. It is most probable that the seeds of consumption existed in the insured ; but, unless there is some plain and certain evidence from symptoms, proof of this will amount to nothing. If inferential proof of this kind were sufficient to avoid a policy, the payment of most policies might be easily and successfully disputed. Had the deceased died soon after the insurance, there might have been greater probability in favor of the view adopted by the office ; but he lived nearly four years afterwards ; hence, if the symptoms had existed in a confirmed state at the time of the insurance, of which there was no direct evidenpe, as the medical officer of the company had certified in favor of the life, the case must have been of an unusuallj'^ protracted kind. In a case in which strangulated hernia was the cause of death, the deceased had insured his life upon his own declaration and a medi- cal certificate. In about thirteen months afterwards he died from the eft'ects of an operation for strangulated hernia. The medical witness who signed the certificate stated at the trial that the de- ceased had never had hernia, and that he had not attended him for that disease. A letter was produced, however, in which he (the witness) had admitted the existence of hernia in the deceased four months before his death. He denied the truth of this statement, and said the tumor which he had reduced by manipulation was varicocele. The question was, whether hernia had or had not existed, and had been concealed from the insurers at the time when the insurance was effected. The admission in the letter carried the period of the alleged existence of hernia to five months after the certificate was granted, whilst the deceased had positively stated in his declaration, that he was not, and had never been affected with rupture, and the medical certificate was to the same effect. One medical witness deposed that he had been consulted by the deceased, and had found him laboring under irreducible hernia five months before he proposed to insure his life ! This gentleman stated that he then informed the deceased he had in- guinal hernia ; he tried to reduce it, but could not succeed. These facts, it was alleged, were not stated to the insurers at the time of the insurance, as they certainly ought to have been. On the other side, two medical witnesses, including the operator, thought that the hernia was quite recent. The operator found no adhesions, and there was nothing to induce him to suppose that the hernia was of fourteen months' standing. Evidence was also _ given to show that the witness who deposed to the existence of inguinal hernia before the insurance might have been mistaken in his diagnosis, and have confounded a hydrocele or a varicocele with a hernia ; but admitting this to be true, the existence of a tumor of 840 CONCEALMENT OF DISEASE. any kind in such a situation should not have been kept concealed from the company or their medical referee. The jury returned a verdict that there was no fraud, but that the deceased had had hernia at the time of effecting the insurance. A second trial was granted, and a verdict was then returned in favor of the plaintiff's. If, under any circumstances, a jury should find that the conceal- ment is material, the legal consequence is that the policy is void. It is not at all necessary that the person should die of the disease concealed. This rule was laid down by the late Lord Tenterden in the case of a Colonel Lyon. The Colonel insured his life by two policies in May and June, 1823, and died of a bilious remittent fever in.October of that year. Payment was refused on the ground of misrepresentation and concealment. Colonel Lyon referred the office for a certificate of his health to a gentleman who had not at- tended him for three years previously. His answers to the printed questions were that he had had no other medical attendant, and that he never had "a serious illness." The medical gentleman to whom he referred certified that his life was insurable, and the policy was issued. It appeared in evidence, however, that the de- ceased had been attended by two other medical practitioners from February to April, 1823, for hepatitis, fever, and a determination of blood to the head. One of these employed very active treatment : he considered him to be in a dangerous state, and would not have certified him to be in health until the end of May, 1823. All agreed that the deceased did not die of the disease for which he had been thus attended. Lord Tenterden stated it to be his opinion, that if a man referred to one practitioner, because he could speak well of his health, and thought that if he referred to other medical men they would not so certify, although the in- sured did not die of the disease with which he was then afflicted, the policy would be void. A verdict was accordingly given for the defendants. The practice of referring to medical men who have been only recently consulted is not infrequent. The opinion of the usual medical attendant might be unfavorable, or he might report on the existence of habits which would render the life unin- sui'able, or insurable only at a high premium. This want of fair- dealing, however, commonly defeats its object. There is expensive litigation, and the policy is pronounced to be void. The case of Wil- shere v. Brown, tried before Lord Abinger in the Exchequer in De- cember, 1842, and of Palmer and Fish v. Irving, tried at the Norwich Summer Assizes, furnish illustrations of this. In the latter case the deceased had returned that he had never had a medical attendant. His life was insured for a large sum on the 21st IS'ovember, 1842, and he died on the 5th December following. There was reason to believe that he had died from inflammation of the lungs ; but it was proved that he had labored under symptoms of pulmonary con- sumption, and had been attended by three medical men shortly before he effected the insurance. This was concealed, and the policy was set aside on the ground of fraud. A singular case was tried at Glasgow in 1837, in which the pro- INTEMPERATE HABITS. 8ll ceedings were inverted, compared with the usual English practice in such cases. An Insurance Company brought an action against the representatives of the insured, on the issue whether the policy had not been obtained by misrepresentation and undue conceal- ment. An insurance was effected on the life of a Mrs. Ralston, on the 10th December, 1833. Her own declaration was that she was in good health, and that she was not afflicted with any disease or disorder tending to shorten life. She referred to her usual medical attendant, who certified that he had known her for ten years, and had been in the habit of attending her professionally; that she was last ilHn the month of September, 1883 ; " that her indisposition was acidity of the stomach;" that she had not, to his knowledge, been affected with any illness of such a nature as to influence her general health ; that she was then (30th ITovember, 1833) in perfect health, and was not subject to fits or any affection of the head, but occasionally to slight headache from acidity in the stomach. lie knew of no circumstance in her business or habits of living tending to impair her health or shorten her life. The deceased died of apoplexy on the 3d September, 1834, within nine months from the issuing of the policy. The Insurance Company were about to pay the amount, when an action was brought by the medical attendant against the executors of the deceased for payment of 162^. for med- ical attendance, etc., on Mrs. Eawlston, from the 15th September, 1838 (two months prior to the date of the policj'^) to the 4th June, 1834. The referees awarded 145L to thfe plaintiff. His books were given in evidence, and it then appeared that between the 19th September and 3d December, 1833, (the date of the proposal for in- surance) he had paid her thirty-five professional visits, most of these of long duration. It further appeared from the diary that she had been frequently bled ; her head had been shaved and blis- tered, and leeches had been applied to her temples. She had also had constant attendance after the insurance, and in the early part of 1834 had had several fits of epilepsy. Tliree medical witnesses deposed that the declaration of deceased and the certificates given by her medical attendant did not set forth her true condition; and that there had been misrepresentation and concealment of material facts. This was also the opinion of the judge, and a verdict was returned for the office. Although the illness, prior to the insurance, might have had no connection with the death from apoplexy, it was held that the insurers ought to have been made acquainted with it. Among the diseases upon the concealment of which policies have been most frequently disputed, may be enumerated gout, dropsy, paralysis, epilepsy, haemoptysis, incipient phthisis, delirium tremens; and to this list may be added drunkenness, intemperance, irregular habits, prostatic disease, and laceration of the perineum in women, as a consequence of delivery. Intemperate habits. — In a large number' of cases the payment of policies is resisted on the ground of concealed drunkenness and gene- 842 INTEMPERATE HABITS. ral habits of intemperance. There is some difficulty in these cases, because medical men may entertain dift'erent opinions respecting the effect of such habits upon the general health, and the degree to which they may be safely carried. There is one thing however certain — whatever may be our opinion of their effect on health, we are bound to state, if known to us, that they exist, and thus put it out of the power of a company to dispute a policy upon such a ground. From the frequent concealment of habits of this kind, some offices now adopt the pi'actice of making it a special question, to which a plain negative or affirmative answer should always be given: "Are you now, and have you alwavs been of temperate habits of life?" When intemperance is alleged, we find not only conflicting medi- cal evidence, but much cross-swearing among the witnesses. It be- comes a question: What is intemperance? and this is answered according to the peculiar views of a witness. A case was tried at the Exeter Spring Assizes in 1842 {Southcomh v. Merriman), which will show the difficulty of getting at the truth. Payment of a policy was disputed by the office on the ground of concealed in- temperate habits. At the trial the representatives of the insured called twelve witnesses to prove that the deceased was a very tem- perate man, while the office called twenty-one to show that he was habitually intemperate! One of the temperance witnesses (for the plaintiff) defined drunkenness to be " when a man has lost his reason, could not give a proper answer, was not able to do business, had lost his legs, and was obliged to be carried home." He ad- mitted that the deceased had occasionally continued drinking for three or four days together, but that was a very rare occurrence. The medical attendant who gave the certificate said that the de- ceased's was a perfectly good life, and be considered him to be a person of sober and temperate habits : he had not thought it requi- site to inform the office of occasional outbreaks, because he did not think that drinking had any effect upon his health. Several wit- nesses proved that deceased was in the tiabit of drinking enormous quantities of beer, and that it required a great deal to make him ramble. The insurance was effected in October, 1839, and the de- ceased died in April, 1841, from inflammation of the lungs ; but, in the opinion of the medical witnesses, this had not arisen from excessive drinking. JSTotwithstanding the concealment of these facts, the jury returned a verdict for the full amount claimed ; but a rule for a new trial was afterwards obtained. This case shows what fallacious views are entertained on the medical questions of life-insurance. In a case like this, it was clearly the duty of a medical man to describe the habits of the deceased. He might, if he pleased, have appended to the c'ertificate that in his judgment they had not affected the health of the person, but the defendants who were to take the risk should have been placed in a position to form a judgment for themselves. In the case of the Hon. H. G. Talbot (Craig v. Fenn, December, 1841), where no answer was returned to the question whether the CONCEALED HABITS OF INTEMPERANCE. 843 deceased was of temperate and moderate habits of life, and the company actually charged a higher premium in consequence, the jury returned a verdict in their favor, the real condition of the in- sured not having been made known to them at the time the insu- rance was effected. [Where the representation was made that the insured was of sober and temperate habits and in good health ; if the representation was true at the time it was made, the subsequent habits of the insured would be no bar to a recovery upon the policy. {Reichard v. Man- hattan^ Life^ Insurance Company^ 31 Missouri E,. 515.) And if the party insuring is not called upon by any general or special question, he need make no statement as to any particular habit, as intempe- rance, though such habit may be prejudicial to his health. Bawls V. Life Ins. Co., 36 Barb. (N. Y.) 357. Where the insurance is by a creditor upon the life of his debtor, declarations of the latter as to his habits, or as to the fact of suppression of information are mere hearsay and inadmissible as evidence. lb. — P.] Concealed habits of intemperance. — In Hutton v. Waterloo Life As- sociation (Q. B. December, 1859), an action was brought by a widow for the recovery of 2500^. upon a policy effected in April, 1854, on the life of her husband. Payment was refused on the ground that the written answers made by deceased to questions proposed by the company were false, and therefore that the contract which was based upon them was void. One question was whether he was subject to delirium tremens or any disease calculated to shorten life, which he answered in the negative ; a second was, whether he was of temperate and sober habits, which he answered in the affirma- tive; and the third was as to the name and residence of his "ordi- nary medical attendant, to be referred to as to present and general state of health," to which he answered, "Dr. Cobb." The inquiry now was whether these answers were true. The action had already been once tried, when the plaintiff' obtained a verdict ; but the court granted a new trial upon the ground that there was no find- ing by the jury. The evidence in the case, medical and general, showed that the deceased was of intemperate habits, and that in May, 1854, he had suffered from delirium tremens, of which disease he died in 1856; further, that Dr. Cobb, to whom he referred as his usual medical attendant, had not attended him since 1851, and that from this date until the date of the insurance he had been attended by another medical man, to whom he had given no reference, although he was his usual medical attendant. The jury found for the defendants on the main issues. This case presented two curious features : 1st, the medical evidence proved that the first attack of delirium tremens came on on May 11, after the insurance had been effected ; and 2dly, the medical attendant of the deceased and the medical officer of the company differed greatly about the deceased's state of health at or about the time the insurance was effected. The medical attendant of the deceased, who was a witness for the company, deposed that 844 CONCEALED HABITS OF INTEMPERANCE. he attended him for an attack of delirium tremens on May 11, and again on May 28, 1854 — both attacks being the results of excessive drinking. The report to the company, made by their own medical officer, dated May 22, 1854, gave, however, a most flattering account of deceased's health, and described him as a " first-class life." In his evidence at the trial this gentleman said that he then observed no indication of delirium tremens nor of drunken habits ; the de- ceased was the picture of health. This serious discrepancy could not be reconciled by a re-examination of the witnesses. The con- cealment of intemperate habits was clearly proved, and on this pro- bably the verdict of the jury chiefly turned. Questions of a similar kind were raised in Wheelton v. Hurdisty (Q. B. Dec. 1856). An insurance had been eftected to a large amount on the life of a Mr. Jodrell, and the payment of the policy was dis- puted on the ground that there had been concealment of intempe- rate habits, and of the existence of delirium tremens at the time the insurance was efi:ected. The jury found that there had been mis- representation and concealment. One of the most singular cases of this description, in reference to conflicting medical evidence, was that of RawLings v. Desborough, tried by Lord Denraan in December, 1837. The main question was, whether a Mr. John Cochrane, whose life had been insured, was or was not a person of intemperate habits at, or before the time of in- surance. A medical certificate had been given to the effect that his habits were not intemperate. The weight of the evidence, how- ever, general and medical, tended to show that he was a thorough drunkard. One of the witnesses for the plaintiff said, the deceased " never appeared to me to take anything to hurt a man ; I never saw him drink more than the rest of the company ; I only saw him intoxicated fifty or sixty times in four years ! His health did not seem to be impaired by what he drank." His groom stated that he had seen his master " tipsy a hundred times, perhaps, but not beastly drunk." The late Mr. Travers examined the deceased for one office, and from what he saw, advised that his life should not be accepted. He considered the man to be laboring under delirium tremens. One observation made by this witness is worthy of remembrance when a medical practitioner is engaged in examining a person for a life- insurance — i. e.,a man may have pursued an intemperate course for some time,'and yet his appearance at the time may be such as to lead a common observer to imagine he was in the plenitude of health when he is liable to become the subject of an immediate attack. Notwithstanding the strong evidence of habits of intemperance from a period anterior to the date of the insurance, the jury re- turned a verdict for the plaintiffs, but a motion for a new trial was soon afterwards made. Lord Den man observed upon this occasion, in respect to what was material concealment, that he did not conceive the true meaning to be, that the party whose life was to be insured was bound to volunteer a statement of every circum- stance that anybody might afterwards think was likely to afl'ect the risk of his life. The real intention was, that he should submit CONCEALED HABITS OF INTEMPEBANCE. 