« Columbia (HnttiersJttp THE LIBRARIES Mthitai ilibrarp 'J .0 ^^- MEDICAL JURISPRUDENCE AND TOXICOLOGY REESE Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/textbookofmedica1902rees TEXT-BOOK MEDICAL JURISPRUDENCE TOXICOLOGY BY JOHN J. REESE, M. D. LATE PROFESSOR OF MEDICAL JURISPRUDENCE AND TOXICOLOGY IN THE UNIVERSITY OF PENNSYLVANIA ; LATE PRESIDENT OP THE MEDICAL JURISPRUDENCE SOCIETY OF PHILADELPHIA SIXTH EDITION REVJSED BY HENRY LEFFMANN, A. M., M. D. PROFESSOR OF CHEMISTRY AND TOXICOLOGY IN THE WOMAn's MEDICAL COLLEGE OF PENNSYLVANIA ; PATHOLOGICAL CHEMIST TO THE JEFFERSON MEDICAL COLLEGE HOSPITAL; VICE-PRESIDENT (BRITISH) SOCIETY OF PUBLIC ANALYSTS PHILADELPHIA : P. BLAKISTON'S SON & CO. rOI2 WALNUT STREET. 1902 Entered, according to Act of Congress, in the year 1902, by P. BLAKISTON'S SON & CO., In the Office of the Librarian of Congress, at Washington, D. C. PREFACE TO THE SIXTH EDITION. Since the publication of the last edition of this work the subject of toxicology has been much developed. The introduction of numerous synthetic organic bodies, and the extensive use of some of them as household remedies have given rise to many instances of accidental and suicidal poisoning. Current medical literature shows that phenol is becoming one of the most common agents for self-destruc- tion, while the extensive use of water-gas greatly increases the list of accidental poisonings. Several new phases of treatment may be noted. Free washing out of the stomach is evidently, whenever possible, a highly beneficial procedure. The employment of alcohol in phenol poisoning is an important advance. Potassium permanganate has also found valuable applications. It is also to be noted that the long-current belief in the anti- dotal value of atropin in morphin poisoning is practically abandoned. The editor has sought to include the recent data of trust- worthy character and has inserted brief descriptions of many cases recently reported. The general character of the book as it left the hand of its distinguished author has been retained. ABSTRACT FROM PREFACE TO FIRST EDITION. This Text-Book has been written more particularly to meet the wants of students of Legal Medicine, The author is aware that the field has already been occupied by able and popular treatises on Medical Jurisprudence, well known to the professions of Medicine and Law ; but an experience of over twenty years as a public teacher of this branch of science has convinced him that students in both these professions who desire to acquire a knowl- edge of Medical Jurisprudence are too often deterred from their purpose by being confronted by the ponderous works of recognized masters, extending to three, and even six, large octavo volumes. To avoid the above objection, the author of the present work has endeavored to condense into a handy volume all the essentials of the science, and to present the various topics in a simple and familiar style, giving greater promi- nence, of course, to those of the greatest practical impor- tance. The author has not hesitated to avail himself freely of the materials so abundantly presented in the elaborate and Vin ABSTRACTS FROM PREFACE TO FIRST EDITION. classic works of Casper, Taylor, Beck, Wharton and Stille, Tidy, Guy, Tardieu, and others, always desiring to give due credit to the authority quoted, and usually doing so at the time ; and he would embrace this opportunity to express his obligations to these authorities. He is sin- cerely desirous to encourage an increasing interest in the students of both Medicine and Law for that most important, but too much neglected, subject— Forensic Medicine ; and he would indulge the hope that the present treatise, in its unpretentious size and style, may aid in so doing. CONTENTS. CHAPTER I. PAGE Definition. — Importance to Students of Medicine and Law. — Order of Proceeding in a Medico-legal Case. — The Coroner's Inquest. — The Criminal Court. — Medical Evidence. — Medical Experts. — Dying Declarations, i? CHAPTER II. Phenomena and Signs of Death. Molecular and Somatic Death. — The Immediate Cause of Death to be found in the Heart, Lungs, or Brain. — Post-mortem Evidences of these. — The " Signs of Death." — Cessation of Respiration and Cir- culation. — Changes in the Eyes. — Pallor of the Body. — Loss of Animal Heat. — Post-mortem Caloricity.— Rigor Mortis. — Post-mortem Lividity, or Suggillation. — Putrefaction. — External and Internal Signs. — Adi- pocere. — Mummification. — How Long Since the Death ? . ... 28 CHAPTER III. Medico-legal Investigations. — The Post-mortem. Responsibility Involved. — Accuracy and Method Necessary. — Examina- tion of the Surroundings. — External Examination of the Body. — Internal Examination. — Details of the Examination. — Measurements and Weights. — Notes 60 CHAPTER IV. Presumption of Death and of Survivorship. Cases Involving Presumption of Death and of Survivorship. — French Law of Survivorship. — Probabilities Afforded by Age, Sex, and Mode of Death, 74 TABLE OF CONTENTS. CHAPTER V. Personal Identity. i-age Important Medico-legal Bearings. — I. Identification of the Living. — Personal Appearance. — Peculiar Bodily Marks. — Remarkable Cases. — II. Identification of the Dead. — Mutilated Remains. — Identification, by Means of the Skeleton, as to Age, vSex, and Stature. — Rules of Pro- portion. — Fractures, Deformities, and Callus. — Age of Bones. — Ex- amination of Hairs and Fibers, 78 CHAPTER VI. Causes Producing Violent Death. Death from Wounds. — Definition of a Wound. — Danger of. — Examina- tion of the Body. — Absence of External Marks of Violence. — Wounds Made Before and After Death. — Hemorrhage. — Ecchymoses. Classification. — Homicidal, Suicidal, and Accidental Wounds. — Gun- shot Wounds. — Differ from other Wounds. — Deflection of the Ball. — Wounds made by Shot, Wadding, and Powder. — Cause of Death from Wounds. — Wounds of the Head, Neck, Spine, Chest, and Abdomen, loi Examination of Blood Stains. Importance of their Identification. — Several Methods of Identifying. — The Chemical Tests. — The Microscopic Test. — The Spectroscopic Test. — The Micrometric Test. — Blood Crystals. — Comparative of Blood Corpuscles, 131 Burns and Scalds. Definition. — Classification. — Symptoms. — Cause of Death. — Post-mortem Appearances. — Burns Made Before and After Death. — Accidental, Suicidal, and Homicidal Burns. — Spontaneous Combustion, .... 148 Death from Different Forms of Apnea (Asphyxia). Death from Suffocation. — Accidental, Suicidal, and Homicidal Suffoca- tion. — Post-mortem Signs. — Asphyxia from Poisonous Gases. — Char- coal Vapor. — Illuminating Gas. — ^Vapors from Privies and Cesspools. — Death by Strangulation.— Modes of Strangulation.— External Signs.— Internal Lesions. — Accidental, Suicidal, and Homicidal Strangulation. Mark of the Cord.— Death by Hanging.— Cause of Death.— Post- mortem Appearances.— Cord Marks,— Generally Suicidal.— Death by TABLE OF CONTENTS. XI PAGE Drowning. — Mode of Death. — Time Required. — Signs of Death, External and Internal. — Accidental, Suicidal, and Homicidal Drown- ing, ^54 Death by Electricity. Medico-legal Relations. — Mode of Death. — Post-mortem Signs, .... 185 Death from Heat and Cold. Diverse Effects of Heat upon the Body. — Post-mortem Appearances. — Effects of Cold. — Post-mortem Appearances 189 Death by Starvation. Accidental, Homicidal, and Suicidal Starvation. — Pretended Cases of Voluntary Starvation. — Symptoms and Post-Mortem Signs. — Medico- legal Relations, ^93 CHAPTER VII. Feigned Diseases. Great Variety of Simulated Diseases. — Fictitious and Factitious Diseases. — General Rules for Diagnosis. — Special Diagnosis, 197 CHAPTER VIII. Pregnancy. Cases where it becomes the Subject of Medico-legal Investigation. — Signs of Pregnancy, Certain and Uncertain. — Corpus Luteum. — Uncon- scious Pregnancy. — Pregnancy in the Dead, 210 CHAPTER IX. Criminal Abortion, or Feticide. Definition. — Frequency of Abortion from Natural Causes. — Proofs that a Fetus has been Destroyed. — Signs Afforded by the Mother. — Age of the Fetus. — Means Employed, 220 XU TABLE OF CONTENTS. CHAPTER X. FAOB Infanticide. Definition. — A Live Birth. — Questions Relating to the Infant. — Was it Born Alive. — Signs of Death Before Birth. — Proofs of a Live Birth derived from the Lungs. — The Hydrostatic Test. — Proofs of a Live Birth derived from the Organs of Circulation and the Abdominal Organs. — Peculiarities of the Fetal Circulation. — Uncertainty of these Signs. — Desiccation of the Umbilical Cord. — Proofs of a Live Birth from the Stomach and Intestines. — Causes of Death in the Newborn Child. — (l) Causes Acting during Birth. — Compression of and by the Cord. — Protracted Delivery. — Debility, Hemorrhage, Fracture of Skull. — (2) Causes Acting after Birth. — Congenital Malformation and Disease. — Exposure. — Improper Food. — Wounds and Injuries. — Suf- focation. — Strangling. — Drowning. — Poisoning. — Accidental Causes. — Mode of Conducting the Examination. — Questions Relating to the Mother. — Signs of Delivery. — Early Signs. — Examination of the Milk. — Concealed Delivery. — Concealment of Birth. — Pretended De- livery, 234 CHAPTER XI. Legitimacy — Inheritance. Medico-legal Importance. — Ordinary Term of Human Gestation. — Pro- tracted Gestation. — Argument from Analogy of the Lower Animals. — Premature Delivery. — Early Viability of the Child. — Live Birth in Civil Cases. — Tenancy by Courtesy. — Laws Concerning Legitimacy. — Paternity. — Affiliation. — Superfetation. — Double Sex in Hermaphro- ditism. — Impotence and Sterility. — Causes of Impotence. — Procrea- tive Power in the Male. — Crypsorchides and Monorchides. — Sterility. — Procreative Power in the Female. — Legal Decisions, ...... 274 CHAPTER XII. Rape. Legal Meaning.— Duty of the Examiner. — Rape on Children. — May be Confounded with Disease. — Rape on Adult Women. — Possibility of, without Consent. — If Unconscious. — Effects of Ether. — Philadelphia Case. — Evidences of Rape on Adults. — Condition of the Hymen. — Seminal Stains. — Post-mortem Evidences of Rape. — Unnatural Crimes. — Legal Relations of Rape, 294 TABLE OF CONTENTS. Xlil CHAPTER XIII. Insanity. page Medico-legal Difficulties of Insanity. — Civil and Criminal Responsibility. — Legal Terms. — Illusions, Hallucinations, and Delusions. — Conceal- ment of Delusions. — Lucid Intervals. — Classification. — Defective De- velopment of the Faculties. — Idiocy, Physical Marks of. — Pathological Marks. — Imbecility. — Cretinism. — Legal Relations of Idiocy and Im- becility. Lesions of the Mental Faculties Subsequent to their De- velopment. — General Intellectual Mania. — Symptoms. — Melancholia. — Symptoms. — Partial Intellectual Mania. — Moral Mania. — Mono- mania. — Kleptomania. — Pyromania. — Dipsomania. — Responsibility of Drunkards. — Homicidal and Suicidal Mania. — General Paresis. — De- mentia. — Puerperal Insanity. — Somnambulism. — Epileptic Insanity. — Post-mortem Lesions. — Medico-legal Relations of Insanity. — Depriva- tion of Liberty. — Signing Certificates of Insanity. — Testimony in Criminal Cases. — Testamentary Capacity. — Opinions in Relation to Marriage and Education of Children. — Criminal Responsibility. — The Plea of Insanity as a Bar to Capital Punishment. — Importance of a Correct Understanding of the Subject. — A mere "Knowledge of Right and Wrong ' ' not sufficient. — Condition of the Will, or Self- Control. — Emotional Insanity. — Simulated or Feigned Insanity. — Pretended Insanity in Criminals. — Importance of Ascertaining the Motive. — Means taken to conceal the Crime. — Mania, the Form usually Feigned, 314 CHAPTER XIV. Malpractice. Definition. — The Physician not an Insurer. — Certain Established Princi- ples. — "Ordinary Skill." — Errors in Judgment. — Frequency of Civil Suits. — Causes Leading to Suits for Malpractice. — Laws in the U. S. affecting Inebriety in Physicians. — Liability of Druggists, .... 365 CHAPTER XV. Life Insurance. Meaning of the Term. — Conditions of the Policy. — Concealment of Facts. — Relation of Intemperance and Suicide to Life Insurance. — Cases, . , 376 XIV TABLE OF CONTENTS. CHAPTER XVI. Toxicology.