845 himself to a full examination and inquiry, that he is bound to state nothing untruly, and that he is bound to answer all questions truly. If he decline to answer, the office may act upon his refusal, and if he answer untruly, he shall gain no benefit from such false statement. In February, 1840, a trial took place before Tindal, C. J. {Pole v. Rogers) relative to a policy on the life of Mr. Peter Cochrane, brother of this Mr. John Cochrane. The insurance was effected in 1834. The insured died the following year of hydrothorax, brought on, as it was alleged by defendants, by very intemperate habits, the exist- ence of which was concealed from them. The evidence, both medi- cal and general, was just as conflicting as in the former case, and it became rather a question of credibility. The jury returned a verdict for the plaintiffs, thereby either denying the existence of intempe- rance, or considering that the concealment of it, if it existed, was not material. This case is worthy of note in one point of view, as it involved a new question in medical jurisprudence — namely, whether we are to regard the immediate or remote effects on the body produced, by intemperate habits ? The Solicitor-General, who appeared for the plaintiffs (the representatives of the insured), argued that the terms " habits prejudicial to health" were too indefinite. Was it to be regarded as an abstract, or relative proposition ? He appeared to rest • his case upon an admission that there was intemperance to a certain degree, but he contended that habits which were not at all prejudi- cial to the health of one man might absolutely kill another. There was a very common habit of keeping late hours ; this might be ut- terly destructive to the health of some persons, but not to that of others. This sort of condition was so vague that it left it open to an insurance office to resist the payment of any policy, unless the meaning of the words was brought within some reasonable and well- defined limits. The jury were bound to see whether the alleged intemperate habits had been indulged in for a long time without injury; they must look to all the habits of the person taken to- gether, and see whether one habit was not counteracted in its effects by another. The insured was a man of very active habits, and therefore excessive drinking would not affect him as it would others who led a sedentary life. This ingenious but sophistical reasoning involves an important medical question. It is well known that intemperance is a relative term, and may be differently construed by different medical wit- nesses. The real question, however, divested of its sophistry, is this: Can any person indulge in an excessive use of alcoholic liquids without this practice sooner or later leading to an impair- ment of health, by producing disorder of the stomach and liver, and remotely affecting different organs ? The effects of such habits may not show themselves immediately, but the office requires to be in- formed of their existence or non-existence, and not of the period when they are likely to affect health visibly, or to engender a fatal disease. To assert that a man can be addicted to excessive drink- 846 CONCEALED HABITS OP INTEMPEBANOE. ing without impairing his health is contrary to all experience. There is no such compensation, or balance of -habits as that which the Solicitor-General supposed to exist in this case. Habit may accustom a man to intemperance — it may enable him to drink a large quantity of alcoholic liquid without being apparently inju- riously influenced by it at the time ; but a deranged state of system will sooner or later follow, and delirium tremens or dropsy will probably supervene. A good natural constitution may enable a man to resist the pernicious effects for a certain period, but ulti- mately they will show themselves in some form of disease; and in the case of these two brothers, the result of their intemperance was made apparent in the very early deaths of both. It is unfortunate that no light is permitted to be throWn on such cases by pathology. Post-mortem examinations are not always made in these cases ; for the death being, as it is called, natural, it is not commonly thought necessary to inspect the body, although as in the above instances, the condition of the liver and other organs might at once have removed a difficulty which arose from the conflicting evidence on the habits of the deceased. In all cases of a contested policy, one important principle is uni- formly acted upon ; those who resist the payment are bound to prove what they allege by conclusive and satisfactory evidence. A court will not receive probability or conjecture — the evidence must be certain. Hence many suits fail from the medical evidence going no further than to show that a particular disease or habit had proba- bly existed at the time of insurance. If the disease or habits be shown to have certainly existed, the evidence may still fail to prove satisfactorily that the concealment was either wilful or material. Contested cases of life-insurance are very instructive : they often show the imperfect manner in which medical observations respecting health or disease are made, and that the medical treatment of per- sons whose lives are insured may become a material question in the event of a policy being disputed. In the case of Chattock v. Shawe, in reference to an insurance on the life of a Colonel Greswold, a question arose not only respecting the concealment of intemperate habits, but as to the concealed existence of delirium tremens, from the examination of handwriting, as well as from the description given by non-professional witnesses. It was here even doubtful what had caused the death of the deceased. According to one medical witness, it was a curious combination of Asiatic cholera, phrenitis, and epilepsy ! It was proved that, more than three years before the insurance was eftected, this gentleman had met with a ■fall, and he was afterwards seized with a fit, described by some witnesses as epileptic, by others as arising from concussion of the brain. The existence of intemperance and epilepsy prior to the insurance was not made out to the satisfaction of the jury, and they returned a verdict for the representatives of the insured. In Walters v- Barker, tried at the Monmouth Summer Assizes, 1844, the deceased, at the age of sixty, insured his life on the 4th May, 1841, and he died in the August following. It was alleged ABSTINENCE. — OPIUM-EATING. 847 by the office that the cause of death was an attack of •paralysis, which it was pretended had existed from a very early period of his life. 'Eo medical evidence was given on either side ; there was merely a presumption that death might have taken place from paralysis ; hence the verdict was for the plaintiffs. Abstinence. The vegetarian system. — We have already considered the effects of habits of intemperance, and the necessity for stating in a certificate the existence of them when known ;. but other habits may exist which have a tendency to shorten life, although in a less obvious manner. What are called temperance principles are, or were very prevalent. There are many persons who have been full livers, and have afterwards taken up the notion that water and a vegetable diet were all that was necessary to support life. This sudden change, especially in persons advanced in life, is very likely to affect the constitution seriously, and, if not to create disease, so to weaken the vital powers as to render any slight illness or accident serious. I knew one instance in which a gentleman who had been in the habit of living on a full diet, with a moderate use of alcoholic liquids, suddenly adopted the plan of living on water and vegetable food; Ije obviously fell off in strength, and lost his previously healthy condition. About a year afterwards he met with a slight sprain to the ankle-joint ; inflammation ensued, which, in spite of the best treatment, assumed an unhealthy character ; suppuration of the joint followed; amputation of the leg was performed, but, in spite of an improved diet, the powers of life never rallied. There was no attempt at union in the flap, and he finally died exhausted. There can be no doubt that these sudden changes in the mode of living are liable to lead to impairment of>-health, and to affect materially the expectation of life. Hence it is our duty to inquire and report upon facts of this kind when they become known to us. In Huntley v. The St. George Insurance Company (]!Tewcastle Au- tumn Assizes, 1858), a medical man insured his life for 2000^. ; and although certified to be in good health, and to all appearance he was so, he died from Bright's disease within three months after he had effected the insurance. There was also disease of the heart. The questions whether he had either of these diseases at the time of the insurance were answered by him in the negative. It was contended that, as a medical man, he must have known that he was suffering from these diseases, and had wilfully concealed them. It appeared from the evidence that the deceased had taken to a vegetable diet, and it was considered that this was the cause of the rapid failing of his health. The jury returned a verdict for the plaintiffs, and the Chief Baron suggested that in future Insurance Companies should put among their questions to insurers, "Are you a vegetarian ?" Opium-eating. — There is another habit said to be common, the concealment of which gave rise to an important trial some years since: I allude to tlie practice of opium-eating. In 1826 the Earl of 848 OPIUM-EATING. Mar effected an insurance on his life, and two years afterwards, i. e., in 1828, he died of jaundice and dropsy at the age of fifty-seven. The Insurance Company declined paying the amount of the policy, on the ground that the Earl was, at the time of the insurance, and had been for some time previously, an opium-eater. This practice was concealed from the insurers; and it was further alleged that it had a tendency to shorten life. It was clearly proved in evidence that the Earl had been a confirmed opium-eater up to the time of his death. According to Dr. Christison, the deceased had taken laudanum for thirty years, at times to the amount of two or three ounces daily — a tablespoonful for a dose. He was a martyr to rheu- matism, and, besides, lived rather freely. Many persons who were constantly about him, and many intimate friends, deposed that until 1826 (the year of the insurance) he was of a cheerful disposition, and clear in his intellects. Some of them admitted that they then perceived a change in his habits, which they attributed to the ad- verse circumstances in which he was compelled to live. In 1825, Dr. Abei'crombie found him enfeebled and broken-down in con- stitution, but without any definite complaint. The main question at the trial was, whether opium-eating had a tendency to shorten life — for on this the issue turned — whether the concealmept from or the non-communication of this practice to the office was, or was not material. Drs. Christison, Alison, Abercrombie, and Duncan were exam- ined on the part of the insurers; and although they entertained the opinion that the habit had a tendency to shorten life, they were unable to adduce any cases in support of it. Their opinion was based not on personal experience, but on the general effects of opium as manifested by its action on the brain — by its producing disorder of the digestive organs, and giving to the person a worn and emaciated appearance. In most of the instances collected, there was no evidence that life had been shortened by the practice. On the contrary, some of the individuals had carried it on for years, and had attained a good old age. The jury returned a verdict for the plaintiff's, not on the ground that the practice was innoxious and its concealment immaterial, so much as on the technical point that the insurers had not made the usual and careful inquiries into the habits of the deceased ; and they were therefore considered as having taken upon themselves the risk from their own laches. It appears that the general question with respect to habits was not answered by the medical referee, and it was, therefore, considered that the office had waived the knowledge of them. A new trial was granted, on the ground of misdirection, but the suit was com- promised. Hence it will be seen that no decision was come to in this case on an important question, which is very likely to arise again. It will be desirable, therefore, to examine some of the facts connected with opium-eating, in order, if possible, to see how far it really tends to shorten life. In the case of the Earl of Mar, it appeared to be a fair inference that the habit did not shorten his life, for he is repre- .EFFECTS OF OPIUM-EATING ON HEALTH. 849 sented to have indulged in it for thirty years; and for twenty-eight years, according to tlie statements of his friends, no injurious effects had followed. Dr. Christison subsequently collected from numerous sources no fewer than twenty-five cases, from which we learn that opium has been taken' in large quantities for forty years together, without producing any marked injury to health. At the London Medical Society, the late Dr. Clutterbuck related the case of a woman \vho for seven years had taken two scruples (forty grains) of solid opium daily. She was fifty-four, had led an irregular life, and had first taken opium to relieve the pains of rheumatism. The dose was not increased, and the usual ill-eftects of opium were absent — such as constipation, nausea and loss of appetite. Although she did not increase the dose, the effects of the diminution of a single grain of her usual quantity wei-e most marked, and she felt them immediately. Many cases of this description are recorded by medi- cal authorities; they appear to show that opium-eating has not necessarily that tendency to shorten life which it has hitherto been supposed to have. There is, however, sufficient evidence to prove that the practice gives rise to prejudicial effects on the system and tends to impair health. It may not have this effect in all cases, except on the withdrawal of the stimulus; but this is not the ques- tion. It might be on this principle argued that the drinking of alcoholic liquids has no tendency to shorten life, because some hundreds of cases may be adduced in which the persons have been addicted to intemperate habits for years, and have still appeared to suffer but little in bodily health. They who have witnessed the effects of opium-eating in Turkey and China agree that the practice leads to the speedy destruction of health. Dr. Oppenheim, in writing on the state of medicine in Turkey, says: "Tlie habitual opium-eater is readily recognized by his appearance. A total attenuation of body, a withered yellow countenance, a lame gait, a bending of the spine (frequently to such a degree as to cauSe the body to assume a semicircular form), and glassy deep sunken eyes, betray him at the first glance. The digestive organs are much deranged ; the sufferer eats scarcely anything, and has hardly one evacuation in a week ; his mental and bodily powers are destroyed.. As the habit becomes more confirmed, his strength continues de- creasing, the craving for the stimulus becomes greater, and in order to produce the desired effect the dose must be constantly aug- mented. After long indulgence, the opium-eater suffers from neuralgic pains, to which opium itself brings no relief. These persons seldom attain the age of forty if they have begun to take opium early." This description of the effects is exactly what we should expect from physiological and pathological reasoning. Dr. Christison states he has ascertained that constipation is by no means a general consequence of the continued use of opium ; but this may be simply an exception to the rule. It is believed by some that the action of the drug may be different in different countries,, and that the description of the effects produced by the use of opium, in Turkey cannot be applied to the English opium-eater. The fol- 54 850 EFFECTS OF OPIUM-EATING ON HEALTH. lowing case, however, which occurred to Dr. A. Thomson at Uni- versity College Hospital, shows that climate has little influence on the effects of this drug: — E. M., aged 35, was admitted May 26, 1835. Ahout seventeen years ago she began to suffer from a pain in the right iliac region, for which a medical gentleman ordered her to take ten dj^ops of laudanum, night and morning. This was gradually increased, the pain continuing, until at last she took three teaspoonfuls every four hours, day and night. At first the ten drops relieved the pain, but it was found necessary to increase the dose to produce the same effect, so that three teaspoonfuls at last did not produce so much relief as the ten drops at first. The effect of the small doses was simply to produce a relief from pain, without otherwise affecting the body or mind. As the dose was increased, however, she found it to produce a comfortable condition of the mind : she felt lively and cheerful, and was capable of doing any amount of work ; it also caused a sense of warmth over the whole body. She had severe family afflictions, but while under the influence of opium was not at all distressed by them, although she felt them severely at other times. If she passed over the usual time for taking a dose, she had the most distressing sensations about the joints, not of pain, but such as she was unaole to describe. She suffered from involuntary motions of the arms, fingers, and toes ; numbness in the limbs and body generally ; profuse perspiration, nausea, vomiting, and loss of appetite; a saline taste in the saliva, and a bad taste in the mouth ; trembling of the limbs, great debility, and a feeling of lassitude. The memory and mental powers generally became impaired, and there was a great depression of the spirits. These symptoms were all relieved by a repetition of the dose. The opium also produced constipation — not more than one motion occurring in a week ; and she does not recollect whether that was produced by medicine or not. • If the dose was deferred, she had always suffered from severe headache. Her sense of smell was so much impaired that she could perceive no pungency in snuff"; her taste was so much lost that she could not distinguish pepper or mustard ; and her hearing was so defective that she could hardly detect the voice of any one who spoke ; yet her own voice sounded most disagreeably loud to her. Her touch was so much affected that she could not execute any needlework. The acuteness of all her senses was, however, restored by the usual dose, the want of which was indicated by flushing and heat of the face. During the period of taking the opium she had very little sleep, and in the intervals she did not attempt to sleep from want of the desire, so that she generally worked all night. What sleep she had was, generally, during the day, but this was much confused and easily broken. About five or six years ago, her resources being exhausted, she obtained admission into the hospital. The laudanum was here discontinued for the first three days, and all the above symptoms were present ; she now for the first time appeared to see the most frightful spectres of animals and other ob- jects in the ward. The symptoms were again relieved by the usual EFFECTS OF OPIUM-EATING ON HEALTH. 851 doses. The doses of laudauum were decreased during the whole time; and when she left the hospital, she took a teaspoonful only in the course of the day. On returning home,, as she was dependent on her friends, she was obliged to discontinue the laudanum and wine, and was unable to get beer; she was now more miserable than before, all the symptoms returning with increased severity, and for the first six months she was almost entirely helpless. There was pain in the chest with a cough, which had continued ever since. She was twelve months at home before the above distressing symptoms disappeared. The consequences of her opium-eating then observed were a much impaired taste, numbness of the limbs, coldness of the feet, inability to walk far without aching pains in the limbs, and a general sense of lassitude. There is abundant evidence that this drug, as it has been admin- istered to children in the factory-districts, has produced serious injury to health and great mortality. In the late Mr. Grainger's report on the Children's Employment Commission, it is stated that laudanum and other preparations of opium are given to young children in gradually-increased doses, until the child will bear from fifteen to twenty drops of laudanum at a time. The child becomes pale and wan, with a peculiar sharpness of features, and rapidly wastes away. The majority of these children die by the time they are two years old. These facts appear to show that climate does not at all aflect the action of the drug in the early periods of life ; and the observations yet made are not sufficiently numerous to justify us in affirming the existence of this influence with respect to adults. Dr. Christison has remarked that many persons probably die young from the efiiects of this habit without the secret being discovered ; for even the medical attendant, as well as intimate friends, may be kept in complete ignorance of the person indulging in it. On the whole, we are bound to conclude that the habit of opium-eating is injurious to health, and is therefore calculat'ed to shorten life. In any proposal for life-insurance the insurers ought to be informed of this habit where it exists, and no medical man should sanction its concealment merely because many persons ad- dicted to it have lived for years in apparently tolerable health. One of the questions put to a medical man is, whether he knows any material circumstance touching the health or habits of the person to which the other inquiries in the certificate do not extend ; and if so, he is required to state them. Now, without going the length of say- ing that the life of an opium-eater is uninsurable upon a common risk, the habit is itself sufficiently material to require that it should be declared in reply to such a question as this. The practice may be, and often is, concealed from a medical attendant ; then the insured, if not candid in avowing its existence, must expose his representatives to the risk of losing all benefit under the policy. Independently of medical facts, which appear to favor both sides of this question, a jury would probably be guided to a verdict by the eftect actually produced on the constitution of a person who has been addicted to the practice. If it has continued many years, and there is no proof 852 TOBACCO-SMOKING — INSANITY. of his health having in consequence undergone any remarlcable change, this might be regarded by the jury as the best possible evidence in favor of the concealment not being in such a case ma- terial. The insurers could not equitably complain of the verdict in the Earl of Mar's case ; for as he began opium-eating at twenty- seven, and died at fifty-seven without any obviously injurious effects being produced by the use of the drug, it could not be said that, in his case at least, the practice had shortened life. It is rarely in our power to apply any better or more practical test than this, under circumstances in which medical facts appear to bear both ways. The case is very different from intemperance in the use of alcoholic liquids : no one can doubt that in this form the results must be inevitably to impair health and to shorten life. The facts here bear one way ; and if instances of longevity can be adduced among spirit-drinkers, they are well known and generally admitted to be exceptions to the rule. The queries put by Insurance Offices are now so explicit, that they must be considered as including the habit of opium-eating ; and there does not appear to be any just pretence for evading the admission of the practice, either on the part of the insured, or (if known to him) of his medical at- tendant. Tobacco-smoking. — I am not aware that the prevalent habit of smoking tobacco has ever been regarded in relation to life-insurance. Although inveterate smokers are liable to attacks of dyspepsia, loss of muscular and nervous power, weakness, and other derangements of the system, there is not, so far as I know, any evidence to show that the practice has a tendency to shorten life. Should the habit be stated in a certificate ? I think it should, if known to the medi- cal referee, and where it is of a most inveterate kind. This would at least prevent objections on the part of a captious company. There is no'rule of law on this point, if we except a dictum of Lord Mans- field: "The insured need not mention what the insurer ought to know, what he takes upon himself the knowledge of, or what he waives being informed of: the insurer need not be told general topics of speculation." Insanity. — When we are called upon to say what diseases have a tendency to shorten life, there is commonly no difficulty in giving a reply, since the name of the disease — its known effects upon the body — the degree of mortality produced by it, and its intractable- ness, are data upon which a medical opinion may be easily expressed. There are some diseases, however, respecting which it is not so easy to return an answer ; and among these may be mentioned insanity, which has already given rise to discussion in a court of law. The treatment of this malady falls out of the usual line of practice ; and there are comparatively few in the profession who have made them- selves acquainted with statistical details respecting it. This may account for the decision in the following case: — In 1835, a trial took place at the York Assizes, in which the INFLUENCE OF INSANITY. 853 question was, whether insanity had, or had not, a tendency to shorten life. The representatives of a clergyman brought an action against the Providence Insurance Company, to recover the amount of a policy effected on the life of a gentleman ; but the oflfice refused to pay on account of the person having been insane, and this fact having been kept from their knowledge when the insurance was effected. Several medical witnesses gave evidence on the occasion. One considered that insanity had a tendency to shorten life ; ano- ther, that it had not ; a third, who admitted that the deceased was laboring under insanity, did not consider that Ms mental state was such as had a tendency to shorten life. The judge charged the jury that the question for them to consider was, whether insanity had a tendency to shorten life, as, if so, this would make the concealment of it material. If insanity had such a tendency, they must find for the defendant ; if not, for the plaintiff. The jury found for the plaintiff, on the ground that insanity had no tendency to shorten life, and that therefore the concealment was not material. There is probably no case which more strongly shows the neces- sity for proper medical evidence on these occasions. The finding of the jury was contrary to all good medical experience, and was founded on a complete mistake. The researches of Esquirol, Farre', and others, show that insanity has a decided tendency to shorten life. So well aware are the insurance offices of this, that the ex- istence, or non-existence of insanity or mental derangement is now made a special question, to which an answer must be given in the declaration. The contrary opinion appears to have arisen from the hypothesis that insanity is not a bodily disease, and in no way con- nected with physical changes in the structure of the brain. Admit- ting this statement to be true, experience is decidedly against the inference based on it, when Ave look at insanity in the aggregate of cases. There was formerly an erroneous notion that insanity had a tend- ency to prolong life ; but more correct statistical researches have shown that the insane are more liable than the sane to various dis- eases, and that when attacked they sink more easily under them ; hence the mortality of the insane is, cceteris paribus, much above the average of that of the sane population. Among other fatal diseases, the insane are especially liable to attacks of paralysis and epilepsy; and paralysis, however slight, is commonly the fore- runner of death in these cases. In private asylums, the mortality is always less than in public hospitals ; but recent researches have shown that the mortality of the insane has been much reduced by the introduction of an improved system of management and treat- ment. Accurate observations have shown that the mortality among male is greater than among female lunatics, and the more advanced the age the greater the proportionate rate of mortality. The con- cealment of insanity in any of its forms, or even of a known hereditary tendency to this malady, would be considered material, 854 ACCIDENTAL CAUSES OF DEATH. inasmuch as either condition forms a special question to which an answer should be returned. Accidental causes of death. Death from sunstroke.^ — There are several offices which now insure persons against accidents occurring on sea or land, and it would seem at first sight that there would be less room for litigation under such circumstances. The proof of the accident and the amount of injury done, or (if fatal) the cause of death, would appear to be a simple matter. But the question arises — What is an accidental as distinguished from a natural cause of death? With our ideas of an accident, we generally associate physical injury or violence done to the person ; and if a man dies from any other cause, his death cannot be said to be accidental. This question came before the Court of Queen's Bench, in January, 1861 {Sinclair v. The Maritime Insurance Company), and the Lord Chief Justice delivered the judgment of the court. The action was brought by the administratrix of a person named Laurence, who, being about to proceed on a voyage as a master of a vessel, insured himself against any personal injuiy from any " accident" which might happen to him upon any ocean, sea, river, or lake. The assured being with his ship in the Cochin River, on the southwest coast of India, and being on duty on board his ship, was, in the language of the special case, " struck down by sunstroke," from the eftects of which he died in the course of the same day. The ques- tion was, whether the death arose from " accident" within the mean- ing of the policy, and the opinion of the court was that it did not. It was difficult to draw a line between a death from "accident" in a policy of this nature and a death from natural causes, such as should be of universal application. But the court might safely assume that in an " accident" some violence, casualty, or vis major was neces- sarily involved, and that a death from a known natural cause could not be considered as accidental. Disease or death engendered by exposure to heat, cold, damp, and the vicissitudes of climate or at- mospheric influences, could not properly be said to be accidental; at all events, not unless the exposure was brought about by circum- stances of an accidental character. Thus, if a mariner in the ordi- nary discharge of his duty caught cold and died, his death would not be accidental, though it might be so if by reason of shipwreck he was compelled to take to the boat, and died from exposure to wet and cold. In one sense the death was accidental, for the effect was uncertain beforehand; but it must be considered as the effect of natural causes, and not accidental. Sunstroke, so far as the court was informed of it, was an inflammatory disease of the brain, brought on by exposure to the intense heat of the sun's rays. To that disease persons exposing themselves to the sun in tropical cli- mates were more or less liable, just as persons exposing themselves to natural causes of a different kind were liable to diseases conse- quent therefrom. Death from "sunstroke" must therefore be con- sidered as arising from natural causes, and not from accident, and judgment will be given in favor of the defendants. LIFE INSURAlSrCE — ALLEGED SUICIDE. 