— (Death from Poisoning.) pagb Definition of a Poison. — Effects. — Proofs of Absorption. — Subsequent Disposition of the Poison. — Elimination. — Cause of Death. — Circum- stances Modifying their Action. — Antagonism of Poisons — Evidences of Poisoning. — i. Evidences from Symptoms. — 2. From Post-mortem Lesions. — 3. Chemical Analysis. — Post-mortem Imbibition of Poisons. — Rules in Performing a Toxicologic Analysis. — 4. Physiologic Ex- periments. — 5. Circumstantial Evidence. — Medico-legal Conclusions. — Classification, 384 CORROSIVE IRRITANTS. Mineral Acids. Certain Common Symptoms. — Post-mortem Appearances. — Treatment. — Analysis. — Toxicologic Examination for the Different Acids. — Sul- phuric, Nitric, and Muriatic Acids, 414 Alkalies and their Salts. Potassa, Soda, and Ammonia. — Similarity of Effects. — Symptoms. — Fatal Dose. — Treatment. — Post-mortem Appearances. — Analysis. — Poison- ing by the Alkaline and Earthy Salts. — Potassium Nitrate. — Potassium Chlorate. — Potassium Bitartrate. — Potassium Sulphate. — Alum. — Chlorated Potassa and Soda. — Salts of Barium, . ....... 426 IRRITANTS PROPER. Phosphorus. — Symptoms. — Fatal Dose. — Treatment. — Morbid Appear- ances. — Diagnosis. — Analysis. — Amorphous Phosphorus. — Poisoning by lodin, Bromin, Chlorin, and Chlorin Oxids, 435 Arsenic. Arsenic. — Arsenous Oxid. — Properties. — Symptoms.— Chronic Poison- ing. — Fatal Dose. — Treatment. — Post-mortem Signs. — Analysis. — Toxicologic Examination. — Other Preparations of Arsenic, 449 Antimony Compounds (Tartar Emetic). Properties of Tartar Emetic. — Symptoms. — Fatal Dose. — Post-mortem Appearances. — Slow Poisoning. — Analysis. — Toxicologic Examina- tion, 474 TABLE OF CONTENTS. XV Mercury Compounds (Corrosive Sublimate). page Corrosive Sublimate. — Properties. — Symptoms. — Post-mortem Appear- ances. — Fatal Dose. — Antidotes. — Analysis. — Toxicologic Examina- tion. — Salivation, 4^4 Lead Compounds. frequency of Chronic Poisoning. — Lead Acetate. — Symptoms. — Treat- ment. — Post-mortem Appearances. — Painters' Colic. — Lead Palsy. — Toxicologic Examination. — Other Preparations of Lead. — Lead Chromate, . , 497 Copper Compounds. Accidental Poisoning. — Copper Salts. — Fatal Dose. — Treatment. — Morbid Appearances. — Analysis. — Toxicologic Examination, ... 506 Zinc and Magnesium Compounds. — Bismuth. — Tin, Iron, and Chrom- ium Compounds, S'fS Vegetable and Animal Irritants. Oxalic Acid. — Sources of the Acid in Nature. — Symptoms. — Fatal Dose. Treatment. — Morbid Appearances. — Analysis. — Toxicologic Examina- tion. — Potassium Oxalates. — Carbolic Acid. — Lysol. — Pyrogallol. Sodium Salicylate. — Betanaphtol. — Naphthalene. — Kerosene and Gasolin. — Croton Oil, Elaterium, Castor Oil Beans, Colchicum, Savin and Oleander. — The Hellebores. — Veratrin. — Gelsemium (Yellow Jasmine). — Gelsemin and Gel.semic Acid. — Poisonous Mush- rooms. — Lily of the Valley. — Camphor, 521 Animal Irritants. Cantharides. — Poisonous Animal Food. — Sausage Poison. — Trichinosis. Cheese Poison. — Poisonous Fish. — Putrescent Food. — Poisoned Flesh, 548 NEUROTIC POISONS. Cerebral Neurotics. — ( i ) Narcotics. Opium. Nature of Opium. — Poisonous Symptoms. — Fatal Period and Dose. Treatment. — Morphin. — Properties. — Tests. — Meconic Acid. XVI TABLE OF CONTENTS. PAGE — Tests. — Toxicologic Examination. — Alcohol. — Acute Alcoholism. — Symptoms. — Post-mortem Lesions. — Analysis. — Detection in the Tissues. — Methyl Alcohol. — Formaldehyde, . 554 (2) Anesthetics. Ether, Chloroform, and Chloral Hydrate, 572 Spinal Neurotics. Nux Vomica. — Strychnin. — Effects. — Fatal Dose. — Treatment. — Post- mortem Lesions. — Diagnosis. — Analysis. — Interferences. — Physiologic Test. — Toxicologic Examination. — Brucin, 57^ Cerebro-spinal Neurotics. — Deliriants. Belladonna. — Symptoms. — Atropin. — Fatal Dose. — Treatment. — Post- mortem Appearances. — Analysis. — Toxicologic Examination. — Poison- ing by Stramonium, Hyoscyamus, Solanum, and Cocain, 601 Depressants. Tobacco and Lobelia. — Effects of Tobacco. — Post-mortem Lesions. Nicotin. — Properties. — Toxicologic Examination. — Lobelia, .... 613 Hemlock. — Symptoms. — Post-mortem Appearances. — Conin. — Reactions. Toxicologic Examination. — Other Poisonous Hemlocks. — Aconite and Calabar Bean. — Properties of the Aconitum Napellus. — Effects. — Post- mortem Appearances.— Aconitin. — Fatal Dose. — Treatment. — Analysis. Toxicologic Examination. — Calabar Bean. — Properties. — Eserin, . . 620 Asthenics. Hydrocyanic Acid. — Natural Occurrence in Vegetables. — Pure and Offi- cinal Acids. — Symptoms. — Fatal Period and Dose. — Treatment. — Post- mortem Appearances. — Tests. — Toxicologic Examination. — Potassium Cyanid. — Oil of Bitter Almonds. — Cherry-laurel Water. — Nitrobenzene, Anilin, Antipyrin, Antifebrin, and Trional. — Symptoms. — Post-mor- tem Lesions. — Fatal Dose. — Digitalin. — Analysis. — Toxicologic Ex- amination. — Case of De la Pomerais. — Cocculus Indicus, . , . 630 Alkaloids of Putrefaction, — Ptomains, 650 TEXT-BOOK OF MEDICAL JURISPRUDENCE 4 ANJD TOXICOLOGY. CHAPTER I. Medical Jurisprudence, Legal or Forensic Medicine, may be defined to be the science which applies the knowledge of Medicine to the requirements of Law. In the discovery of truth, the great purpose of Law, every department of human knowledge should be made to assist. Cases affect-^ ing life, reputation, or property, and requiring for elucida-^ tion an appeal to medical knowledge, are termed medico- legal cases, and the science of the application of medicine to them is named Medical Jurisprudence. The students of Medicine and Law are equally interested in a knowledge of this science, and it should require no argument to show its importance to members of these professions. Many cases brought before a court can only be settled by an appeal to medical knowledge ; sometimes it is to one department of medicine, and sometimes to another ; and it not infrequently happens that several branches of the science 2 17 I 8 MEDICAL JURISPRUDENCE, may be called into requisition in order to aid in arriving at a proper decision. It is more particularly when the physician appears upon the witness stand, and assumes the functions of the medical ivitncss, that medico-legal knowledge is of the most impor- tance. After he has accomplished the investigation of some case there remains the duty of giving the results of his in- vestigations to the court in the form of evidence. This will be more manifest as we detail the mode of proceeding in a criminal case. The Coroner's Inquest. — The first public duty usually imposed upon the physician who has been in attendance, or has investigated a case of violent death, is to testify at the coroner's inquest. In many civilized countries, especially English-speaking communities, a special officer, the coroner, is appointed to investigate the unknown or unexplained causes of sudden death. For example, a body is discovered with or without marks of external violence, or dragged out of the river ; the body of a new-born child has been found in a well or cess-pool, or floating in the water ; a person is discovered dead at some hotel, far distant from his home ; or a person in apparent health suddenly drops dead in the street. In these and in analogous cases the law provides for an investigation to ascertain the cause and circumstances of the death ; and, if due to violence, then the nature of it — i. e., whether from a wound (gunshot or otherwise), from a bludgeon, an axe, hammer, or other blunt weapon ; or whether occasioned by a fall. In the absence of all external marks of violence, then, might the death not have been produced by poison ? In each one of these cases a further question must be solved — was the death homicidal, suicidal, or accidental ? THE coroner's INQUEST. 1 9 The coroner's jury consists of a few men (the number varies in different places), mostly selected from the district in which the inquest is held. Their duty consists in (i) viewing the body and establishing its identity and (2) in holding the inquest, which is a sort of petty court, wherein inquiry is made as to the cause of death, and (in case of homicide) to ascertain, if possible, the guilty person. Wit- nesses are examined, and the person who has performed the post-mortem examination makes a report and gives his opinion as to the cause of death. The jury consult and render a verdict. In some cases, particularly in cities, where the coroner has one or more specially appointed physicians, it is not considered necessary that the jury should personally view the body ; it is regarded as sufficient if the body has been identified by the examining physician, and the autopsy reported. The special duty of the coroner's inquest is to discover the cause of death ; it does not fall within his province to discover the individual who caused it. Nevertheless, it often happens that, in the course of the investigation, sus- picion may so strongly point to some one as to warrant the coroner committing the suspect to prison to await further investigation. The usual verdict in cases of violent death (shown to have been neither suicidal nor accidental) is that of murder or manslaughter, against some person or persons, known or unknown. The office of coroner, as at present constituted in many places, exhibits antiquated and inconvenient methods. In Massachusetts the office has been abolished, the investiga- tion of sudden or suspicious deaths being carried out by physicians, called " Medical Examiners," who do not refer evidence to a special jury, but can place any suspected criminal in the charge of the courts. 20 MEDICAL JURISPRUDENCE. The post-mortem examination is an inseparable part of the coroner's inquiry in a case of this character, and con- stitutes its most important factor. It should be performed carefully and thoroughly. The autopsy should be per- formed deliberately, and by daylight if possible. It will always be an advantage if the examination be performed by two experts. In giving evidence before the coroner's jury, the medical witness must not undervalue the importance of the situ- ation ; nor forget that the testimony is generally recorded, and will be available at a subsequent trial. This fact shows the importance of drawing up the report with due care and accuracy. The Criminal Court. — If the coroner's jury or other pre- liminary method of inquiry indicates the probability that a crime has been committed, the matter is referred to the prosecuting officer, generally called in the United States, the District Attorney, who prepares a "bill of indictment" that is a document which sets forth the nature of the crime as far as known and the name of any suspected person. This bill is submitted to a special body of persons, called the grand jury, which deliberates in secret, usually calling only such witnesses as the authorities indicate, though it has power to send for other persons. If the grand jury de- cides that there is sufficient evidence to justify a trial in open court, the document is returned marked " true bill," but if not deemed so, the bill is "ignored." A true bill leads to a trial. The indictment is read in open court and the accused is required to plead guilty or not guilty. To this trial the medical witness is summoned to appear by a sub- pena, which must be obeyed. He will undergo a strict and severe examination as to his opinions and observations on JUDICIAL PROCEDURE. 