855 In the case of a person being killed by lightning whose life was insured against accidental death, the question might arise whether such a mode of death was accidental or not. Death by lightning is certainly not a natural cause of death, and in common language any person killed by lightning is said to have died accidentally. [Where a death takes place in such manner that it may have happened from natural causes, the assured are not liable unless it is 'proved to have been caused by accident. Treio v. Ins. Co., 5 Hurls. & Norm. 211. A clause in a life-insurance policy provided in case " of a bodily injury to the insured of so serious a nature as to wholly disable him from following his usual business, occupation, or pursuits," for the payment of £5 per week during the continuance of such dis- ability. The insured, a solicitor and registrar of a county court, was confined to his bedroom for several weeks by a sprained ankle, and was consequently unable to attend to his business. It was held that he was "wholly disabled" within the meaning of the policy, and therefore entitled to recover. Hooper v. Accidental Ins. Go.., 5 Hurls. & ISTorm. 546.— P.] Suicide. — Among the conditions in policies of insurance, there is generally a stipulation in the contract that the policy shall be void if the person who insures his life commits suicide. Thus a medi- cal question may arise as to whether suicide was, or was not, com- mitted in a particular case. A person may die from poison, wounds, drowning, or other forms of asphyxia ; and it may be difficult to say in certain cases whether the death arose from accident, suicide, or from violence inflicted by another. Such cases are often left in great uncertainty at coroner's inquests — -the evidence received being imperfect or insufficient; because in cases of sudden death, provided there be no suspicion of murder, it is considered of little moment to make a strict inquiry. If the life of the deceased should happen to be insured under a policy containing this condition respecting suicide, the question may become of great moment to the interest of the insurers, and they will require clear evidence that the death was natural or accidental, and not suicidal, before paying the amount of the policy. The cause of. death should in all cases of violence be determined by a medical man: this will put an end to any dis- pute concerning the payment of the policy, and relieve the repre- sentatives from the trouble and expense of litigation. If the death be sudden, and any suspicious circumstances are left unexplained, it is certain that a civil action will follow. We are not therefore safe if, at a coroner's inquest, we suppose that we have only to satisfy a common jury by a hasty opinion expressed from an external view of the body, or an ill-conducted inspection, merely because it may appear to us quite certain that the deceased could not have been murdered. Should the deceased happen to be one of that class of persons on whose lives insurances are commonly effected, the whole of the circumstances connected with the examination of the body, and the medical opinion of the cause of death, must come to light. 856 LIFE INSURANCE — SUICIDE BY POISON. and if carelessly performed will probably be made the subject of a severe cross-examination. I have known several instances in which there have been painful exposures of this kind, because the medical witness thought any kind of evidence would serve the purpose of a coroner's jury. The verdict of a jury at an inquest is not binding on a company: they have not only a right, but often good reason to dispute it, and they frequently exercise this privilege. The In- surance Companies are- exiposed to all kinds of frauds, some of them of a most fearful kind, actually leading, as in the case of burial- clubs (a kind of life-insurance), to the perpetration of murder for the sake of the small amount insured. A case of some interest in reference to the question of suicide by poison, on the part of a person whose life had been only recently insured for a very large sum, was tried before Lord Tenterden in 1832 {Kinnear v. The Bock Insurance Company) ; the late Mr. J. H. Green, Mr. Key, and myself were called upon to give evidence on the part of the defendants. This trial would not have occurred but that the medical inspection of the body for the inquest two years previously had been most improperly conducted, and no satisfactory evidence of the cause of death assigned. As a sum of 10,000l rested upon the issue, the insurers felt that they had a right to de-" mand a full and perfect inquiry. The depositions taken at the in- quest on, decease were sent to me for examination, and from these it appeared that the person whose life was insured died two years before the action was brought ; the body was carelessly inspected for a coroner's inquest, and the contents of the stomach, without being subjected to any chemical analysis, had been thrown away. These circumstances placed great difficulty in the way of produc- ing proof, and in fact so far as medical evidence was concerned they left the question almost a mere matter of opinion. An application was made to me on the part of the Insurance Company, to know whether the exhumation of the body and any further processes of analysis would be attended with any benefit, but an answer was returned in the negative. From the manner in which the first examination had been conducted- — also from the fact that, as the symptoms under which the deceased had die,d could only have been presumptively those of narcotic poisoning, it was altogether impro- bable that, after two years' interment, any trace of narcotic poison would be discovered in the remains. The deceased — who, according to the evidence given at the trial, had been for some time in a low state of mind — returned to his house, in the Regent's Park, on the evening of the 19th October, 1830. The house was then undergoing repair ; his family were in the country, and the only person residing with him at the time was a man-servant. The account given by this person was that the deceased returned home about ten o'clock in the evening, apparently in his usual health : he ordered him to place a decanter of wine, a tumbler, and a wineglass on the library table adjoining his bed-room ; told him that he was going to take a composing draught, and desired 'that he might not be called on the following morning, saying that VITIATION OF POLICIES BY SUICIDE. 857 he would ring his bell if he wanted anything. The deceased went to bed, but about twelve o'clock the servant was awakened by a noise, as if the bar of the library-shutters had fallen. On getting up, he saw his master, without a light, in the act of returning from the library to his bedroom, which adjoined it ; he took a light from witness, and again went to bed. On going up stairs ten minutes afterwards, witness found the light extinguished, and the door of the deceased's bedroom fastened. On the next morning, at 9.30, witness went to deceased's bedroom, and knocked at the door as usual, but received no answer ; he went again at ten o'clock, but the door was still fastened, and the deceased did not answer when he knocked. The workmen who were employed in the house alarmed witness, about twelve o'clock, by telling him that they had heard his master moaning or groaning. A ladder was then pro- cured, and the room was entered by the window. The decased was in bed, and appeared to have just died as the witnesses entered. A surgeon was immediately sent for, who on his arrival examined and tasted some liquid which was found in a tumbler on the table. Search was made for a phial, but none could be found ; however, it was proved that there were on the library table a piece of blue and a piece of red paper, evidently the cover and wrapper of a phial, which were not there previously. It was also deposed that a cork and string were found in the fireplace. The window of the library was open, the shutters having been unfastened. The surgeon, who was called, stated that the body was lying in a composed state, the countenance being somewhat pale. There was perspiration on the skin, with patches of a livid color here and there distributed over it. The body was inspected for the coroner's inquest by two physicians and two surgeons. An accumulation of putrid blood is said to have been found in the stomach, with an efl:usion on either side of the chest. The vessels of the brain were somewhat turgid, but there was no extravasation. The contents of the stomach were thrown away without any chemical analysis having been made. It appears that the only approach to analysis was the drawing of a stick of nitrate of silver across the mucous membrane of the stomach at the time of the inspection. The cause of death assigned by these witnesses was the' rupture of a blood- vessel in the stomach. A verdict of " Death from natural causes" was returned ; the body was buried, and it was supposed that all inquiry had ceased. The cause of death assigned by the witnesses being considered altogether inadequate to account for this event ' under the circum- stances — the suddenness of death in a person who was in perfect health the evening before — the absence of any sign of effusion of blood in the brain, so frequently met with in sudden death from apoplexy — together with the circumstantial evidence that some liquid had been taken by deceased, and the phial disposed of, afforded a strong ground for suspicion. The insurers refused pay- ment of the amount of the policy, and demanded an inquiry. The circumstantial evidence not being of itself sufiicient to esta- 858 LIFE-INSURANCE — SUICIDE BY POISON. blish the fact of poisoning, additional evidence was required to determine — 1. "Whether the cause of death assigned by the wit- nesses at the inquest was adequate to account for it ; and 2. Whether, if not, the facts proved relative to the death of the deceased were consistent with narcotic poisoning — whether, in short, death by poison was, or was not probable. Mr. Green, Mr. Key, and myself were requested to give an opinion on these points. "With regard to the first, we said the cause of death assigned by the witnesses was inadequate and unsatisfactory. The blood found in the stomach was loosely described as half-putrid and not coagulated : so far from its being proved that it had been effused during life, it was not improbable, from the careless manner in which the inspection was made, that it had proceeded from some vessels divided by the examiners. Admitting that it had been effused during life, it did not furnish a satisfactory explanation of the cause of death, since the quantity was small. That it was not satisfactory to the inspectors themselves appeared certain from the fact that they examined the stomach for some kind of poison by the rough experiment of drawing a stick of nitrate of silver over the mucous membrane ! Further, gastric hemorrhage rarely de- stroys life on a first attack, and is generally accompanied by vomit- ing of blood ; but the deceased had never been subject to hsema- temesis, and there had been no bloody vomiting. With regard to the second question, the facts proved might be explained by supposing that the deceased had taken a poisonous dose of laudanum, or of some preparation of opium : it might be contended that no opiate was present in the stomach, but it did not appear that any analysis had been made. The deceased had died in about the period at which this poison operates fatally, and it was for the jury to determine from the circumstantial evidence, as the medical evidenfce wholly failed to throw light upon the subject, how far this was likely. We all agreed that narcotic poisoning in the deceased's case was, so far as we could speak in the absence of an analysis, probable, inasmuch as the facts proved respecting his death agreed with this view, and the results of the medical inspection so far as they went were quite consistent with it. On the other hand, the question might arise whether there were no natural causes which would have destroyed life within twelve hours in the same tranquil manner in which the deceased was supposed to have died. To this it may be replied, that apoplexy and other diseases might also have accounted for death ; but there was no evidence from the inspection to establish the existence of these, and death from a narcotic poison was, medically speaking, j ust as probable. In short, as the evidence was essentially of a negative kind, and there were two ways of accounting for death, either of them consistent with the medical facts, it remained for the jury to decide from the whole of the circumstances which was the more probable. The cause of death was entirely a matter of medical presumption. It was im- possible to swear that the deceased could not have died from apoplexy, or from the eflfects of a large dose of an opiate. As the VITIATION OP POLICIES BY SUICIDE. 859 case was only one of suspicion, and not of actual proof, a verdict was returned for the plaintiff. There can be no doubt of the propriety of the verdict, since the law always justly insists upon what the circumstantial evidence, combined with medical opinions, was here incapable of affording — namely, direct and not inferential proof oi death from poison. The insurers had alleged suicide by poison — this they were bound to prove by clear and distinct evidence ; the plaintiff was not required to show that the death was natural. If, besides the paper-wrappers, string, and cork, a phial which had evidently contained laudanum had been found, or the liquid in the tumbler, instead of being merely tasted or smelt by the medical gentleman and then thrown away, had been carefully analyzed, or had the same cautious pro- ceedings been adopted with regard to the contents of the stomach, clear evidence might have been adduced which would have satisfied the jury that the deceased had died from narcotic poison. In sup- posing that the deceased took a fatal dose of an opiate, it was as- sumed that he had disposed of the bottle by throwing it out of the library-window, which was found open after the shutters had been fastened: no traces of the composing draught which he had told his servant he should take were found — not even the phial — and the colored wrappers of paper, cork, and string found in the bedroom were not accounted for. The only point that went against the presumption of narcotic poisoning was this : the servant swore on the trial that his master's bell rang about nine o'clock. If this were true, the deceased could not then have been under the influence of a narcotic poison, as he must have walked across the room to have rung the bell. This would have given but three hours for the fatal operation of the poison, while most cases of poisoning by opium have not proved fatal in less than from six to twelve hours. Still, opium has been known to cause death within a short period. Sir R. Christison met with a case where the person died in three hours, and Dr. Beck another where death occurred in two hours and a half. But on comparing the evidence of this witness at the inquest and the trial, there was a great discrepancy. He said nothing of a bell ringing when examined at the inquest recently after his master's death (z. e. two years before the trial), when it might be supposed that the whole of the circumstances were fresh in his mind. Among the medico-legal questions connected with this subject is the following: Does the proviso in the policy respecting suicide in- clude all acts of self-destruction, or is it restricted only to those cases in which either a sane or a partially insane person consciously destroys himself? This question has been elsewhere considered (Chap. 66). The act of suicide does not necessarily indicate in- sanity; but even if it did, the rule of law, as settled by a majority of the judges in reference to this proviso in cases of life-insurance, is that whenever an insured person destroys himself intentionally, whatever may be the state of his mind, the policy is void. If a person, whether sane or insane, kills himself unintentionally, then 860 VITIATION- OF POLICIES BY SUICIDE. the insurei's are liable; but the onus of proof in this case lies upon the plaintiffs, i. e., those who wbuld benefit by the policy. Accord- ing to the practice of some offices, the act of suicide does not ren- der a policy void. [The leading English cases on this subject are Sorradale v. Hun- ter, 5 Mann. & G-rang. E,. 639, and Cleft v. Sohwaibe, 3 Mann., Grang. & Scott E.. 437. In the former ca,se, the provision was that the policy should be void if the assured "should die by his own hands." The assured threw himself into the Thames and was drowned. The jury found, however, that though this was done voluntarily, and with intent to destroy life, the assured " was not capable of judging between right and wrong." The majority of the court held the policy to be avoided. Chief Justice Tindal dissented, delivering a very able opinion sustaining his views. In the other case, the policy provided that it should become void if the assured "committed suicide." He did, in a fit of insanity, commit suicide by taking sulphuric acid. Crbswell, J., directed the jury that they must find for the plaintift", unless the assured, when he died by his own voluntary act, "was able to distinguish between right and wrong, and to appreciate the nature and quality of the act that he was doing, so as to be a responsible moral agent." Upon a bill of exceptions, this instruction was held to be erroneous, the majority of the court being of opinion that it was immaterial under the terms of the policy, whether the assured was, or was not at the time a responsible, moral agent. Chief Baron Pollock and Justice WiOHTMAN dissented, on the ground that as " soon as it is ascertained that a person has lost his sense of right and wrong, it matters not what else of the human faculties or capacities remain, and that he can no more commit suicide than he can commit mur- der." The same question arose in Breasted v. Farmers' Loan and Trust Co., 4 Hill (]Sr. Y.) E. 73; affirmed in 4 Seld. 299. The policy in that case provided that it should become void in case the assured should "die by his own hand." He committed suicide by drown- ing himself in the Hudson Eiver, being at the time of " unsound mind, and wholly unconscious of the act." The case came before the court upon a demurrer. ISTelson, C. J., delivered the opinion of the court, giving judgment for plaintiff. A similar decision has recently been made by the Supreme Court of Maine upon an insurance effected by Joseph Esterbrook, who afterwards became deranged, and committed suicide by shooting himself (Legal and Insurance Eeporter, Sept. 1866, p. 281.) As to the construction of the words " die by his" own hand/' see Hartman v. Keystone Ins Co., 9 Harris (Penna.) 466. — P.] M. Brierre de Boismont reports a case which is also instructive in reference to this difficult question. On the 12th of October, 1840, a man was found dead, apparently strangled, on the road to Stettin. His affairs were found to be in an unsettled state, and it was supposed he had destroyed himself; but the position of the body, and the condition in which it was found, were apparently « VITIATION OF POLICIES BY SUICIDE. 861 not consistent with this theory. The hands were tied behind the back, and there were the appearances of a robbery. As all the cir- cumstances pointed to a violent death at the hands of another, a judical inquiry was made, which, from want of evidence, led to no important result. The deceased, who was a merchant, had recently effected an insurance on his life for the amount of 40,000 francs, which was to be paid to his family on his death, except in case of his committing suicide. This sum was paid into court, and was subsequently reclaimed by the office on the ground that the de- ceased had destroyed himself. A witness had come forward with an autograph letter of the deceased, in which he had described the motives that had led him to perpetrate the act, and the mode in which he had carried out his design. This document clearly proved that he had sacrificed his own life for the sake of his family, in order to preserve them from impending ruin. According to the private letter to his friend, which had every appearance of authen- ticity, he had suspended himself to a beam, from which a friend, according to a previous arrangement, had cut him down, and had then disposed his body on the high road, under such circumstances as to give the impression that he had been the victim of a murder- ous assault. ("Ann. d'Hyg.," 1866, 2, 397.) The attempt thus made to defraud the Insurance Company by hastening the terra at which the insurance would fall in, and by falsifying the conditions of the policy, was defeated by the production of a private letter. There is another kind of fraud which perhaps is more common, namely, that in which the insured simulates death in order that his relatives or creditors may receive the amount of the insurance. Two instances of this kind of fraud have been related in a former part of this work. In one, the insurer endeavored to make it appear that he lost his life while bathing on the sea-shore, his clothes being found on the steps of a bathing-machine; in the other, the case of a fraudulent bankrupt, the man registered his own alleged death, and followed his own coffin to the grave in a country churchyard ! In both cases the fraud was detected, and the offices were saved from a heavy loss. It is naturally supposed that a man has a direct interest in pre- serving his own life, but this of course will not prevent him from falling a victim to the criminal designs of a another. The insurable interest of a person in the life of another became an important question in January, 1863, in Hebdon v. West. The plaintiff, a clerk in a banking-firm, had effected an insurance on the life of one Ped- der, who was a member of the firm. Plaintifl' became indebted to the firm for a sum of 5000^., and Pedder having informed the plain- tiff that he should not be troubled with any demand for repayment during his (Pedder's) life, the plaintiff insured Pedder's life in the defendant's company for the sum of 2500^. It was the payment of this sum to the plaintiff that was now in dispute, the defendant con- tending that plaintiff' had no insurable interest in the life of Pedder. The case was argued, and the court put to counsel the cases which had been already decided, of a father insuring his son's life or a 862 iNSURAisrcE murders. husband his wife's. It had been held that in these cases there was no insurable interest. Ilence, when a husband desired to make a provision for his wife, he insured his own life — she did not insure his. Further, they instanced the remarkable case of Wainwtnght (p. 863), in which that person induced his sister-in-law to insure her life, and then poisoned her, in order, as next of kin, to get hold of the sum assured. That case showed the immense importance of the law requiring a real interest in the life of a person whose life was insured. The result of the argument was that the court re- served its judgment ; but there appeared to be no agreement con- cerning what was a legal insurable interest in the life of another. [See Beese v. Mutual Ins. Co., 23 JST. Y. (9 Smith) 516 ; Bawls v. Insurance Co., 36 Barb. {1^. Y.) 337. In the latter case it was held that a creditor's insurance upon the life of his debtor was not in- validated by the running of the statute of limitations against the debt before death. — P.] Insurance murders. — The insurance of lives has been considered to be objectionable," on the ground that it tends to create an interest in the death of another, and thus to lead to secret acts of murder. The 14th ^George III. c. 48, expressly enacts that no insurance on life shall be valid unless the person insuring has a direct legiti- mate interest in the person whose life is insured. This statute was enacted for the purpose of preventing gambling in policies, and to guard society against the risk of persons insuring contriving the death of the insured for the sake of the payments to be made under the policy ; but its effect is simply to render the policy void ; it does not require that the pi'emiums shall be refunded, nor does it award any penalty on the oftenders. As policies of life-insurance may be bought and sold like other property, they may fall into the hands of persons who have no other interest in them than the desire that such policies should speedily become claims by the death of the insured. The interest of such holders, it has been justly observed, lies in the death and not in the life of the insured. [In a recent case in Pennsylvania, JSlliott's Executor's A'p.^ 14 Wright 75, it was decided that the assignment of policies of life in- surance by a debtor who was insolvent when insured, in trust for the benefit of his wife, is fraudulent and void as against creditors. But that policies effected without fraud directly and on their face for the benefit of the wife and payable to her, are not fraudulent as to creditors. — P.] A case is related in which a man was found dead at St. Fergus, in Scotland, from a pistol-shot wound under very suspicious circum- stances. The medical and moral facts were not consistent with the theory of suicide ; on the contrary, they all pointed to a cool and deliberate act of murder. A medical man was placed on his trial for this alleged crime, and the motive assigned for the act was that the prisoner had recently effected insurances in three dift'erent offices to the amount of about 2000^., upon the life of the deceased — a poor man, in whose life it was proved he could have had no INSURANCE MURDERS. 863 lawful pecuniary interest. The insurances were only for short periods, and as in the Scotch offices the policies are not rendered void by suicide, the amounts could be claimed even assuming that the deceased had destroyed himself. The body, weapon, and other objects had, it was supposed, been arranged with a view to make it appear that the act was suicidal. It is a significant fact, however, as a key to explain the death of the deceased and the mo- tive of the accused, that the risk connected with the largest in- surance (lOOOZ.) commenced on the 24th N^ovember, 1852, and ter- minated on the 24th November, 1853. Only one premium to the amount of about eleven pounds had been paid, and this payment was proved to have been made by the prisoner. The deceased was found dead on the 20th November, 1863 ; {. e., only four days before the date at which the policy of insurance on his life would have lapsed. The evidence went to show that the accused had the mo- tive, means, and opportunity of committing this crime ; but as there were no circumstances which could directly fix it upon him, he was acquitted of the charge. A remarkable case was tried in this country in 18^5 (Wainivright V. Bland, Exchequer, 29th June, 1835), in which the amount of a policy of insurance effected for two years on the life of a Miss Ahercromby was sought to be recovered. The action was brought against the Directors of the Imperial Assurance Company, and was resisted by them on the grounds that the lady had been destroyed by poison, and that the plaintiff Wain wright had no lawful pecuni- ary interest in her life. As there is strong reason to believe that this was one of the first murders brought about by the use of strych- nia in this country, it may be considered as the type of those which twenty-one years afterwards were for a time successfully perpetrated by the criminal William Palmer. Strychnia had been discovered only twelve years previously, and it was then but little known as a poison either in England or France. The history of the case is re- markable, as the real cause of death was completely overlooked. Two fine-looking young women of the name of Abercromby, the daughters of a deceased officer, with no other property than pen- sions of ten pounds a year from government, lived a few miles out of town with a man of the name of Wainwright and his wife, who were also in reduced circumstances. They came to London in 1880, as the winter was setting in, and took lodgings. The elder girl, having just attained her twenty-first year, was sent, sometimes alone and sometimes with her sister, to no fewer than eight or ten insurance offices, to effect insurances at each on her own life. Being in full and vigorous health, she met with a favorable reception from several offices, although she could assign no other reason for wishing to in- sure her life than that she was told it was right for her to do so. Five offices granted policies in her own name, some for two, others for three years, for no less a sum than 16,000L Among them the Imperial, in October, 1830, accepted an insurance on her life for two years for 3000^. On the 13th of the following December, when in perfectly good health, she madfe her will, and assigned this and other 864 INSURANCE MUEDERS. policies to the plaintiff Wainwright and his wife. On the evening of this day the whole party went to a public theatre, and on their return had a supper of oysters and porter. On this occasion Miss Abercromhy was first taken ill ; it was said she suffered from an hysterical attack, but there is no clear account of her illness at this time. It was not until the 16th that she was seen by a physician, but her illness was not such as to excite alarm ; it was supposed to be hysterical. On the 21st this physician was called suddenly to her, and he then found her in violent tetanic convulsions, resembling those which are sometimes the effects of a wound, i. e., tetanus. She said she was sure she should die, and she suddenly went off into a fit of convulsions. The physician left the house, returned in about an hour, and she was then just dead. The appearances presented by the body are imperfectly reported ; there was an effusion of serum at the base of the brain, and to this death was referred. There was no analysis of the contents of the stomach ; it is said they were minutely examined, and that there was no appearance of anything sufiicient to account for death ; but the person to whom this ex- amination was intrusted was not called to the trial. Wainwright, as executor and trustee, applied for payment of two of the policies which had been assigned to him, but this was refused. He then went to France with his family, and five years afterwards (in 1835), through an agent, brought an action against the Imperial Assurance Company. On this occasion the jury could not agree in a verdict. (" Med. Gaz.," vol. 16, p. 606.) An- other action was afterwards brought against the company, and the facts above stated came out at the trial. The Attorney-G-eneral said that the plaintiff' had left the country, and there was good reason to believe that he would never again return to it. The judge charged the jury that, whether murder had been committed or not, the executors could recover, provided the insurance had been ef- fected bond fide on behalf of the deceased. His lordship directed their attention to the extraordinary fact of this young lady, the deceased, having effected these large insurances for only two years ; of her sudden illness and death in convulsions soon after the assign- ment of the policy ; and reminded them that no proof had been adduced to substantiate the reasons she had given to the various offices for effecting the insurances on her life. By the will and assignment made to the plaintiff and his wife, these persons were placed in a situation in which the law would not allow any one to stand — namely, that of having a strong interest in procuring the death of a fellow-creature by unlawful means. The jury returned a verdict for the insurers, on the ground of misrepresentation and want of interest. There can be no doubt that this young woman died from the effects of a dose of strychnia, administered to her, shortly before she was seen by the physician on the afternoon of the 21st Decem- ber. Tetanus, as it is produced by this poison, is rapidly fatal ; but as it arises from wounds, it comes on slowly, and is only fatal after some days; and there was no wound, or other natural cause to ac- INSUKANCE MURDBES. , 865 count for its occurrence. Wainwright was subsequently tried, con- victed of forgery, and transported. He died many years afterwards in one of our penal settlements, and, before his death, it is reported that he substantially admitted that he destroyed Miss Abercromby and several other persons by strychnia. Someof the poisonings which took place at Rugeley in 1855-6, and which culminated in the conviction and execution of the noto- rious 'WilUa7n Falmer for the murder of J. P. Cook, originated in the easy system of raising money by the insurance of lives. The body of Ann Palmer, the wife of the prisoner, had