21 the case. He will be cross-examined as to his professional knowledge and acquirements, the extent of his opportunities for making such investigations as the one pending, the ac- curacy of his post-mortem or toxicologic examination, and other matters which may annoy and confuse him to no small degree, unless he be prepared beforehand by medico- legal knowledge and training. A witness properly fortified need have no fear for himself; for, as he goes upon the stand honestly to testify to the truth, " he need only," to quote the language of the late Dr. Taylor, " bear in mind two considerations : first, that he should be thoroughly pre- pared on all points of the subject on which he is to give evidence ; and, secondly, that his demeanor should be that of an educated gentlemen, and suited to the serious occasion on which he appears." In regard to medical evidence several points require brief notice. After opening the case before the court, the prosecuting attorney calls witnesses and examines them "according to the rules of evidence" ; this is technically called the exmni nation in chief. The cross examination follows ; this is conducted by the counsel for the defense, and may be aimed at contradicting and overthrowing, if possible, the previous testimony. A counsel for the de- fense is allowed very considerable latitude in the cross- examination of the witness, and it will be necessary for the witness to exercise considerable self-control, since it is only in this way that a brow-beating attorney can be parried. The witness must also remember that there are technical methods in the law which are not comprehended by others, and it is especially advisable that if objection be made by either attorney to any question, the witness should pause until the matter is decided by the judge. It is inadvisable 22 MEDICAL JURISPRUDENCE. for a witness to appeal to the judge for protection against a line of questions. An honest and properly informed phy- sician has nothing to fear from a lawyer. Reexamination sometimes follows the cross-examination of the witness, when it becomes necessaiy to clear up or explain any matter that may have been obscured by the cross-ex- amination. After the examination of the witnesses called by the prosecuting officers, that of the witnesses for the defense fol- lows, and the same general line of examination is pursued. When expert witnesses for the defense are called, a most unpleasant exhibition frequently takes place, one expert directly contradicting another on the opposite side. Such professional tilting is sometimes sneeringly designated as the "war of the experts," and is certainly deeply to be re- gretted, as it tends greatly to prejudice both the court and the public against expert testimony in general. It is well to understand the difference between an ordi- nary and an expert witness. The former testifies only to facts which he has seen, or heard, or learned from personal observation. The "expert" or skilled witness does not necessarily testify to facts, but gives his opinion on facts observed by himself or testified to by others. An expert witness is supposed to be specially skilled in the matter on which he is to testify. It is just here that much difficulty arises in cases involving expert evidence. The so-called "experts" are often selected with the intention that they shall advocate particular views or belittle in every possible way the ability or work of the experts on the opposite side. The expert witness has his rights as well as his duties and responsibilities. One of these rights is his compensation. It has often been made a subject of just complaint that an MEDICAL EVIDENCE EXPERTS. 23 expert witness is placed upon the stand and his professional opinions, which may be of the utmost value in the pending case, extorted from him piecemeal by the questionings of counsel, and yet he receives as his compensation merely the pay of an ordinary witness. Some legal authorities admit that the expert is not bound to submit to this impo- sition, and that he is entitled to a special fee for his services. In this country the practice of the courts in relation to the compensation of medical experts is not settled. In many states the law allows no additional compensation to the expert, and it is not an infrequent practice to subpena him as an ordinary witness, and when in the witness box to use him as an expert. What shall the expert do in such a case ? How shall he conduct himself consistently with his own dignity and proper rights ? Certainly the court would would not use a man's private property — the work of his hands, his skilled manual labor, or the product of his farm or merchandise — without adequate compensation; why, then, should they exact from him that which is the result of the labor of his brain, than which nothing can be more exclusively and definitely a man's own private property? It is to be regretted that so few of our American courts and legislatures have appeared to recognize the true bearings of this subject so that with us the old practice still prevails of affording no legal protection to the medical expert in the matter of fees. It rarely happens in important criminal cases, especially in poison cases, that either the prosecution or the defense would venture to trust their interests to a reluctant witness ; and certainly he would be a reluctant witness who had been dragged perhaps hundreds of miles from his home and business by a subpena which the law forces him to obey. 24 MEDICAL JURISPRUDENCE. and who, after spending, it may be, days in attendance upon the court, is compelled to give, for the paltry pittance of the wages of a day-laborer, that which has cost him years of labor and study to acquire, in the shape of an opinion, on which may turn the question of life or death to the prisoner. In all such cases the ordinary practice is to arrange beforehand with the expert for his proper fee, and the witness should be admonished to look carefully about his interests in this matter. Let him remember that the district attorney, who usually directs the affair, may have no authority to pay the fee ; neither does this authority always lie with the court. The responsible parties in the case are often the county commissioners, or some equiva- lent county authority. With these alone ought the expert to make his arrangements, and always previously to under- taking the case ; and to these alone can he look, legally, for his fee. As regards the obligation of a witness to obey a subpena when he is to be questioned only as to his opinion, the mandate of the court in this country is obligatory ; the witness's duty is to obey it, and then, if not previously, endeavor to arrange about his compensation before giving his evidence. The subject of expert testimony has engaged the atten- tion of some of the ablest minds in both the professions of law and medicine, but with no very definite results. No doubt, our present system of volunteer medical experts is open to objections, which, under our present laws, cannot be remedied. A system is much advocated of each State appointing one or more experts, who shall be State officers, physicians of thorough education and experience and train- ing in this particular line, who shall devote their time and REMUNERATION TO EXPERTS. 25 attention exclusively to this duty, and for which they shall receive an adequate compensation. Such an office, properly filled, and kept aloof from all political considerations, might be of real benefit ; but it would not, necessarily, abolish the unseemly contention of the experts in the court room, for in the United States the clause in the Constitution pro- viding that in every criminal trial the accused shall have the power to call witnesses in his favor and be confronted by the witnesses against him will permit of the same con- tentions between experts that now occur. Moreover, it is not likely that in our present poHtical system a satisfactory selection of "State experts" will be made. Social as well as political influences will operate to control such appoint- ments, and the former as well as the latter are capable of promoting unfit persons. The system of State experts is in vogue in some countries in continental Europe ; but the method of criminal procedure is different in such places, and does not exhibit the care of the rights of the accused which is the principle of English jurisprudence. It is worthy of note that some eminent authorities in continental Europe are advocating the adoption of some phases of the English system. There are a few practical rules relating to the giving of evidence which it is well the medical expert should observe. He should prepare himself thoroughly upon all the points bearing on the case in which he is called to give evidence. This he should do in order to further the ends of justice, and also to avoid personal censure. He should be accu- rate as to weights, measures, distances, size, relationship of objects, etc., never guessing, but testifying with certainty and precision. 26 MEDICAL JURISPRUDENCE. He should maintain a quiet, dignified, and composed demeanor on the stand, not exhibiting any irritabihty of temper, however much he may feel provoked by the rude- ness of the opposing counsel. He should beware of any display of arrogance or assumption of manner, or of stub- borness or testiness of behavior, which are sure to make him appear to disadvantage in the court room. The witness should give his answers in a clear and audi- ble tone, and these replies, together with his explanations, should always be given in the simplest possible language ; and they should be free from all ambiguity, otherwise they will require explanation, which is apt rather to weaken the testimony. It will be better, also, for him to avoid all vol- untary remarks, and confine himself closely to answering the questions put to him. He should never be afraid frankly to confess his igno- rance. Nothing is more dangerous than for a witness to attempt to guess, for fear of being thought ignorant. He should particularly avoid the use of all technical expressions and learned formulae in giving his descriptions. Pomposity and pedantry should, of course, be avoided by every sensible and well-bred witness, since they are certain to expose him to ridicule and contempt. Dying Declarations. — By this term is understood such declarations as are made by a dying person, who believes that he is in actual danger of death, and that his recovery is impossible. Such declarations are received in evidence without being sworn to. The law presumes that decla- rations made at so solemn a crisis as at a dying moment must be sincere. They may not, however, necessarily be true, although sincere — i. c, believed in, at the time, by the deceased. Dr. Taylor quotes an instance of a dying woman EXPERT EVIDENCE. 27 in St. Thomas' Hospital who accused a man of assaulting her. He was found guilty and executed. A year after the execution his innocence was established, the real murderers having been discovered. These declarations, moreover, must relate to the actual circumstances of the death, and to nothing else. A magistrate or other official authorized to take deposi- tion in important cases, if such can be had, is the proper person to take down dying declarations, the physician in attendance merely giving opinion as to the hopelessness of the case and the soundness of the person's mind. In the absence of an official, the medical man is the best substitute, and he should content himself by simply writing down the exact words of the dying person, without adding his own interpretation of them. If possible, the dying person should sign the declaration after having it read over. CHAPTER II. PHENOMENA AND SIGNS OF DEATH. Among the numerous and diversified cases claiming medico-legal attention, perhaps the most frequent are those of violent death. A knowledge of the Signs of Death becomes of the utmost importance, since cases not infrequently pre- sent themselves in which there is considerable doubt and uncertainty as to the reality of the death. For a proper comprehension of this subject, attention should first be directed to the distinction between molecular and somatic death. By the former term is to be understood the incessant disintegration of tissue which is going on in the body during the active processes of Hfe ; the waste of material thus produced being compensated by the repara- tion. In youth, the supply is in excess of the waste, and growth is the result ; in advanced age, the reverse is the case. Somatic death is the cessation of all the vital func- tions of the body, or the death of the whole body. The latter is the popular idea of death, and the time when it takes place is generally recognizable. The precise period when universal molecular death occurs cannot be accurately determined. No doubt, molecular life may continue some time after somatic death, as is evidenced by post-mortem temperature and muscular irritability, by the post-mortem beating of the heart, and by certain acts of nutrition and secretion. Although the outlets of human life are so numerous and varied, and the phenomena of death are diversified, the im- 28 PHENOMENA AND SIGNS OF DEATH. 29 or actual cause must in every instance be referred to an arrest of the function of one or other of the three great centers of life — the heart, the lungs, and the brain. And so intimately are the functions of these three "centers" connected together, that when one ceases to act, the actions of the others speedily cease. Each one of these three vari- eties has its own special phenomena or signs ; and each exhibits its own peculiar or characteristic post-mortem appearances. The following is Bichat's classification: (i) death beginning at the brain, (2) death beginning at the heart, and (3) death beginning at the lungs. I. Death Beginning at the Brain — Coma. Symptoms. — Stupor, more or less profound ; insensibility to external impressions ; loss of consciousness ; breathing slow, ster- torous, and irregular ; respiration gradually faihng, and ceases as the medulla oblongata begins to be affected. The chest ceases to expand ; the blood is no longer aerated ; the pulmonaiy circulation is arrested ; the lungs cease to act, and finally the heart's pulsations are brought to a stop. Post-mortem Appearances. — (i) Effusion of blood or serum in the brain or cavities, caused by [ci) apoplexy, {U) rupture of vessels from injury or fracture of the skull, or in disease of the arteries, under excitement. (2) Pressure caused by {a) embolism, {U) abscess, tumor, or other organic distur- bance ; {c) congestion of the vessels of the brain. (3) Con- cussion from a blow or fall. II. Death Beginning at the Heart — Syncope. — The heart may cease to act from two distinct causes : (i) from a deficiency in the quantity of blood — its normal stimulant 30 MEDICAL JURISPRUDENCE. (anemia) ; and (2) from a defect in the quality of the blood, or from a loss of heart power {asthenia). Anemia is produced by sudden loss of blood in disease, as in rupture of an aneurysm ; uterine and other hemor- rhage ; or by violence, as from wounds of heart and large vessels, causing fatal hemorrhage. Symptoms. — Paleness of face ; lividity of lips ; vertigo ; cold sweat ; slow, weak, and fluttering pulse ; gradual insen- sibility. There may also be nausea and vomiting, halluci- nations, delirium, jactitations, irregular breathing, sighing, and convulsions before death. The nervous symptoms are due to want of brain power, in consequence of a deficient supply of blood. Post-mortem Appearances. — Heart contracted and empty ( if inspected early). If life has been protracted for several hours, a heart 'tlot may be found. , General paleness of the organs and tissues. '' ' i-.m -i :"■■ Asthenia. — Here, the cause of the cessation of the heart's action is either a defect in the quality of the blood or some disorder of the organs producing a loss of heart power : (i) by disease, as {a) various cardiac disorders^ such as fatty degeneration, diseases of the valves, etc.; ((5) all exhausting diseases, as phthisis, cholera, cancer, etc.; (2) starvation; (3) certain injuries, as blows on epigastrium ; (4) certain poisons. Cases of heart failure are- popularly termed /«r- alysis of the heart. Symptoms. — Coldness of hands and feet ; lividity of lips, fingers, toes, nose, and ears ; extreme muscular weakness ; feeble pulse ; sense and intellect not affected, but preserved to the last. This latter is well seen in the collapse of Asiatic cholera. Post-mortem Appearances. — The heart not contracted ; its DEATH BEGINNING AT THE HEART — SYNCOPE. 3 I cavities contain more or less blood, or else are dilated and flabby. Blood in all large vessels, but no congestion of lungs or brain. III. Death Beginning in the Lungs — Apnea — (As- phyxia). — Respiration may be arrested (i) by any mechan- ical impediment to the ingress of air into the lungs, as (a) pressure of the thorax ; (^d) tetanic spasm of the muscles of respiration ; {c) paralysis of the pneumogastric or phrenic nerves ; [d") exhaustion of muscular power ; (e) foreign bodies in the air passages ; (/) compression of the throat ; (^) suffocation ; (//) drowning. (2) By disease, as pneumonia, phthisis, etc., spasm of the glottis, edema of the glottis, phaiyngeal abscess, embolism of the pulmonaiy artery, and the accumulation of serum, blood, or pus in the pleural cavities. (Strictly speaking, most of these diseases cause death through mechanical interference with breath- ing.) Symptoms. — Great dyspnea, lividity of the face, loss of consciousness, vertigo, and occasionally convulsions. Post-mortem Appearances. — The right side of the heart and the whole venous system are usually filled with dark blood ; the left side, together with the arteries, is generally empty. Cases are, however, reported where the right cavi- ties of the heart were found empty. The lungs themselves are nearly always gorged with dark blood ; but there are some exceptions to this, which will be noticed hereafter. By keeping in mind the foregoing varieties of somatic death, together with the characteristic post-mortem appear- ances attendant on each, the examiner will be considerably aided in arriving at a definite conclusion as to the real cause of death in any particular case. 32 MEDICAL JURISPRUDENCE. In every inquest over a dead body five important ques- tions will present themselves for solution : (i) The reality of the death. (2) The cause of the death. (3) Was the death instantaneous, sudden, or was the death agony prolonged? (4) The time that has elapsed since the death. (5) In the case of the body of a new-born infant — Was it born alive ? The first of th'ese questions comprises the phejiomena and signs of death. How can we distinguish a case of real from one of apparent death ? In the great majority of in- stances, of course, there is no practical difficulty; but ex- ceptional cases do, at times, present themselves in persons recently dead, where the corpse still retains so much the appearance of life as to occasion some doubts about the reality of dissolution. The natural horror of being buried alive also suggests the most scrupulous caution in the matter, although we rarely, if ever, hear of cases of pre- mature burial in civilized countries ; yet instances are not wanting to show that such may have actually occurred in places where a fatal pestilence has prevailed to such a de- gree as to produce a panic and demoralize the community. Dr. Tidy reports that Nussbaum states "that he believes many to have been buried during the war (Franco-German) that were not really dead, but merely suffering from an extreme lethargy arising from loss of blood, exhaustion, hunger, cold and fear." The following may be regarded as the Signs of Death ; but no single sign should be relied upon exclusively: I. The Complete and Continuous Cessation of the Func- tions of Circulation and Respiration. — In some cases of apparent death — syncope, trance, catalepsy — these two SIGNS OF DEATH. 33 functions seem to be suspended for a time ; but the sus- pension is apparent, not absolute. The absence of the pulse at the wrist is no criterion of the suspension of the circulation, as this may be going on so feebly as only to be detected by a very close stethoscopic examination of the heart, which should never be omitted in cases of doubt. The condition of both the circulation and respiration, in such cases of apparent death, simply resembles that of certain animals in the state of hibernation. Thus, M. Bouchut informs us that in the marmot the heart beats during its state of activity amount to 80 or 90 a minute, but are reduced to 8 or 9 very feeble pulsations during the period of hibernation. Instances are recorded (like that of Colonel Townshend, by Dr. Cheyne) of a vol- untary suspension of the heart's action ; but as these cases occurred many years ago, before the discovery of auscultation, it is, we think, highly probable that the sus- pension was not absolute, but only reduced down to so fine a point as to have escaped notice. It is certainly contrary to all scientific reasoning that life can continue many min- utes without the circulation of the blood ; therefore we need have no hesitation as to the reality of death, if we can be positively certain of the continuous arrest of this function, say for one hour. The converse of this proposi- tion, however, is not always true ; that is, the pulsation of the heart may continue for a brief time after actual death. Duval mentions having seen the heart of a criminal beat fifteen times after decapitation, the left auricle pulsat- ing for an hour. This is corroborated by some obser- vations made in Paris upon the body of a decapitated criminal. This same phenomenon, as is well known, is witnessed still more remarkably in the heart of the stur- 3 34 . MEDICAL JURISPRUDENCE. geon, frog, and snapping turtle, which will continue to pulsate many hours after removal from the body. This fact, as also the post-mortem contraction of the muscles under galvanic stimulus, proves the continuance of molec- ular life after somatic death. This question of the beating of the heart in a still-born infant being regarded as a valid sign of life, will be dis- cussed later. The same remarks may be made with regard to the function of respiration. The absolute and contimwiis cessa- tion of breathing — say one hour — may be regarded as a positive sign of death. In cases of apparent death, as already remarked, this function may apparently be sus- pended ; but it is in reahty only reduced down to its mini- mum of action. This likewise should be verified by care- ful and repeated auscultation. The common practice of holding a feather near the nose or mouth may serve, by its movements, to indicate breathing. So likewise the deposit of moisture on a mirror, held in the same position, will in- dicate the feeblest respiration. But neither of these is an absolutely positive sign, since they both fail when applied in the case of the hibernating animal which we know is really alive. Another method is to place a small vessel containing mercuiy on the thorax of the body lying face upward ; the slightest respiratory action will be indicated by the move- ments of a reflected image, made to fall on the surface of the bright metal. It may be remarked that in cases of trance, catalepsy, and other instances of suspended animation, the body never exhibits either the pallor or coldness of real death. More- over, if a ligature be applied around the finger of a corpse. SIGNS OF DEATH. 35 no change of color will be observed ; but if the experiment be made on a living body, the tip of the finger will become of a red or purple color, in consequence of the arrest of the capillary circulation at that spot. A ligature around the wrist will cause swelling of the dorsal veins of the hand if there is any life (B. W. Richardson). The most powerful counter-irritants, e. g., oil of mustard, cantharides, etc., will produce no redness or blisters on the dead body. II. The Condition of the Eyes. — The changes pro- duced in the eyes by death are: (i) The entire loss of sensibility to light ; the pupils neither contract nor expand under this stimulus. This, however, is not a positive sign, since the same insensibility to light is witnessed during life in certain cerebral affections, and is also the result of the action of certain poisons. (2) The action of atropin and other mydriatics to expand the pupil, and of calabar bean (eserin) to contract it during life, is lost within a few hours after death. These agents do, however, produce a visible effect if applied veiy soon after the cessation of life, and before the body has become cold, and all muscular irritabil- ity has ceased. (3) The cornea loses its transparency, and the eye-ball its elasticity, very speedily after dissolution. But these conditions may likewise exist before death, as the results of disease. In apparent death, the cornea retains its translucency ; the papilla of the retina is of a rose-red color ; and the fundus of the eye is furrowed by the arteries and veins of the retina. At the moment of death, the papilla of the optic nerve becomes quite pale, and the central artery of the retina disappears. It should also be remarked that the eye sometimes retains its luster after death. This is seen after poisoning by hydrogen cyanid and carbon dioxid. 