been lying fif- teen months in the grave, under a professional burial certificate of death from bilious cholera, when the sudden death of Cook and the detection of antimony in his body, led to the exhumation of the body of this lady. It was then found that she had died from the effects of antimony, which was detected by Dr. Rees and myself in all parts of the body, even in the ovaries. When the history of the illness which preceded death was gone into, it was found that the symptoms were consistent with the effects of tartarized anti- mony, but not with those of bilious cholera, or any other disease. Antimony had not been prescribed for the deceased during her illness, and it was therefore clear that it must have been adminis- tered to her by some one, up to within a short period of her death. "With an actual life interest in his wife's property to the extent of only 3000^., and within the short period of nine months of her death, William Palmer made, or caused to be made, proposals for insuring her life in eight different offices for an aggregate sum of 33,000^. Three of these proposals made by himself — to the iN^orwich Union in December, 1853, for 3,000/. ; to the Scottish Equitable in Janu- ary, 1854, for 5,000/. ; and to the Sun in February, 1854, also for 5,000/. — were accepted by these offices. He thus contrived in less than three months to eff^ect a total insurance of 13,000/. to cover a life-interest of 3,000/. on his wife's property ! The other proposals, to the amount of about 20,000/., were declined by the offices to which he applied. The total premiums paid by Palmer on the- three policies amounted to 888/. ; and he was at the time so pressed for money, that he drew a bill which was actually discounted on the security of the policies, so that he contrived to make the policies pay for themselves. As he was in embarrassed circum- stances, and unable to meet bills of this kind without becorning still more deeply involved in debt, the realization of the policies by the death of his wife became to him a matter of necessity. Within little more than six months after effecting the insurance on her life, the wife died from poison^ under his immediate superin- tendence. On her death, these large sums were claimed by Palmer,. and were paid to him by the offices. Although there was at the time some suspicion that the wife had died from poison, there was no inquest or inspection, and the body was hastily buried. These facts only came to light more than a year afterwards, during the investigation of another murder in 1855. It seems that the general respectability of Palmer, his social and professional position, to- 55 866 INSURANCE MURDEBS. gether with the two medical certificates of the cause of the death of the wife, checl^ed any intention which might have existed on the part of these offices to resist the payment of the policies. Wil- liam Palmer, however, carried his life-insurance speculations much further than this. Having no pecuniary interest whatever in the life of his hrother, "Walter Palmer, he either made or induced him to make proposals for the insurance of his life, in various offices, to the amount of 82,000^. The Prince of Wales office accepted the proposals to the extent of 13,000^. under certain limitations. On the 16th August, 1855, "Walter Palmer died suddenly, in the pre- sence of his brother and another man of doubtful character, with Avhom he had recently placed him as a lodger; and it was rendered highly probable, if not proved, that the prisoner William had shortly before purchased at a druggist's a bottle of prussic acid. The policy had been previously assigned by "Walter to William, for a nominal consideration ; but when William Palmer made applica- tion for the amount after the death of his brother, the office refused payment ; and, for very good reasons. Palmer failed to enforce it. He subsequently tried, but ineft'ectuallj^ to insure, to the extent of 25,000/., the life of his groom, George Bates, described by him in his proposal as a "gentleman" of independent means; and he advised a man named Cheshire, the postmaster of Rugeley, also to make proposals on his life to the extent of 5000/. and assign the policies to him. But for the revelation of facts connected with the death of Cook, these two persons on whose heads a heavy life- insurance value had thus been set, would have been the next vic- tims. Thuggism, as formerly perpetrated in India by a certain class of Hindoos, might be regarded as a venial oiFence compared with this professional mode of raising large sums of money upon human life. It is now the custom of Offices to require a statement whether the life has been already proposed to other Offices, and whether the proposal has, or has not been accepted. But this is only a partial method of checking such nefarious speculations. In France and most Continental States insurances of this kind are said to be strictly forbidden, not for the prevention of gambling (which is rather encouraged), but in order to guard society against the risk of the persons insuring contriving the death of the insured. That these regulations are not sufficient to guard against secret murder and speculation in human life is, however, clearly established by the case of Dr. De la Pommerais, who, in May, 1864, was con- victed in Paris of the murder of a woman named Pauw. The reader will find an account of the medical circumstances connected -with this act of murder, which equals, if it does not surpass in atrocity, the murders perpetrated by "William Palmer on his wife and brother, in vol. 2, p. 438, of " The Principles and Practice of Medical Jurisprudence," 1873. De la Pommerais had first cohabited with the deceased. Having thrown her off, he married, in August, 1861, a lady of some fortune, Madlle. Dubizy. Some time after the marriage, the mother of this INSURANCE MURDERS. 867 lady died under very suspicious circumstances, as it was supposed, from poison administered by the prisoner. In June, 1863, he sud- denly, and without any apparent cause, renewed his intimacy with the deceased Pauw, who was living in great poverty with several of her children. Having advanced to her small sums of money, amounting on the whole to about 211, he induced her to insure her life in various Insurance Offices for the sum of 22,000^., and after^ wards to assign the policies to him. The reasons which he gave for effecting these insurances were— partly that he had advanced to the deceased large sums of money (4000^.), and partly that, in the event of her death, he wished to provide for his illegitimate children. The first statement was proved to be untrue, and the second was inconsistent with the claims which he subsequently made. on the Offices. The woman was examined, found to be in good health, and insurances on her life were effected for two or three years, to the large amount above stated. La Pomraerais paid the first premiums, amounting to 600^. He had thus entered into engagements for three years to pay in premiums a sum of about 800^. per annum, when his practice did not bring in more than 400?. per annum, and he had no other resources. He induced the de- ceased to feign that she was ill and had met with an accident; but the surgeons and physicians whom she consulted found, on exami- nation, that there was nothing the matter with her, with the excep- tion of a few attacks of vomiting. She continued well up to the 16th of November, when the prisoner visited her, and passed the evening with her. She was taken very ill that night, and after violent vomiting and convulsions, with fainting, she died on the morning of the 17th, and it was proved, from the effects of digi- taline, — a large quantity of which the prisoner had purchased some time before, and of the disposal of which he could give no satisfac- tory account. He found no difficulty, however, in procuring a medical certificate to the effect that deceased had died from gas- tritis and perforation of the stomach. The policies of assurance had been assigned to him by the deceased shortly before her death ; and it was the early claim which he put in for the payment of them that first led to suspicion. There was no answer to the charge of murder by the administration of digitaline, and the prisoner was convicted and executed. The proper method to stop this secret system of murder would be by placing severe legal restrictions on the sale or assignment of policies, and by preventing the purchase of them by strangers, who can only have an interest in the death of the insured at the earliest possible period. The burial-club murders are said to have been much checked by a regulation which prohibited a person from re- covering under this species of insurance more than the amount proved to have been actually paid for the funeral. It would be well if this principle were universally carried out, but from the evidence given at the trial of Mary Ann Cotton {Beff. v. Cotton, Durham Lent Assizes, 1873), there is reason to believe that in- surances on lives are still secretly effected simply for the purposes INSURANCE MURDEES. of murder. The prisoner was indicted for the murder by poison of her stepson, who died in July, 1872. The body of the deceased was exhumed, and arsenic was detected in it. This was the sole cause of death. This woman, it was stated upon well-ascertained facts, had at different times killed by poison her mother, fifteen children, three husbands and a lodger — making altogether twenty persons ; and the lives of most, if not all, of them were insured. In some of these cases she had claimed, and received from the In- surance Offices, the pi-emiums on these deaths. One of her three husbands thus disposed of and four of her children, were insured in the British and Prudential Insurance Office. They died rather rapidly one after the other, and the medical man assigned gastric fever as the cause of death, when the symptoms vs^ere not consistent with this cause. The prisoner obtained from the Office a sura of thirty-five pounds by the death of this husband, and some smaller amounts from burial-clubs, by the deaths of the children ! She then married a man with a family of children, and was very anxious to have his life and the lives of his children insured. One day he found her at an Office trying to procure an insurance on his life. He left her, and his life was thereby saved. This woman was very properly convicted and executed. No toxicomania was pleaded in defence ! It is clear from the evidence in this and other cases, that some of the Insurance Offices which find clients among the poor, furnish great facilities for such murders, arid that the managers are not sufficiently careful in making inquiry into the means, motives, and objects which induce persons in this class of life to effect in- surances on the lives of others. The trial and conviction of this criminal for these insurance murders bi'ought to light another fact, namely, the great insecurity of life in this country, owing to the perfunctory manner in which medical men discharge an important duty in filling up certificates of the causes of death. With fully-marked symptoms of arsenical poisoning, these sudden and violent deaths were registered, one after the other, as gastric fever. A public writer, commenting on these cases, justly observes: "Are the symptoms of arsenical poisoning so subtle that trained doctors cannot be expected to notice them ? Is it creditable to medical science that a man should be allowed to die ■ with a fatal quantity of arsenic in his stomach without foul play being suspected? But perhaps the greatest wonder is, that a woman could successfully practice for so many years a system of poison- ing, without betraying her dreadful secret, or awakening more than once material distrust among her neighbors." The success of this criminal depended, first, on the facilities for insuring the lives of others in a low class of Insurance Offices, and, secondly, on the carelessness with which causes of death are certified. INDEX. ABDOMEN, wounds of the, 357 Abortion, 526 causes of, 527 from drugs, 530 from injections, 538 signs of in the living and dead, 538 feigned, 540 law relative to, 540 medical responsibility in cases of, 545 proofs required, 546 Abortives, specific, 531 Abstinence, effects of, 487 Accidental wounds, 275, 279 Acetate of lead, 170 of copper, 173 of morphia, 208 Acetic acid, 126 Acid, sulphuric, 110 nitric, 115 hydrochloric, 119 oxalic, 120 acetic, 126 arsenious, 140 arsenic, 159 carbolic, 191 prussic, 212 carbonic, 447 sulphurous, 456 tartaric, 125 hydrosulphuric, 466 Acid poisons, 110 Aconitina, 248 Aconite, poisoning with, 245 root mistaken for horseradish, 247 leaves and seeds of, 247 Aconitum napellus, 245 Adipocere, 75 -SJthusa cynapium, 244 Affiliation, evidence in cases of, 660, 683 Age, medical questions concerning, 636 for prooreative nower, 681 impotency deplnding on, 682 of the new-born child, rules for determin- ing, 550 Aidoiomania, 810 Air, in veins, a cause of death, 356 confined, suffocation from, 458 of drains and sewers, composition of, 471 Alcohol, poisoning with, 222 Algaroth, powder of, 180 Alienation, mental (See Insanity.) Alkalies, poisoning with, 127 Allotropic phosphorus, action of, 138 Almond-flavor, 218 Almonds, bitter, essential oil of, 218 Aloes, noxious effects of, 186 Ambidextrous persons, wounds by, 280 Amenorrhoea, 494 a cause of insanity, 692 Amentia, 742 Ammonia, poisoning by, 129 Ammonlated mercury, 167 Ammonio-chloride of mercury, 167 Amnii, liquor, stains of, 546 Amorphous pliosphorus, 138 Analysis, articles preserved for, 27 fallacies connected with, 28 Anamirta cooeulos, 229 Androgyui and androgynae, 668 Animal irritants, 192 Antimonv, tartarized, poisoning by, 176 chronic poisoning by, 179 chloride of, 182 Apncea, death from, 384 Aqua-fortis, 115 Areolae of the breast, state of, in pregnancy, 496 Arrowroot, detection of, 583 Arsenates, alkaline, poisoning by the, 159 Arsenic, 140 eating, 85 symptoms caused by, 140 .post-mortem appearances, 142 death from external application, 143 analysis as a solid, 144 in solution, 146 Marsh's process for, 147 Reinsch's process for, 148, 154 detection of, in organic mixtures, 149 sulphides of, 159 acid, 159 Arsenious acid (see Arsenic), 140 Arsenites, alkaline, poisoning by, 156 Arsenite of copper, 157 in paper-hangings, 157 Arsenuretted hydrogen, fatal effects of, 159 tests for, 147 Arteries, wounds of, 354 Arterial and venous blood, 298 Artificial inflation of the lungs, 569 Asphyxia, death from, 58 various forms of, 384 from mechanical causes, 443 from gases, 446 Assizes, trial at the, 39 Atelectasis of the lungs, 564 Atelectasis a cause, of still-birth, 59 Atropa belladonna, 249 Atropia, 251 Attesting witnesses, 779 870 INDEX. BACON, 196 Ballottement in pregnancy, 500 Balls, apertures produced by, 369 deflection of, 370 Barber's poisoned wheat, 230 Barium, chloride of, 132 Baryta, poisoning by, 132 Bastardy, adulterine, 639 Battle's vermin killer, 236 Bearsfoot (Hellebore), 188 Belladonna, 249 Bestiality, 724 Bichloride of mercury, 160 Binoxalate of potash, 125 Birth, concealment of, 524 proofs of, in criminal law, 554 date of, 620 partial and entire, 620 proof of, in civil law, 622 plural, 639 monstrous, 634 Births, premature, 645 protracted, 650 posthumous, 662 Bismuth, subnitrate, 184 arsenic in, 185 Bitter almonds, essential oil of, 218 Black hellebore, 188 Bladder, rupture of the, 360 Blistering-fly, poisoning by, 192 Blood on weapons, 235, 297 on clothing and furniture, 288. 292 marks of, in death from wounds, 289 tests for, 291 arterial and venous, 298 corpuscles of, 303 on linen, 292 human and animal, 305 optical examination of, 301 loss of, a cause of death, 311 extravasation of, on the brain, 343 in cases of abortion, 546 in stomachs of new-born children, 585 menstrual, 723 Blood-crystals, 307 Blood-stains, examination of, 291 on linen, 292 date of, 292, 302 distinguished from rust and fruit stains, 295 microscopical examination of, 303 spectral examination of, 301 guaiacum process, 300 in cases of abortion, 546 of rape, 723 Blows or falls, injuries produced by, 266 Blue vitriol, 173 rocket, 245 Body, cooling of the, in death, 62 destruction of the, by fire, 380 specific gravity of the, 398 inspection of the, in cases of poisoning, 23 position of the, in death from wounds, 283 position of the, in death from hanging, 418 Bones, fractures of the, 363 Books, quotations from, 48, Born alive, signification of, in criminal and civil law, 554, 629 Brain, wounds of the, 348 Breasts, changes in pregnancy, 496 Brick-kilns, vapor of, 467 Broom-tops as an abortive, 530 Brucia, effects of, 239 Buoyancy of the body, living and dead, 395 Burnett's fluid, poisoning with, 183 Burning, homicidal, 380 Bdrns and Scalds, 375 on the living and dead body, 375 the result of accident, homicide or sui- cide, 375 by corrosive liquids, 381 from lightning, 479 Butler's vermin killer, 236 Butter of antimony, 182 riADAVERIC rigidity, 63 \) Csesarean extraction, 631 Calabar bean, poisoning by, 230 Camphor, poisoning with, 227 Canalis venosus, closure of the, 582 Cantharides, effects of, 192 detection of, 193 Cantharidine, 193 Capacity, testamentary, 774 test of, 774 Carbonates of potash and soda, 128 of ammonia, 130 of baryta, 133 of lead, 172 Carbolic acid, 191 Carbonic Acid, suffocation by, 447 symptoms caused by, 449 appearances in death from, 456 analysis, 450 combustion in mixtures of, 451 of lime and brick-kilns, 457 Carbonic oxide, 455 Carburetted hydrogen, suffocation by, 459 Carnal knowledge, 699 Carotid arteries, wounds of the, 355 Catamenia (see Menstruation), 494 Caustic alkalies, poisoning with, 127 Cement-kilns, vapors of, 457 Cerebral or narcotic poisons, 86, 205 Cerebro-spinal poisons, 86 Certificates of insanity, rules regarding, 752 Ceruse, poisoning by, 172 Cesspools, effluvia of, 469 Charcoal vapor, effects of, 452 Chest, wounds of the, 351 changes produced in the, by respiration, 568 Child-murder, 648. (See Infanticide.) Child, legal detention of a, 575 new-born, age and maturity of, from the sixth to the ninth month, 560 evidence from development of, 646 inspection of the body of, 553 changes in the body of the, after birth, 679 Children, supposititious, 666 Chloride of barium, 132 of mercury, 160 of antimony, 182 of zinc, 183 of iron, 184 Chloroform, poisoning with. 224 Cholera mistaken for poisoning, 94 Cholesterine, 588 Chronic poisoning, 100 INDEX. 571 CHROifio Poisoning by phosphorus, 135 by arsenic, 141 by mercury, 161 by lead, 172 by antimony, 179 Chronic insanity, 747 Cicatrization of wounds, 336 Cicatrices, 337 colored, 339 Cicuta virosa, 242 Cider poisoned with lead, 173 Circulation, cessation of the, in death, 57 Circulation, foetal changes in the, 580 Circumstantial evidence, in wounds, 282 Citrate of iron mistaken for blood, 297 Classification of poisons, 86 Coal-vapor, effects of, 462 gas, suffocation by, 459 Cocculus indicus, poisoning with, 229 Coke-vapor, effects of, 452 Colohioina, 188 Colchieum, poisoning with, 187 Cold, death from, 483 infanticide by, 601 Coldness of the body in death, 62 Colic, painter's, 172 Colica pictonum, 172 Colocynth, effects of, 186 Color-test, influence of morphia in disguising, in strychnia, 239 Colostrum of milk, 584 Coma, or death by the brain, 59 Combustioi), human, alleged, 380 in carbonic acid and air, 451 Commissions of lunacy, 760, 769 Compression of the brain, 343 Concealment of pregnancy, 504 of delivery, 508 of birth, 524 of sex, 678 Conception, date of, 641 Concussion of the brain, 341 and intoxication, 342 Concussion of the spinal marrow, 349 Confessdons in drunkenness, 811 Confined air, effects of, 458 Congenital diseases in new-born children, 593 Conia, 241 Conium maculatum, poisoning with, 240 Contracts of lunatics, 771 Contused wounds, 268 Contusions on the living and dead, 262 Cooling of the body after death, 62 Copper, arsenite of, 157 poisoning by salts, 173 in articles of food, 175 Copperas, poisoning with, 184 Cord, umbilical, death from laceration of, 591 length of the, 606 strangulation by the, 609 Cord, mark of the, in hanging, 409 in strangulation, 423 Coroner's inquests, 37 Corpora lutea, 517 Corrosion distinguished from ulceration, 104 Corrosive liquids, burns from, 381 Corrosive poisons, 87 CoEEOsivE Sublimate, symptoms of poison- ing with, 160 post-mortem appearances, 162 tests for, 163 in organic liquids, 164 Counsel, license of, 42 privileges of, 47 Courtesy, tenancy by, 628 Cranium, fractures of the, 269, 347 accidental in the new-born child, 603 Cretins, 742 Criminal abortion, 526. (See Abortion.) Criminal responsibility in insanity, 781 in drunkenness, 810 somnambulism, 818 in deafness and dumbness, 818 Croton oil, poisoning with, 187 Crying, evidence of live birth, 624 CrypsorchiHes, virility of, 685 Cuts and stabs, 271 Cyanide of silver, 214 of potassium, 217 DALEY'S carminative, 207 Date of birth, 620 of conception, 641 Datura stramonium, 255 Daturia, 256 Dead, wounds and contusions on the, 261 Dead body, examination of the, 22 burning of the, 380 Deadly nightshade, 249 Deaf and dumb, 818 Deafness and dumbness, feigned, 819 Death, signs of, 60 causes of sudden, 57 muscular irritability after, 64, 66 reality of, 65 apparent in new-born children, 365 acceleration of, in personal injuries, 320 from surgical operations on wounded per- son, 329 proof of in cases of life insurance, 823 presumption of, 824 Debility, death of a new-born child from, 591 Decay, food rendered poisonous by, 203 Declarations of dying person, 33 Defloration, signs of, 710 Deformities, evidence from, 659 Deformities, sexual, 668 of the face from wounds, 349 Delirium mistaken for insanity, 738 Delirium tremens, following wounds, 329 in reference to insanity, 752 in drunkards, 814 Delivery, 507 in the living, 508 at a remote period, 510 feigned and unconscious, 511 during sleep, 512 signs of, in the dead, 575 protracted, death of the child from, 591 sudden, in the erect posture, 606 violence inflicted on the child during, 607, 611 locomotion and exertion after, 607 Delusion in insanity, 734 in reference to testamentary capacity, 773 De lunntico inquirendo, 760 Dementia, 741 senile, 744 Dementia naturalis, accidentalis, 733 Derangement, mental, 729 Destructive things, 81, 83 Development of child, evidence from, 623, 646 De ventre inspioiendo, writ of, 602 872 INDEX. Diaphragm, wounds of the, 356 Digitalis, poisoning with, 264 Digitaline, 255, 867 Dipsomania, 810 Direction of wounds, 278 Discharge of lunatics, 768 Diseased flesh, poisonous, 193 Disease, influence of, on poisons, 90 Dislocations, 366 Divorce, medical evidence in suits of, 696 Docimasia pulmonaris, 563 circulationis, 680, 582 Douttful sex, 668 Drains and sewers, noxious gases of, 469 Dress, examination of the, in wounds, 272 Dkowningi, cause of death from, 384 death from secondary causes in, 388 appearances in, 386 medical proofs of, 393 buoyancy of the body in, 397 marks of violence in cases of, 399 homicidal or suicidal, 401 from partial immersion, 402 a cause of death in new-born children, 598 Drugs used as abortives, 530 Drunkards, restraint of, 769, 813 Drunkenness, responsibility in cases of, 810 interdiction in cases of habitual, 769, 813 as affecting degree of guilt in homicide, 815 Ductus arteriosus, closure of, 681 Dumb, responsibility of the, 818 Dyes, red, mistaken for blood, 295 Dying declarations, rules respecting, 22, 23 EARTHENWARE, wounds from, 268 Eccentricity mistaken for insanity, 740 in wills, 776 EccHYMOSis, from violence, 262 changes of color in, 263 ■ production of, after death, 264 not always a result of violence, 265 in hanging, 409 in strangulation of the umbilical cord, 611 natural marks resembling, 613 caused by lightning, 481 Eclampsia, 512 Eczema from arsenic, 142 Effusion of blood (see Extravasation), 279 Effluvia of drains and sewers, 469 Electric fluid, action of, 475. (See Light- ning.) Embryo, examination of the, 520 Emerald green, poisoning with, 158 Emetic, tartar, poisoning with, 176 Epispadias, 639 Epithelial scales, 584 Ergotin, 634 Ergot of rye as an abortive, 531 Erotomania, 810 Erysipelas following wounds, 329 Essence of mirbane, 219 Essential oil of almonds, 218 Ether, poisoning with, 224 Evidence and testimony, 54 Evidence, medical, 41 rules for the delivery of, 53 Evidence of poisoning in the living, 89 in the dead, 98 notes, when and how used in, 28 circumstantial, in wounds, 282 Examination in chief, 46 cross, 46 Examination of wounds, 260 of weapons, 267, 271 of fire-arms, 375 the female in child-murder, 617 of lunatics, 762 Excitement a cause of extravasation, 346 Exhaustion, death from, 311 Exhumation of bodies, 25 Extent of wounds, 276 Extract, Goulard's, poisoning with, 172 Extravasation of blood on the brain, 343 date of, 347 FACE, wounds of, 349 Facts, specification of, in insanity, 763 Family likeness, evidence from, 657 Fasting, long, effects of, 487 Fatuity, 741 Fat poisoned by lead glaze, 173 Features, evidence from the, 657 Fecundity in women, 695 Feigned poisoning, 76 wounds, 273 strangulation, 434 pregnancy, 501 menstruation, 495 delivery, 611 abortion, 540 insanity, 746 deafness and dumbness, 819 Fern, decoction of, as an abortive, 530 Fever, death from, after wounds and opera- tions, 331 Fire-arms, examination of, 375 Fish, poisonous, 194 Flagellation, death from, 315 Fleming's tincture of aconite, 246 Fish, diseased, poisoning by, 194 Flogging, military, death from, 315 Flour, accidental poisoning of, 173 Fly-paper, 157 Fly-water, death from, 167 Fcetal circulation, changes in the, caused by respiration, 680 Fcetal stomach, contents of the, 582 Foetal heart, sounds of the, 499 changes in the, after breathing, 680 Foeticide. (See Abortion.) Foetus, characters of the, from conception to the sixth month, 620 from the sixth to the ninth month, 662 Food, poisonous, 193 putrescent, 203 death from privation of, 486 Fool's parsley, poisoning with, 244 Foramen ovale, closure of the, 681 Fowler's mineral solution, 157 Foxglove, poisoning with, 254 Fractures, 363 accidental, in the drowned, 401 in new-born children, 603 Fragilitasossium, 364 Fruit-stains resembling blood, 295 Fungi, poisoning with, 231 n ALL-BLADDER, wounds of the, 359 \J Gamboge, effects of, 186 Game, poisoned, 203 INDEX. 873 Gardner peerage case, 656 Garotte robberies, 431 Gaseous poisons, 446 Gelatinized perforation of the stomach, 106 Gelseminum, 190 Genitals, wounds of the, 362 Gestation, natural period of, 641 duration of, from one intercourse, 642 short periods of, 645 protracted, 650 mistakes in the mode of computation of, 653 period of, not fixed by law, 655 Glass, wounds caused by, 268 powdered, effects of, 83 Godfrey's cordial, 207 Gonorrhoea, in rape, 708 Goulard's extract, 172 Goulard-water, 172 Green vitriol, 184 Green hellebore, 188 Grievous bodily harm, 259 Guaiacum process, for blood, 300 Gunpowder, wounds from, 372 Gunshot wounds, nature of, 368 near or distant, 368 accidental, homicidal, or suicidal, 370 HABIT, its influence on poisons, 84 intemperate, in cases of life insurance, 741 Hsematin, properties of, 291 crystals of, 307 Hair, evidence from, on weapons, 285 the color of, in paternity, 660 Hallucinations in insanity, 734 in drunkenness, 812 in sleep, 817 Hanging, death from, 404 appearances in death from, 406 evidence of, from mark of the cord, 409, 411 of the dead body, 413 marks of violence on the body in, 414 homicidal, 416 circumstantial evidence in cases of, 417 evidence from position of the body in, 418 fracture of crystalline lens, a result of, 420 Hartshorn, poisoning with, 129 Head, wounds of the, 340 injuries to the, in new-born children, 603 Heart, wounds of the, 352 Heat, excessive, death from, 486 Hellebore, poisoning with, 188 Hemlock, poisoning with, 240 water-dropwort, 243 Hemorrhage, death from, 311 Internal, death from, 313 death of the new-born child from, 591 Henbane, poisoning with, 232 Hepatization of the lungs, 564 Hereditary transmission of insanity, 744, 807 Hermaphrodites, legal rights of, 673 Hermaphroditism, 668 Hernia, phrenic, 356 Hierapicra, 186 in abortion, 530 Homicidal Monomania, 784 symptoms of, 785 legal tests, 789 Homicidal Monomania, varieties of, 787 medical tests of, 792 medical evidence in oases of, 796 Homicidal wounds, characters of, 275 burning, mistaken for spontaneous, 380 Horseradish mistaken for aconite, 247 Hunger, death from. (See Starvation.) Hydrate of chloral, 226 Hydrochloric acid, 119 Hydrocyanic acid. (See Pru.ssic Acid.) Hydrogen, test for arsenic, 147 HvDEO static Test, 563 objections to the, from sinking of the lungs, 564 erroneous inferences from, 566 effects of putrefaction on the, 668 artificial inflation, 569 general conclusions respecting the em- ployment of, 574 Hydrosulphate of ammonia, 461 Hydrosulphuric acid, poisoning with, 466 Hymen, evidence derived from the, in rape, 703 as a sign of virginity, 711 Hyosoyamus, poisoning with, 232 Hypospadias, 689 TDENTITY of substances, 26 X Identity from the flash of gunpowder, 374 Idiocy, 742 Idiosyncrasy in poisoning, 85 Idiots, rape on, 716 Illusions in insanity, 734 in drunkenness, 812 Imbecility, 742 senile, 744 Immaturity of the foetus, or venter, 619 of the partus, in cases of legitimacy, 647 death of the child from, 591 Impediments, canonical, to marriage, 697 Impotency, causes of, 680 from age, 682 from local disease and malformation, 685 from general disease, 689 as a ground for divorce, 696 Impulse to crime, 794, 800 Imputed poisoning, 95 wounds, 273 strangulation, 434 Inanition, death from, 489 Incapacity, sexual. (See Impotency.) Incendiarism, propensity to, 809 Incised wounds, 268 Ineoherency, 743 Incompetency, mental, medical tests of, 762 Indian tobacco, 263 Indigo, sulphate of, 111 Infanticide, 548 inspection of the body in, 553 proofs of life before respiration in, 554 after respiration, 557 static test in, 560 Ploucquet's test in, 662 proofs of live birth in, 575 natural causes of death in, 591 violent causes of death in, 594 summary of medical proofs in, 608, 618 proposed changes in the law of, 675 Infans in law, 519 Infantile leucorrhoea, 705 Infants, action of opium on, 205 INDEX. Inflation, artificial of the lungs, 569 Influence of morphia in disguising the color test of strychnia,' 239 Inheritance, questions relating to, 620 Inquests, coroners', 37 Insane, responsibility of the, 771, 781 Insahity, medical definitions of, 729 moral, 731 legal definitions of, 733 early symptoms of, 734 hallucinations and illusions in, 734 lucid intervals in, 735 various forms of, 737 hereditary trrnsmission of, 744, 807 feigned, 746 post-mortem appearances in, 747 rules for applying restraint in, 749 signing certificates of, 752 interdiction in eases of, 769 evidence of from written documents, 766 plea of, in criminal cases, 781 homicidal, 784 puerperal, 807 Insect-powders, 235 Insemination, 641 Inspection of the body, in poisoning, 23 in wounds, 283 in child-murder, 553 for coroners' inquests, 26 Insurance, life, 822 Intellectual insanity, 731 Intemperate habits as affecting life insurance, 841 Intercourse, duration of gestation after, 644 carnal, legal proofs of, 701 Interdiction in insanity, 749 Intervals, lucid, in insanity, 735 validity of acts performed during, 735 Intestines, ruptures of the, 360 Intoxication mistaken for concussion, 342 Iodine, 138 Iron, salts of, poisoning with, 184 Iron moulds mistaken for blood stains, 295, 297 Iron filings, 83 Iron, muriate of, 184, 630 Irritant poisons, general effects of, 87 Irkitants, mechanical, 83 mineral, 110 vegetable, 186 animal, 192 JALAP, effects of. 186 Juniperus Sabina, poisoning with, 187 Jury of matrons, 502 KIDNEYS, ruptures of the, 360 King's yellow, 159 Kleptomania, 809 LABOR, premature, induction of, 645 Laburnum, poisoning with, 267 Lacerated wounds, 268 Lactation b. cause of puerperal insanity, 808 Latent disease, death from, in wounds, 326 Laudanum, poisoning by, 207 Lead, poisoning by acetate, 769 tests for the salts of, 170 chronic poisoning by, 172 Lead-glaze, poisonous effects of, 172 Lead palsy, 172 Legal tests of insanity, 789 Legitimacy, legal presumption of, 639 period of gestation in reference to, 641 disputed, from shortness of gestation, 645 viability in reference to, 647 proofs of, from the state of the offspring, 646 disputed from long periods of gestation, 660 in what cases admitted, 654 inferred from paternal likeness, 659 Leucorrhcea, infantile, 706 Levant-nut, 229 License of counsel, 42 Life, legal and medical, 632 Life Insurance, 822 principles of, 822 proof of death, 823 suicide in relation to, 804 questions connected with proposals for, 827 policies vitiated by fraud, 834 policies vitiated by concealment of habits, 834 policies vitiated by concealment of dis- ease, 836 acts of murder in connection with, 864 Lightning, death from, 476 post-mortem appearances, 476 action for damages from, 482 Likeness, parental evidence from, 657 Limekilns, vapors of, 457 Liquids, corrosive, burns by, 381 Liquor amnii, 646 Liquor arsenicalis, 156 Litharge, poisoning with, 173 Live birth in civil suits, 619 proofs of, in child murder, 664 Scotch law concerning, 624 summary regarding, 678 Liver, ruptures and wounds of the, 369 Lobelia, poisoning with, 263 Lochia, evidence of delivery from the, 509 Lockjaw, death from, in wounds, 328 Long fasting, effects of, 487 Lucid intervals, 735 Lucifer-matches, poisoning with, 134 Lunacy, 343 commissions of, 760 Lunacy acts, legal provisions of the, 764 breaches of the, 755 Lunatics, wounds inflicted by, 226 restraint applied to, 749 discharge of, 768 civil responsibility of, 771 contracts of, 771 marriage of, 771 testamentary capacity of, 774 interdiction of, 769, 769 examination of alleged, 762 wills by, 774 Lungs, wounds and ruptures of the, 352 examination of the, in new-born children, 668 specific gravity of, 562 atelectasis of the, 564 variably affected by respiration, 567 putrefaction of, 668 artificial inflation of, 569 Lung-tests, 569 Lypemania, 740 INDEX. i<0 MAGNETIC sleep, rape during, 717 Majority, questions relative to, 636 when attained, 637 Malapraxis, 367 Malformation, death of the child from, 692 sexual, 668 Mania, 737 suicidal, 800 homicidal, 784 puerperal, 807 Mania sine delirio, 731 Marriage, impediments to, 696 of lunatics, void, 771 Marsh's process for arsenic, 147 Matrons, jury of, 502 Maturity of the new-born child, signs of, 551 Meadow-saffron. (See Colchioum.) Meat, unwholesome, 196 Meconic acid, tests for, 210 Meconium, 685 microscopical characters of, 588 Mechanical injury, death from, 314 Mechanical irritants, 83 Medical evidence, 17 Medical witnesses, 41 Medical jurisprudence defined, 17 Medical jurists, duties of, 18 Medical witnesses act, 38 Medical privilege, 43 Medical etiquette, 44 Medical responsibility, in wounds, 334 in cases of insanity, 749 in delivery, 545 Medico-legal reports, 29 for coroners' inquests, 32 Melted metals, burns from, 376 Melancholia, 740 Menses, suppression of, in pregnancy, 494 Menses (see Mensthuation), 494 Menstrual blood, character of, 723 Menstrual climacteric, 694 Menstruation, suppression of, a sign of preg- nancy, 494 feigned, 495 appearances of, after death, 539 relation of gestation to, 643 fallacies in calculating pregnancy, 651 age at which it appears, 653 pregnancy before. 