36 MEDICAL JURISPRUDENCE. III. The Pallor of the Body. — This sign is very uni- form, though not without some exceptions, as in the case of persons of very florid complexions, and in exceptional instances where the cheeks and lips retain their rosy color for some days after death, so as to occasion some uncer- tainty as to the actual fact of death, in the minds of relatives. It is also wanting in cases of death from yellow fever and jaundice ; moreover, the red, inflammatory zones around ulcers and burns, tattoo marks, the spots of purpura, and ecchymoses or bruises do not disappear after death. It must also not be forgotten that a death-like pallor is seen in cases of swooning, and sometimes in the cold stage of ague, and in collapse. IV. Loss of Animal Heat. — During life, the animal body possesses the wonderful faculty of maintaining its own normal temperature (about 98° F.) independently of the surrounding medium. This is effected as the result of cer- tain vital processes. At the moment of death there is a slight rise in temperature ; but a decline begins soon and continues until the body acquires the temperature of the surrounding medium, precisely as any other warm body parts with its excess of heat to the surrounding medium. It never gets lower than this medium, unless the tempera- ture of the latter becomes suddenly increased ; then, for a while, the body will be really cooler than the temperature of the atmosphere. The sense of touch does not convey an accurate idea of the actual coldness of the dead body, since the conducting power of the tissues varies materially. The direct application of the thermometer to the body is the only safe method. If the temperature in the mouth is LOSS OF ANIMAL HEAT. 37 lower than the surrounding atmosphere, it is a strong pre- sumptive sign of death (Richardson). The time in which the coohng of the body is completed is stated to be, on the average, from fifteen to twenty-four hours. Prof Casper makes it from eight to twelve hours. It varies considerably, according to the condition of the body itself, according to the medium in which it is kept after death, and also according to the manner of death. Fat bodies retain heat longer than lean ones ; the bodies of young children and of old persons cool more rapidly than those of adults ; while the bodies of those who die from suffocation, electric shocks, and from certain other diseases, e. g., yellow fever and tetanus, retain heat longer than others. The body, of course, cools more rapidly if exposed to the air unclothed than if covered up in the bed-cloths ; also in a large airy apartment, than in a small, close room. It will cool more rapidly in water than in the air. In death from chronic wasting diseases, and also in cholera, the body cools very rapidly. According to Taylor, loss of blood does not hasten the cooling process. The interior of the body retains its heat considerably longer than the surface, so that if an autopsy be made within twenty-four hours after death, even when its exterior feels perfectly cold, the abdominal viscera may exhibit a temperature twenty degrees, or more, higher than that of the surface. It should not be forgotten that coldness of the body is a frequent phenomenon of sickness ; it is witnessed in hys- teria and ague, also in cholera. Its value as a sign of death consists in the fact that it is progressive and con- tinuous, while the coldness of disease is sudden and not 38 MEDICAL JURISPRUDENCE. permanent. Hence the degree of coldness of the body will often be a good indication of the time that has elap-sed since death. Another fact to be noticed is that the rate of cooling after death, although progressive, is not uniform ; it is much more rapid during the earlier hours than later. Dr. Goodhart's observations show that during the first three hours after death the loss of heat per hour amounted, in the robust, to 3.5°, in the emaciated, to 4.7° ; while when the body was nearly cold, the loss per hour was, in the emaciated, 1.12°, and in the robust, 1.26°. A marked and prolonged rise of temperature after death is observed in some cases. This exceptional condition occurs occasionally in the bodies of those who have died from yellow fever, cholera, tetanus, smallpox, and some other acute disorders. The exact cause of this singular rise of temperature (^post-mortem caloricit)>) is not clearly under- stood. In some instances the increase of heat has amounted to 9° F. Dr. Davy records a post-mortem temperature of 113° F. in the pericardium. We may suppose that in these cases molecular life has continued after the cessation of somatic life. We know that muscular irritability and contractility continue for many hours (under certain condi- tions) after death, and this undoubtedly indicates the con- tinuance of their molecular activity up to a certain point. The injection of a few drops of solution of ammonium hydroxid hypodermically leaves no mark in actual death, but occasions a dark spot in apparent death. V. Cadaveric Rigidity, or Rigor Mortis. — By this is understood the stiffening of the body so generally observed after death. It usually occurs simultaneously with the CADAVERIC RIGIDITV. 39 cooling process. It may be stated to be universal in death from any cause, and to be present in the lower animals as well as in man. In some instances, however, it is so tran- sient as to escape notice. It comes on at very variable periods, from a few moments to eighteen to twenty hours after death. This remarkable variation in its approach is chiefly due to the condition of the muscular system at the time of death. Its duration is equally variable, lasting from a few moments to many hours, or even weeks. After the rigidity passes off the body regains its original pliancy and decomposition immediately commences. As a general rule, the putrefaction of the body is retarded until the rigor mor- tis has passed off. It commences usually in the muscles of the eye, which often become rigid within a few minutes after death ; next in the muscles of the neck and lower jaw; then in the chest and upper extremities ; afterward in the muscles of the ab- domen and lower limbs. The rigidity generally passes off in the same order; thus, the legs frequently remain quite rigid after the upper portion of the body has regained its suppleness. The seat of the rigor mortis is undoubtedly the muscular system. That it is in no wise dependent upon the nervous system is proved by the fact that all the nerves supplying a muscle may be divided and yet the muscle will continue to act, contracting under the galvanic stimulus. But re- sponse ceases immediately on division of the muscle. Even the removal of the brain and spinal marrow has no effect in preventing the muscular contraction. Again, the muscles of a paralyzed limb become equally rigid with those in sound health. The cause of the contraction is usually ascribed to the coagulation of the muscular plasma, a 40 MEDICAL JURISPRUDENCE. proteid principle possessing the property of coagulation to a high degree. The reaction of a muscle in rigor mortis is acid (reddens blue Htmus); but it becomes alkahne after the rigidity passes off While in the state of rigor mortis, the muscle is opaque ; before this, it is partially translucent. Brown-Sequard has shown that a current of arterial blood will restore muscular contractility to a rigid limb. The duration of rigor mortis is one of its most important features. As already observed, this is extremely variable, although, as a rule, it does not set in until the body has begun to cool ; still, in some of the lower animals, and notably in birds, it often manifests itself while the body is yet warm. From the observations of Brown-Sequard and others it appears that the period after death when the rigor mortis manifests itself, together with its duration, is depen- dent chiefly, if not altogether, upon the previous degree of muscular exhaustion. To properly understand this, it should be remembered that immediately after death the muscles are in a state of complete relaxation, giving to the body perfect pliancy. This condition may last for so brief a space of time as not to be noticed, though usually it con- tinues for three or four hours, after which rigidity com- mences. During this period of relaxation the muscles have not yet lost their molecular life, so that they will respond to galvanic and other stimuli. Hence, although the con- traction of a muscle by electricity is no positive sign of somatic life, still it will enable us to conclude either that the person is yet alive or, more probably, that death has very recently occurred. The cessation of all muscular con- tractility under galvanic stimulus is a proof not only of the death of the individual, but it also indicates that the death w^as not very recent — hardly within three or four hours. CADAVERIC RIGIDITY. 4 1 So long as the muscles retain their contractility, the rigor mortis is postponed. It can now be understood that whatever produces ex- haustion of the muscular system must thereby hasten the approach of cadaveric rigidity. Thus, in death from ex- hausting diseases, as in phthisis, or after protracted convul- sions, or when the muscular system becomes exhausted by over-exertion and fatigue, as is seen in over-driven cattle, or in animals hunted in the chase, the rigor mortis shows itself early, and lasts but a short time ; whereas, if death occurs suddenly, in a previously healthy person, the rigidity is postponed for many hours, but when once established it continues for a much longer period. Thus, according to Brown -Sequard, the bodies of decapitated healthy criminals were observed not to become rigid until after the lapse of ten to twelve hours, and the rigidity lasted over a week, even in warm weather. An experiment of the above-named physiologist very satisfactorily proves this statement. Three dogs of equal size were poisoned with strychnin in different doses. One took two grains, and died almost immediately. The second took half a grain, and died in twelve minutes. The third took one fourth of a grain, and died, after pro- tracted convulsions, in twenty-one minutes. In the first animal, whose muscular system had been least exhausted by the spasms, rigor mortis did not set in before the lapse of eight hours, and the duration was nineteen to twenty days. In the second, where the muscular exhaustion was greater, the rigidity appeared after two and a half hours, and lasted five days. In the third, in which the muscular exhaustion was the most protracted, the rigor mortis was developed as early as thirty minutes, and lasted less than a day. 42 MEDICAL JURISPRUDENCE. It has been supposed by some that the rigor mortis does not occur in the bodies of persons killed by lightning ; ex- perience shows this to be a mistake. It is also stated to be absent in those killed by snake-poison, in whom likewise the blood remains fluid. Neither is it interfered with by the previous loss of blood by hemorrhage. It is, however, dependent on temperature, at least so far as regards the duration, which is shortened by heat and prolonged by cold. Bodies submerged in cold water retain their rigidity for a considerable length of time. When a joint or articulation stiffened by complete rigor mortis is forcibly bent, the rigidity is destroyed. If, how- ever, the rigidity is incomplete, it will be resumed after- ward. This may serve to distinguish real death from certain cases of catalepsy, tetanus, and hysteria, accom- panied by rigidity. In all these latter cases the stiffness will return on removal of the opposing force. Cadaveric rigidity is not so strong as voluntary muscular contraction. As a rule the flexors are more affected than the extensors, so that the limbs are generally found to be slightly bent after death. The fact that the involuntary muscles are likewise subject to rigor mortis should not be lost sight of, as it might lead to an error as to the true pathological state of an organ, on making an autopsy. The heart, for instance, may be found very firmly contracted after death by rigor mortis ; this might be mistaken, by the inexperienced, for a true con- traction of the organ, the result of previous disease. Closely connected with rigor mortis, if not indeed a modi- fication of this very state, is the condition described as cadaveric spasm. This is exhibited in the bodies of persons who have died by sudden and violent deaths, in whom there CADAVERIC RIGIDITY. 43 seems to be present a powerful will-power just prior to the death, and producing strong muscular contraction at the moment of dissolution. This spasmodic contraction, more- over, appears to pass at once, after death, into the usual rigor mortis. The best illustrations of this peculiar condi- tion are afforded in those cases of determined suicides who have taken their lives by shooting themselves with a pistol. Very commonly, in such cases, the weapon is found so tightly grasped in the dead hand that considerable force is required to remove it. The same condition is sometimes witnessed in the bodies of drowned persons ; fragments of wood, grass and weeds, or . other objects which had been convulsively seized in the water before death, bein^ found tightly grasped in their hands ; and where two persons have perished together by drowning, it is not uncommon to find them, after death, convulsively clasped in each other's arms. To a similar reason, doubtless, is to be ascribed the singular and striking postures sometimes exhibited by the bodies of soldiers killed in battle. Thus, the attitude of one is de- scribed as " resting on one knee, with the arms extended, in the act of taking aim ; the brow compressed, the lips clenched — the very expression of firing at an enemy stamped upon his face, and fixed there by death. A ball had struck this man in the neck. Another was lying on his back, with the same expression, with his arms raised in a similar attitude, the Minie musket still grasped in his hands, undischarged " (Taylor). VI. Cadaveric Lividity, or Suggillation. — This term is applied to those livid or violet-colored patches or dis- colorations which are observed upon the body at variable 44 MEDICAL JURISPRUDENCE. periods after death, usually after several hours. It is the result of the settling of the blood in the capillaries by gravi- tation. Hence, it is noticed in the most dependent parts of the body, such as (supposing it to be lying on the back) the back, under surface of the neck, calves of the legs and under portions of the thighs. These patches, at first isolated, grad- ually increase in size and coalesce, so as to cover a large surface of the body. Cadaveric lividity is an unqestionable " sign " of death. It makes its appearance sometimes much earlier than at others, and for this variation no very satisfac- toiy reason can be assigned. The most important point connected with cadaveric lividity* is not to confound it with ecchymosis or bruising, to which it bears a considerable resemblance. Several cases are recorded where a body has been found covered with these death -spots, and the mistake has been made of supposing them to be bruises and consequently attributing the death to violence inflicted during life. The medical examiner should be particularly cautious not to confound them. Fortunately, a very simple test will settle the ques- tion. If the scalpel be drawn through a suggillation, no blood will flow; the most that will be obsei-ved will be a few bloody points or specks, arising from the division of small veins of the skin. If, however, the patch be ecchy- mosis (where the effused blood has been infiltrated into the cellular tissue), the incision will either be followed by a flow of blood or else a coagulum will be seen. Moreover, while the ecchymosis is sometimes raised above the level of the surrounding skin, the cadaveric stain never is. The change of color following an ecchymosis — from purple to green and yellow — will also serve as a ground of distinction. These cadaveric spots are not affected by age, sex or constitution, CADAVERIC LIVIDITY. 45 and they follow upon all kinds of death, not excepting that caused by hemorrhage. Suggillation takes place in the internal organs as well as upon the surface of the body, producing in the former appearances strongly resembling true congestion and in- flammation, for which they are, without doubt, frequently mistaken by the inexperienced, and as it may be a matter of considerable consequence in a post-mortem examination not to confound these two conditions, the examiner should be very cautious as to his pathological inferences. These internal suggillations are also termed hypostatic congestions ; they appear chiefly in the lungs, brain, kidneys and intes- tines. The fact that they invariably occur in the most dependent portions of these organs should be suggestive of their true origin, since a real congestion or inflammation exhibits itself either throughout the whole organ or else upon its upper surface equally with the lower one ; cer- tainly it is not confined exclusively to the under portion, as is the suggillation. The observer should be careful not to be misled by finding suggillation on the upper part of an organ, as it may have been that the body has been recently turned over. When it occurs in the intestines, it may readily be distinguished from true inflammation by simply lifting up several folds of the bowels, when the horizontal line which previously had marked the hypostatic settling of the blood becomes immediately broken and disjointed, whereas, if it had been a real congestion or inflammation, the redness would have involved the whole circumference of the intestines and there would have been no broken line of separation. In the brain, hypostatic congestion might be mistaken, by the inexperienced, for one form of apoplexy ; and in the 46 MEDICAL JURISPRUDENCE. spinal cord, it might be confounded with spinal meningitis. In the heart, true suggillation is not believed to occur ; but this is replaced by the formation of post-mortem clots. VII. Putrefaction. — This is usually regarded as the most unequivocal " sign " of death. By this term is under- stood those spontaneous chemical changes undergone by all dead animal bodies resulting in the elimination of fetid gases. The period after death when putrefaction first manifests itself varies considerably, being dependent upon several con- ditions, some of which are connected with the body itself and others extraneous to the body. Among the conditions inherent to the body itself are : 1 . Corpulence. — Fat and flabby bodies undergo putrefac- tion more speedily than thin and lean ones, doubtless on account of the preponderance of fluids in the former. 2. Age and Sex. — For the same reason, the bodies of new-born children and of women dying in child-bed ( ac- cording to Casper) decompose more rapidly than others, especially the aged. 3. TJie Manner of Death. — The bodies of persons dying of diseases in which the vitality of the blood has been impaired, as in typhus fever, pyemia, etc., undergo rapid putrefaction ; also after death from certain poisons, and especially gases, illuminating gas, and hydrogen sulphid ; also from suffocation from smoke, and, indeed, from suffo- cation generally. Putrefaction is also accelerated in bodies that have been much bruised and mangled by machinery, or by railway and other accidents ; but we must except those cases where the body remains protected from atmos- pheric influences, as when buried beneath ruins, etc. On the other hand, the process is retarded in death by alcohol, PUTREFACTION. 47 phosphorus, sulphuric acid, arsenical compounds, and some narcotic poisons. The antiseptic properties of alcohol and arsenic are well understood. The action of acids is a direct retarding influence on the development of the microbes causing putrefaction. Admitting all the above conditions, and giving them due allowance, there are doubtless other causes, as yet unknown to us, which influence the rapidity of putrefaction. Casper adduces the instances of four men about the same age and general physique, and all killed at the same time in a riot. They w^ere buried at the same time, and in precisely similar coffins and graves ; yet on subse- quent examination, the extent of decomposition was found to be very different in the different bodies. The external conditions influencing putrefaction are air, moisture, and temperature. These conditions act by reason of their influence on the development of microbes to which putrefaction is due. Most microbes require oxygen for growth and multiplication ; all require heat and moisture. The processes for preserving perishable articles, such as meats and fruits, illustrate these principles. The influence of air is not limited to the mere supply of oxygen ; but it modifies putrefaction according to the amount of moisture it contains. For this reason perfectly dry air, such at that of the arid deserts of Arabia and Africa, by its rapid desic- cating properties, arrests putrefaction, the body speedily losing its fluids by evaporation and shriveling up into a sort of mummy. The effects of an entire exclusion of air in retarding the process of decomposition in a human body are witnessed in the burial of royal personages in leaden coffins hermetically sealed, and these afterward enclosed in marble sarcophagi. When these have been opened, hun- dreds of years subsequently, the remains have been found 4^ MEDICAL JURISPRUDENCE. preserved. On the other hand, bodies naked, or but slightly clothed, and buried in pine coffins, which soon decay, and in shallow graves to which the air has easy access, will undergo very speedy decomposition. The nature of the soil and the depth of the grave also materiariy influence this process. Thus, a loose, sandy soil and a shallow grave favor it by the ready admission of air, while soil of a stiff, clayey nature and a deep grave would retard it, for the opposite reason. From recent observations, it has been ascertained that part of the atmospheric influence upon decomposition is the presence of the microorganisms, termed bacteria or bacilli, which float in such myriads in the air, and which find their peculiar habitat in dead animal matter. The different tissues and organs of the body undergo decomposition in proportion to the amount of fluids they contain. In this respect the brain of the young infant and the eye contrast widely with the bones and teeth. The human body contains about eighty per cent, of fluids ; hence its great tendency to putrefy after death. The bodies of drowned persons undergo rapid decomposition, unless the water be extremely cold, or contains substances with antiseptic properties which prevent the growth of microbes. Bodies thrown into dung-heaps and cesspools speedily putrefy. If a body be completely deprived of its fluids by drying, putrefaction is arrested, as has been noted. The influence of temperature as an agent in putrefaction is very manifest. The temperature most favorable to this process is that between 70° and 100° F. It commences, however, as low as 50° ; but it is completely arrested at 32°, below which the body becomes frozen, and also at 212°, at which point all microorganisms are killed. An PUTREFACTION. 