474, 692 appearance of, in infants, 693 age at which it ceases, 694 absence of, a cause of sterility, 692 in hermaphrodites, 669 Mental alienation, 729 Merourius Vitse, 180 Mercuric methide, 168 Mercury, poisoning by the salts of, 160 chronic poisoning by, 161 ammonia-chloride of, or white precipi- tate, 167 oxide of, 168 sulphates and nitrates of, 168 methide of, 168 Metallic irritants, 140 Methide, mercuric, 168 Microscopical evidence, 107, 303, 719, 722 Milk, detection of, in the stomach, 684 Mind, unsoundness of, 733 Mineral green, poisoning with, 157 solution. Fowler's, 156 Minium, poisoning with, 173 Minor. (See Minority.) Minority, questions relating to, 636 Mirbane, essence of, 219 Miscarriage, legal meaning of, 526, 540 Mole-pregnancy,. 621 Moles, nature of, 521 alDortion of, 521 Monkshood, poisoning with, 245 Monomania, 739 suicidal, 741 homicidal, 784 Monorchides, virility of, 685 Monsters, abortion of, 546, 692 legal definition of, 635 do not inherit, 635 sexual, 586, 668 Monsters, destruction of, not permitted, 593 Monstrosity, death of the child from, 592 Monstrosity, sexual, 668, 688 Moral insanity, 731, 783 Morphia and its salts, poisoning with, 208 influence of, in the color-test, 239 tests for, 209 Mortality of wounds, 310 Motives for crime, 792 Muco-purulent discharges, 710 Mucous discharges, characters of, 704 Muriate of iron, 184, 530 of morphia, 209 Muriatic Acid, poisoning with, 119 Mushrooms, poisoning with, 231 Mussels, poisoning with, 194 NMYI mistaken for marks of violence, 615 Narcotic poisons, 88, 205 Narcotico-irritants, effects of, 88 N-avel-string (See Umbilical cord.) Neck, twisting of the, in the new-born, 607 Needles and pins, actions of, 83 Neurotic poisons, 87, 205 New-born child, legal meaning of, 549 Nicotina, poisoning with, 227 Nightshade. (See Belladonna.) Nitrate of potash, 130 Nitre, death from, 131 Nitric Acid, poisoning with, 115 vapor of 116 analysis, 117 Nitrobenzole, 219 Noma pudendi, 704 Non compos mentis, 733 Notes, use of, in evidence, 28 Ncxious substances, legal meaning of, 82, 541 animal food, 193 Nux vomica, poisoning with, 194 rp.DEMA of the lungs, 664 vX-J (Enanthe crocata, 243 Oil of vitriol, poisoning with. (See Sulphu- ric Acid.) croton, 187 of bitter almonds, 218 of savin, 187, 635 of tansy, 536 Operations, surgical, death from, 329 Operation, Cesarean, 631 Opium, symptoms caused by, 205 appearances in death from, 206 process for detecting, 208, 211 Orbit, wounds of the. 349 Orpiment, poisoning by, 159 876 INDEX. Ovum, examination of the, 520 Oxalate of potash, acid, 125 Oxalic Acid, symptoms and appearances caused by, 120 PAINTER'S colic, 172 Palsy from lead, 172 Paper hangings, arsenic in, 157 Papier Moure, 157 Paraplegia, virility in cases of, 690 Paregoric elixir, 208 Parental likeness, 657 Parturition. (See Delivery.) Partus, the new-born child, 549 Paternity, questions on, 657 Peach-nut oil, 219 Pearlash, poisoning with, 127 Pearl white, 184 Perforation of the stomach from poison, 104 spontaneous, 105 Personal injuries, 258 death from slight, 320 Phosphorus, poisoning by, 133 red or amorphous, action of, 138 Phrenic hernia, 356 Phrenitis, 738 Picrotoxine, effects of, 230 Pins and needles, administration of, 83 Plouoquet'a test, 562 Plural births, 639 Poison, definition of a, 79 law respecting the administration of, 81 influence of habit on, 84 of idiosyncrasy, 85 irritant and corrosive, 87 narcotic and narcotico-irritant, 86 effects modified by disease, 90 slow and rapid death from, 98 gaseous, 446 Poisoned game, 204 Poisoned grain, 230 Poisoning, evidence of, in the living, 89 disease mistaken for, 94 feigned and imputed, 95 evidence in the dead, 101 chronic, 100 ulceration, corrosion, and softening, 103 rules for investigating cases of, 30, 96 infanticide by, 616 Poisonous food, 193 gases, 446 fungi or mushrooms, 231 Poppies, syrup of, 207 Pork, diseased, poisoning with, 196 Porphyridium cruentum taken for blood, 305 Posthumous children, 662 Potash and its carbonates, poisoning with, 127 oxalate of, 125 nitrate of, 130 sulphate of, 131 arsenite of, 156 arsenate of, 159 Potassium, cyanide of, 217 Precipitate, white and red, 167, 168 Pkegnancy, signs of, 494 feigned, 601 plea of, in bar of execution, S02 concealment of, 504 unconscious, 505 in the dead, 506 proof of, in oases of abortion, 540 Pregnancy, longest duration of, 642 before menstruation, 692 crimes perpetrated during, 818 earliest age for, 692 latest age for, 694 following rape, 718 Premature births, 645 labor, induction of, 545 Presumption of death, 823 of survivorship, 825 Procreative power, age for, in the male, 681 in the female, 691 Projectiles, 369 Protracted births, 650 gestation, 653 Peussio Acid, symptoms caused by, 212 fatal doses of, 213 analysis, 213 detection of, in the tissues, 217 Ptyaiism, mercurial. (See Salivation.) Puberty in males, 681 in females, 691 premature, 693 Puerperal mania, 807 Pulmonary tests, 559 Punctured wounds, 268 Purulent discharges in alleged rape, 705, 710 Putrefaction, effects of, 70 of the lungs, 568 Putrescent food, 203 Pyaemia a cause of death in wounds, 333 Pyromania, 809 QUICKENING a sign of pregnancy, 497 Quicksilver. (See Mbrcuey.) RAPE, definition of, 699 proofs of, in children under puberty, 700 vulval and vaginal, 702 evidence from marks of violence in, 702 loss of physical evidence in, 703, 718 false charges of, 704 gonorrhoeal discharge in, 706 on girls after puberty, 709 on adults, 713 under narcotics, 715 on idiots, 715 during sleep, 716 from mistake of person, 716 pregnancy following, 718 microscopical evidence in, 722 evidence of, in the dead body, 723 by females on males, 724 Red lead in snuff, 173 Red phosphorus, 138 Red precipitate, 168 Redness of the stomach in poisoning, 102 Re-examination, 47 Reinsch's process for arsenic, 148, 154 Reports, medico-legal, 29 Respiration, cessation of the, in death, 60 signs of, in the nejr-born child, 563 imperfect, 565 before birth, 573 Responsibility, medical, 334, 545, 757 Restraint in insanity, 749 Rigidity, cadaveric, 63 Rigor mortis, 63 INDEX. 877 Rules for the delivery of evidence, 53 Kust, stains of, mistaken for blood, 295 Rye, ergot of, action of, 533 SAFFRON as an abortive, 537 Salivation, arsenioal, 142 mercurial, 162 Salt of sorrel, 125 Saltpetre, action of, 131 Sal volatile, 130 Sanguineous tumors in the new-born, 603 Sausage poison, 196 Savin, poisoning with, 187 as an abortive, 537 Scalding, homicidal, 379 Scalds and burns, 375 Scalp, wounds of the, 340 tumor in new-born children, 603 Scammony, 186 Scheele's green, 157 prussic acid, 212 Scirrhus of the lungs, 564 Secale cornutum, 533 Self-delivery, violence in, 607 Self-inflicted wounds, 273 Senile dementia, 743 Sewer gases, noxious effects of, 469 Sex, concealed, 678 distinction of, 668 destruction of by an operation, 676 mixed and doubtful cases of, 671 civil rights depending on, 673 Sexual malformation, varieties of, 668 influence of, on electoral rights, 675 a cause of impotency, 689 Shellfish, poisoning by, 194 Shock, death from, 314 Shot, wounds from, 371 Skull, fractures of the, 344, 604 accidental fracture of. in parturition, 604 Sleep, delivery during, 511 rape during, 716 homicide during, 817 Slow poisoning, 100 . Small-shot, wounds produced by, 371 Smothering, death from, 444 accidental, cases of, 445 Snuff, poisoned with lead, 173 Soap-lees, poisoning by, 127 Soda and its carbonate, poisoning by, 128 Sodomy, 724 Softening of the stomach from poison, 104 Somnambulism, responsibility in cases of, 816 Sorrel, salt of, 125 Spanish flies, poisoning with, 192 Spasm, cadaveric, 67 Specific gravity of the human body, 398 Spectral analysis of blood, 301 Spermatorrhoea a cause of impotency, 688 Spermatozoa, age at which they appear, 682 examination of stains for, 720 Sphacelia segetum (see Ergot), 534 Spinal marrow, injuries to the, 349 poisons, 88 Spirie, concussion of the, 349 fractures of the, 349 Spirits, poisoning with (see Alcohol), 222 Spirits of hartshorn, death from, 129 . Spirit of salt, 119. (See Muriatic Acid.) Spleen, ruptures of the, 360 Spontaneous combustion, alleged, 380 Spontaneous perforation of the stomach, 104 Stabs and cuts, 271 Stains, acid, on clothing, 114, 118 of blood on linen and weapons, 292, 297 of meconium, 587 of amniotic liquid, 546 in cases of rape, 719 Starch, detection of, 583 Starvation, death from, 487 appearances in death from, 489 infanticide by, 601 Stas's process for strychnia, 238 Static test, the, in infanticide, 560 Sterility in males and females, 681, 691 causes of, 688, 696 Stibiated tartar, 176 Stillbirths, 554 Stomach, redness of the, 102 softening of, 104 perforation of the, 104 wounds and ruptures of the, 360 foetal, contents of the, 582 Stramonium, poisoning with, 255 Strangulation, causes of death, 421 post-mortem appearances in, 422 accidental and suicidal, 429 homicidal, 430 evidence of, from marks of violence, 432 imputed homicidal, 434 destruction of new-born child by, 609 accidental, by umbilical cord, &09 marks on child resembling, 613 Strychnia, poisoning with, 233 symptoms and appearances, 234 analysis, 236 in oTganic mixtures, 238 influence of morphia in disguising the usual color test of, 239 Suhacetate of lead, 172 of copper, 173 Sublimate, corrosive, poisoning with, 160 Subpoenas, rules respecting, 39 Sudden death, 57 SuPFOCATiON, causes of death in, 439 post-mortem appearances, 440 evidence of death from, 442 accidental cases of, 442 of children, 443 from gases, 446 by carbonic acid, 447 by charcoal vapor, 452 by carbonic oxide, 455 coal vapor, 456 by vapors of lime and brickkilns, 457 confined air, 458 by coal-gas, 459 nitrous oxide, 462 sulphuretted hydrogen, 466 by sewer gases, 469 of new-born children, 595 Sugar, detection of, in the foetal stomach, 583 of lead, poisoning with, 169 Suggillation (Ecchymosis), 73, 263 Suicidal wounds, characters of, 279 mania, 741, 800 Suicide and insanity, 800 Suicide, 800 not necessarily from insanity, 802, 807 a felony, 802 in relation to life insurance, 806, 855 hereditary tendency to, 807 878 INDEX. Sulphate of indigo, 111 of potash, 131 of copper, 173 of zinc, 183 Sulphate of iron, 184 Sulphide of jinimonium, 469 StrLPHURETTED HYDROGEN, effects, 466 appearance in death from, 487 detection of, 471 Sulphuric Acid, symptoms, 110 analysis, 112 burns from, 381 Sulphurous acid, action of, 456 Sunstroke, death from, 486 Superconception, 662 SuperfoBtation, 662 Supposititious children, 666 Surgical operations, responsibility for, 334 Survivorship, 825 Syncopal asphyxia, 58 Syncope, death from, 57 Syphilis in case of rape, 708 Syrup of poppies, 207 TANSY, oil of, 636 Tartar Emetic, poisoning with, 176 tests for, 178 Tartarated antimony, 176 Tartaric acid, 125 Tartarized antimony, 176 Technical terms, 31, 56 Tenancy by courtesy, 628 Teratology (see Monsters), 635 Testamentary capacity, -774 Testicles, period at which they descend, 551 non-descent of the, 685 Testimonial competency from age, 636 Tetanus from wounds, 328 Theft, insane propensity to, 809 Thornapple, poisoning with, 253 Throat, wounds of the, 277 Thugs, murder by, 255, 431 Tobacco, poisoning with, 227 Indian, 253 Toucher in pregnancy, 500 Trial at the Assizes, 39 Trichiniasis, 198 Trichomonas, 722 Tumors, sanguineous, 603 ULCERATION distinguished from corrosion, 104 Umbilical cord, evidence of live birth, 579 laceration of the, 591 death from compression of the, 591 strangulation by the, 609 Unconsciousness, acts in a state of, 817 Unconscious pregnancy, 504 delivery, 511 intercourse, 715 Unnatural offences, 724 Unsoundness of mind, 733 Uterine age of foetus, 550 Uterus, changes in the, from pregnancy, 500 VAGINA, wounds of the, 363, 703 purulent discharges from, 705 Vaginitis in infants, 705 Vagitus uterinus, 673, 628 Vapors, of charcoal , effects of, 452 of coal and coke, 456 of lime, brick, and cement kilns, 457 rape under narcotic, 715 Vegetable irritant poisons, 186 Veins, wounds of, 355 death from entrance of air into, 356 Venereal disease in cases of rape, 708 Venter, 520. (See Ovum or Embryo.) Ventre, de, inspiciendo, writ of, 502 Veratria, 189 Verdigris, 173 Veratrum viride, 188 Vermin powder, or killer, 236 Vertebras, fractures of the, 349 in drowning, 401 injuries to the, in hanging, 405, 417 in cases of child-murder, 607 Vesications from burns and scalds, 377 Vesicular mole, 522 Viability, in monstrosity, 635 in legitimacy, 647 in concealments of birth, 524 Violation. (See Rape.) Violence in self-delivery, 607 Virgo intacta, 712 Virginity, signs of, 710 Virility, proofs of, 681 Viscera, preservation of the, 25 Vitriol, oil of, poisoning by (see Sulphuric Acid), 110 blue, poisoning by, 157 white, 183 Vitriol, green, 134 Vomica, nux, poisoning with, 233 WADDING, wounds from, 372 Wall-pnpers, arsenical, effects of, 157 Water-hemlock, 242 Waters, potable, poisoned with lead, 172 Weapons, used in producing wounds, 267, 271 evidence from, 284 found in the hands after death, 284 blood and other substances on, 285 Wheat, poisoned, 230 White precipitate, poisoning with, 167 lead, 172 White vitriol, 183 hellebore, 188 Wills of the insane, law regarding, 774 Wills, proofs of eccentricity in, 775 burden of proof in alleging insanity, 779 in senile dementia and in extremis, 777 attesting witnesses to, 780 made in drunkenness, 811 Wine of colchicum, 187 Witnesses, medical, 41 admitted in court, 49 rules respecting the examination of, 50 Wolfsbane, poisoning by, 245 Wood, smouldering, death from, 454 Wounds, medico-legal definition of, 258 producing grievous bodily harm, 269 examination of 260 vital and post-mortem, 261 without hemorrhage, 262 produced by weapons, 267 incised, lacerated, and contused, 268 from glass or earthenware, 268 self-inflicted or imputed, 273 evidence from situation, 276 INDEX. S79 Wounds, nature and extent of, 276 direction and shape of, 278 suicidal and accidental, 279 by right or left hand, 279 circumstantial evidence in, 282, 290 in what position inflicted, 283 direct cause of death, 31 1 fatal from hemorrhage, 311 fatal from mechanical injury, 314 from shock, 314 from erysipelas, 329 from delirium tremens, 329 mortality of, 310 death from latent disease in cases of, which of two caused death, 319 death from slight wounds, 320 fatal after long periods, 321 secondary causes of deiith from, 322 fatal from unskilful treatment, 324 fatal from imprudence, 324 from unhealthy state of body, 326 acceleration of death from, 327 fatal from abnormal conditions, 327 tetanus following, 328 fatal from surgical operations, 329 fatal from pyaemia, 333 . 319 Wounds of the head, 340 struggling after severe, 355 of the face, 349 of the spine and spinal marrow, 349 of the chest, 351 of the lungs and heart, 352 of the arteries and veins, 354 of the diaphragm, 356 of the abdomen, 357 of the liver, spleen, and kidneys, 359, 360 of the intestines and stomach, 360 of the urinary bladder, 360 of the genitals, 362 gunshot, 368 from gunpowder, 372 caused by lightning, 477 on the new-born child in infanticide, 602 YELLOW arsenic, poisoning with, 159 Yellow jessamine, 190 Yew, poisoning with, 257 ZINC, poisoning by the salts of, 183 Zoosperms (see Spermatozoa) , 682 THE END.