49 animal body may be preserved for an indefinite period if completely frozen in snow or ice. It is recorded that the body of a Russian nobleman that had been buried in the frozen soil of Siberia, on being exhumed after a period of ninety-two years, was found in a state of almost perfect preservation. The effect of temperature in the process of putrefaction is familiarly shown in the influence of the seasons. In summer a body will decompose very much sooner than in winter — a circiunstance that should not be forgotten when giving an opinion respecting the date of death in an un- known case. According to Casper, the relative rapidity of decomposition in bodies exposed to the air, kept in cold water, and buried in the earth, is in the ratio of one, two, and eight ; that is, putrefaction advances as rapidly in one week in the open air as in two weeks in the water and in eight weeks in the earth (average). Dr. Konig, of Hermannstadt, has reported on the ap- pearance of a number of bodies of Hungarians taken from a deep pool of the waters of the Echoschacht after the lapse of forty years. They were in a state of perfect pres- ervation, without a trace of decomposition or of the forma- tion of adipocere. The internal organs were of the con- sistence of those of a newly-deceased corpse, and the brain was hard, as if presei-ved in spirit. In the interior of these bodies a large amount of sodium chlorid was found, crys- tallized in cubes, deposited on the organs, and which had evidently penetrated into the bodies from without. These crystals were found even within the perfectly closed peri- cardium and adhering to the heart. It may here be remarked that a body floating near the top of the water will decompose more rapidly than when at 50 MEDICAL JURISPRUDENCE. the bottom ; and when taken out of the water and exposed to the air, the putrefaction will be far more rapid than if left in the water. External Signs of Putrefaction. — The following is the order generally observed, externally, in the progress of putre- faction of bodies exposed to the open air. In from one to three days in summer (three to six in winter), there appears a greenish or yellowish-green spot upon the abdomen, three or four inches in diameter, accompanied with the peculiar odor of putrefaction. The eyeball becomes soft and yield- ing within the same period. In a few days more this greenish discoloration has spread generally over the whole body — first in spots, which subsequently gradually coalesce. Dirty red streaks now show themselves throughout the surface, marking the course of the blood-vessels. In ten or fifteen days (in warm weather) the epidermis begins to loosen, forming blebs or blisters containing fluid. Gases now begin to form in the chest and abdomen, causing these cavities to swell out greatly. The eyeballs protrude from the same cause ; the face is swollen ; the features are so much bloated as to be no longer recognizable. In two or three weeks the blebs of the cuticle may have burst open ; maggots appear ; the formation of gases increases, so that the body is enormously swollen. If it be now punctured, the gas which is emitted will frequently take fire on the approach of a flame (hydrocarbons). Other gases are like- wise formed, the result of animal decomposition, as car- bonic acid, hydrogen sulphid, hydrogen phosphid, nitrogen, and amin. The nails now loosen ; and in the further prog- ress of putrefaction the cavities burst open and discharge their contents ; the softened flesh dissolves off from the bones, which now become exposed, and ultimately fall 7 \jJa\I^IAM iU-^ eUa^ u owr»^ ^n*-*^ ORDER OF PUTREFACTION. 5 I apart from the skeleton. The sexes cease to be distin- guishable, except perhaps by the discoveiy of a uterus, which appears to be almost the last organ to yield to putrefaction. The foregoing description is only a general and average one, since the process of the external putrefaction of the body is variable, and is influenced by many circumstances, some of which are not yet fully understood. Internal Signs of Putrefaction. — The order in which the internal organs of the body undergo decomposition being more regular as to time, affords a rather better criterion as to the period of death. The first organ of the body that shows signs of decomposition after death is the lining mem- brane of the windpipe (larynx and trachea) ; this assumes a dirty red coloration simultaneously with the appearance of the greenish spot upon the abdomen. That this is not the result of injection of the blood-vessels is proved by the microscope. In the earliest stage of death this membrane is always very pale, except when the death has been caused by laryngitis or suffocation. The examiner should be cautioned not to mistake this mark of putrefaction for con- gestion. Veiy soon after this stage of redness it becomes of an olive-green color, the rings of the trachea separate, and it falls to pieces and disappears. The next (2) organ to decompose is the brain of young infants. The reason of this lies, of course, in the fact that this organ at such an early age is so very delicate and is so little protected by its bony covering from the outer air. When decomposing, it changes into a soft, rosy, pulpaceous mass, and flows out of the smallest openings. Then follows (3) the stomach. This organ is among the earliest to putrefy after death. The decomposition first 52 MEDICAL JURISPRUDENCE. manifests itself in discolorations of the fundus, together with the formation of dirty red spots or streaks in the posterior portion of the organ, owing to hypostatic congestion. These spots soon ramify, and cover the whole lining mem- brane. There is great risk of mistaking these spots for signs of congestion or inflammation due to irritant poison- ing. The examiner should be specially cautious on this point, as it is often impossible to distinguish them apart by a merely ocular inspection. It is quite certain that a post- mortem redness of the mucous membrane of the stomach cannot, of itself, prove a case of poisoning. In the further progress of putrefaction the stomach softens, the spots be- come greenish and gray, then black, with dark red streaks (veins) running through them. It is finally converted into a pulpaceous mass, and ceases to be recognized. Next to the stomach the intestines (4) follow in the pro- cess of decomposition. They become discolored, very much as in the case of the stomach ; then they become distended with gas, burst, and discharge their contents. The spleen (5) comes next in the order of putrefaction. If not diseased at the time of death, it may retain its integ- rity for two or three weeks. It first assumes a dark red color then a greenish-blue, then becomes soft and pulpy, so that its substance can be rubbed down with the handle of the scalpel. Following the spleen, the omentum and mesentery (6) are the organs next to decay. If there is not much fat con- nected with them, they will rapidly dry up and disappear. The liver (7) resists putrefaction for a considerable time after death — in adults for several weeks. In infants it de- composes earlier. It first becomes of a green color, then black ; then softens, shrivels, and finally disappears. In ORDER OF PUTREFACTION. 53 case of death by arsenical poisoning the Hver might resist decomposition for a considerable time. The brain of adults (8) does not begin to show signs of putrefaction until the end of the fourth or fifth week, and sometimes even later. The process is usually most marked at the base, which softens and becomes bluish-green, and gradually progresses upward and then inward. If the brain has been injured, as by a depressed bone, or by a gunshot wound, it is affected earlier. Next in order is the heart (9). This is one of the toughest of all the organs. The softening here begins in the columnse carneae, and progresses toward the walls of the organ, which finally deliquesce into an unrecogniz- able mass. It is remarkable that the lungs (10), which are very soft organs, and are so nearly connected with the outward air, should resist putrefaction so long. These organs are often found quite sound for weeks, provided they were healthy and uninjured at death. The first evidence of their decom- position is the formation of little bladders of air in the sulci, between the lobes, on the under surface, looking like a string of beads. These increase rapidly, the lung structure turning first green, then black, and finally soften- ing and disappearing. The kidneys (11) follow the lungs. They become red- dish-brown and soften, then assume a greenish-black color, and disappear. Next in order (12) follow the bladder and esophagus; next (13) the pancreas, which, though a soft organ and located near the stomach, is among the last to decompose. Then follow (14) the diaphragm and the arteries, — the tissue of the latter persisting when ever>'- thing around it has fallen into a shapeless mass. 54 MEDICAL JURISPRUDENCE. Last of all, according to Casper, is the uterus (15), which has been found to retain its identity at the end of seven months after death. This fact is of great medico-legal importance where the question arises of the possibility of pregnancy. This description of the progress of putrefaction, both ex- ternal and internal, of the hurtian body is taken chiefly from Casper. It is intended to represent the average, both as regards appearance and time. As already stated, there may be considerable deviations from the order laid down, depending upon circumstances. Modern embalming has reached such a stage of perfection as to delay putrefaction indefinitely. Embalmed bodies have been exhumed after two years' burial and evidences of injury proven to the en- tire satisfaction of an accident insurance company, at whose instance the examination was made. Saponification or Adipocere. — It sometimes happens that the process of putrefaction is interfered with under peculiar circumstances and gives place to a condition known as the saponification of the body. This was first observed by Fourcroy, who discovered, during the removal of human remains from one of the public cemeteries of Paris, that a number of the bodies, instead of undergoing ordinary putre- faction, had been converted into a new substance, which he styled adipocere. This adipocere has an unctuous feel, somewhat like sper- maceti and is of a dirty white color. Chevreul found it to be an ammonium soap — principally ammonium oleate and stearate. The ammonium is derived from the nitrogen of the tissues. The presence of water seems to be essential ADIPOCERE. 55 to this change. It only occurs in bodies that have been buried in wet or very moist soil and never in those in a loose or sandy soil. Frequently, when a grave fills with water, the contained body is converted into adipocere. The same thing may take place in bodies which remain in the water for a certain time. The composition of adipocere is not always precisely the same. It is usually an ammonium soap, but may contain calcium — the latter condition existing especially when the body has been immersed in water containing notable amounts of calcium salts. This was determined experi- mentally by Orfila, who placed an ammonium adipocere in a solution of calcium sulphate ; he found that after a time it had been changed into calcium oleo-stearate. Adipocere is insoluble in water, but partially soluble in alcohol. It emits a greasy smell in burning. Its odor resembles some- what that of musty cheese. From the fact that if a body remain immersed in the water for any length of time it is likely to be changed into adipocere, it becomes an important medico-legal question to establish the period necessaiy for this conversion. De- vergie ascertained that the body of a new-born child was more or less changed into adipocere after remaining in the water for five or six weeks. We see at once the value of this knowledge, since bodies of new-born infants are fre- quently thrown into wells, privies and cesspools. If a body be found under such circumstances, with the process of saponification only just begun, it is probable that it could not have been long in the water and vice versa. Accord- ing to the same authority an adult body requires an immersion in water for one year before the conversion is completed, and when it is buried in wet earth, a period of 56 MEDICAL JURISPRUDENCE. three years may elapse before the change is completely effected. Mummification. — This constitutes another process by which the ordinary putrefaction of the body is interfered with. By mummification we understand the complete ' desiccation or drying up of the body. It results either from burial in the arid and sandy soil of hot countries, . such as Arabia and Egypt, or from exposure of the body / to a constantly cold and dry atmosphere — where, for in- i stance, it is placed in a vault through which a constant stream of dry, cold air is pouring. Such a condition of things is found at the Hospice of St. Bernard, in Switzer- land. In the charnel house attached to this establishment the bodies of those who have perished in the snows are placed. The atmosphere is so constantly cold and dry that the flesh and fat completely dry up. It is quite impossible, from the mere inspection of a mummy, to venture an opinion as to the length of time that has elapsed since death. Many Egyptian mummies are several thousand years old. Certain agents retard, and others promote, decomposition. The former comprise the various antiseptics. Lime, although popularly supposed to hasten putrefaction, in reality retards it, as is shown by a simple experiment of Dr. John Davy, who buried a piece of raw flesh that had been first covered over with powdered lime. It continued sound much longer than another piece that was buried without the lime. No doubt the lime here partly operated by excluding the atmos- pheric air. The strong acids and alkalies, although they do not hasten putrefaction, produce chemic changes, and in this way aid in the removal of a body. MUMMIFICATION. 5/ The period and method of interment materially influence the rapidity of putrefaction. If decomposition has set in before burial, the action will progress far more rapidly than in a body which was interred before putrefaction had begun. The depth of the grave and nature of the soil also exercise a marked influence. The cause of death may influence the rapidity of the decomposition of the body. Having disposed of the first question — is the death real or apparent ? — we may consider the second : How long a time has elapsed smce the death ? It sometimes becomes of extreme consequence to determine this in connection with the attempt to prove an alibi on the part of the pris- oner. This matter is to be determined, in the absence of direct evidence, solely by attending to the different " signs " or phenomena of death, already described. The inferences may be drawn, first, from the signs occurring before putre- faction ; secondly, from those occurring after it. I . Inferences From the Sig?is Exhibited Before Putrefaction. — If the body is only slightly cold, and rigidity is just commencing about the jaws, the eyes glazed, and the eye- balls sunken, death has occurred, most probably, from a quarter of an hour to four or five hours previously. The inference can never be more than approximative for the reasons already given. Suppose the body to be perfectly cold (externally) and rigid throughout ; it has probably been dead from twelve or fifteen hours, to three or four days. If rigidity is complete over the body, and cadaveric lividity (suggillation) js mani- fested over the surface, death has probably occurred one to four days previously. The importance of attending to the above phenomena is 5 58 MEDICAL JURISPRUDENCE. shown by a case mentioned by Taylor. A man was con- victed and transported for killing his wife. The woman was discovered, at 8 o'clock in the morning, with her throat cut. She was very rigid throughout the upper part of her body, and the whole body was cold. The prisoner was able to prove an alibi between the hours of 4 and 8 a. m., and his counsel endeavored to show that the post-mortem cold- ness and the partial rigidity might have developed within four hours, which, if true, would have exculpated the accused. This point was overruled by a mass of medical testimony to the contrary. 2. Inferences aftei' Putrefaction. — Suppose the body ex- hibits the gi'eenish discoloration on the abdomen and the pecuHar odor of putrefaction exists ; the rigor mortis has passed off, leaving the body cold, but pliant : death has probably occurred one to three days previously, in summer, and three to six or eight days, in winter. If the greenish-yellow discoloration extends more or less over the whole surface, together with greenish-brown stains, and dark red lines over various parts, along with relaxation of the sphincter ani muscle, it must have been dead from eight to ten days, in summer, and from ten to twenty days, in winter. If blebs are found over the skin, and some of them opened, with maggots in the muscles ; if the body is green all over, and the chest and abdomen are enormously dis- tended ; the nails loose, or falling out ; the color of the eyes not recognizable ; the features very much swollen — then the death must have occurred two to three weeks previously, in summer, or four to five weeks, in winter. If the chest and abdomen have burst open and dis- charged their contents, and some of the bones are denuded INFERENCES AFTER PUTREFACTION. 59 of their fleshy coverings ; the eyes enormously swollen ; the body has been dead, probably, from two to four months. The above " inferences," it must be remembered, are only approximative. They cannot be positive under any circum- stances ; and, moreover, they are predicated on the suppo- sition that the body under examination has not been buried, but exposed to the action of the atmosphere. Great care must be taken not to give a very positive opinion on this question, as the inferences are to a great extent conjectural, and dependent on many contingencies. Some definition of winter and summer should be given — e. g., over 60° for summer, and below this for winter. Attempts have been made recently by some French observers to determine what time has elapsed since the interment of a body, by the succession of various species of animal life developing in and about the tissues, and some interesting results have been obtained. Such data, how- ever, will need to be verified for each district, season, and kind of soil before being of any practical value. CHAPTER III. MEDICO-LEGAL INVESTIGATIONS— THE POST-MORTEM. The physician who undertakes the examination in a medico-legal case, including a post-mortem, assumes a seri- ous responsibility. He must be fully prepared to meet the various contingencies that may present themselves, and he should execute his work thoroughly and with strict impar- tiality. The examiner should be an expert anatomist and pathologist, and a close and careful observer. In all cases where dispute is likely to arise, it is advis- able to have two examiners, and any suspected person should be allowed representation by some one of his own selection. It will be proper, however, to secure the con- sent of the coroner, public prosecutor, or other officer for representatives of suspected or interested parties to be present. As a general rule such opportunities are not solicited by attorneys representing clients accused of crime. The examination should be made by daylight, since artifi- cial light conceals shades of color which it is important to recognize, such as stains by nitric acid. Analytic and microscopic investigations are needed in many cases, and great care should be taken to place all organs which are to be examined for poison in separate clean jars. Many physicians will thoughtlessly place several abdominal viscera, such as liver, kidney, and stomach, in one jar ; but this is highly objectionable, since it deprives the chemist of all opportunity to determine if the poison has been absorbed during life, a most important point. If examinations are to 60 THE POST-MORTEM; 6 1 be made for blood stains, on the clothing ot the body or on any surrounding objects, these should be marked, wrapped up and preferably removed from the room or immediate vicinity of the body before the post-mortem is begun, there- by avoiding the suspicion that the objects had become blood-stained during the post-mortem, which would de- stroy the value of any evidence adduced by future exami- nation. The examination should be exhaustive, so that the exam- iner may be able to testify with some positiveness as to the cause of death. For example, the discovery of a disease of the heart sufficient to cause death should not preclude an examination of the lungs and brain, in either of which the real cause of the death may be found. Poison in the stomach may coexist with a ruptured aneurysm, a clot in the brain, or a diseased heart. The examination, more- over, should be conducted methodically, and all the details recorded. The post-mortem ought to be made on the first day sub- sequent to the death, but it should never be declined on account of the interval that may have elapsed, nor even if the body be in a state of putrefaction. The surroundings should first claim attention, such as the locality at which the body was discovered, as this may afford a clue, especially in the case of infanticide^ when for example, the body of the infant is found in a privy-well or dung-heap. Sometimes the body will have been dragged by the murderer to a distant spot ; or the victim may have followed his assail- ant a short distance after receiving the blow. Footmarks should be noted, together with their direction ; evidences of strnggling, as denoted by the condition of the grass, dust, or mud in the road, and disturbed or broken condition of 62 MEDICAL JURISPRUDENCE. bushes, which also may be bespattered with blood ; the finding of a weapon or missile. Marks of bloody fingers or blood tracks from bloody shoes should be sought for before any blood is drawn by the post-mortem examination. If there be no wound or evidence of bleeding having occurred from the body under examination, the presence of blood on the hands or any part of the clothing or body would sug- gest that his assailant had received a wound. If in a room, the position of the body in reference to articles of furniture, to any weapon, to glasses, cups, bottles, etc., from which poison may have been taken. It is also advisable to make a rough drawing of the locality. As regards the body itself, the examiner should note its exact position when found : this is especially important if death was caused by a wound. The clothes should be carefully examined to determine whether torn or cut, and whether any torn fragment corresponds with the garment of the accused, or of the deceased ; whether marked by blood-stains, or by an acid ; if stabbed, whether the cuts correspond with the wounds on the body. The clothes should be removed, and the body minutely inspected. It should also be identified, if possible. Notes should also be made of the sex, height, weight, age, and general develop- ment ; of scars and other marks ; abnormalities ; blood, seminal, and other stains ; the color of the skin and condi- tion of the eyes and teeth ; the temperature and rigidity of the body ; the degree of putrefaction ; lividity and ecchy- moses ; matters flowing from the nose, mouth, and ears — blood from or in either of these orifices is often indicative of fracture of the skull ; state of the tongue ; expression of the countenance. The hands should be inspected, to ascertain if they hold a weapon — whether loosely or tightly grasped ; THE POST-MORTEM. 63 or if portions of hair or clothing are firmly held (denoting a struggle), and whether these articles correspond with those found on the prisoner ; whether stained with blood or blackened by powder (the latter indicating firearms). The presence or absence of foreign bodies in the nose, mouth, anus, and vagina should also be noticed. All wounds should be carefully examined as to depth, extent, and direction, and whether they suit the weapon that may be supposed to have occasioned them ; the condi- tion of their edges, as indicating whether recent or not ; marks of inflammation, suppuration, or gangrene ; whether any foreign body be present, as a ball, fragments of cloth- ing, etc. The scalpel may be used, if necessary, to enlarge the wound, with care not to interfere with its original char- acter. If there is contusion without solution of continuity, the examiner should not fail to look for internal injuries. In fractiu'cs and luxations, notice their condition and that of the surrounding parts. In cases of burns, observe their degree and extent ; whether merely inflamed or vesicated, and the state of the adjacent parts. \\\ females, examine the genital organs, especially in case of alleged rape, pregnancy, and recent delivery. In nezv-born cJiildreii, ascertain their length and weight, their color, sex, diameters of head, the condition of the lungs, hair, nails, membrana pupillaris, genital organs, and condition of the umbilical cord. The question of a live -birth will be treated more fully in a later part of this work. The modern methods of photography permit valuable pictures to be taken, so as to preserve accurate evidence of the surroundings and position of a body. It is scarcely nec- essary to refer to the uses that X-ray methods may subserve in medico-legal work. 64 MEDICAL JURISPRUDENCE. The Internal Examination of the Body. — It is impor- tant that the examination should be thorough and syste- matic, and in order to secure this it will be necessary to follow a definite course under all circumstances, or to be able to supply a sufficient reason for a deviation in any par- ticular case. If the investigator be in the habit of always examining the head last, he will be astonished at the amount of blood which will escape if the head be examined first, and thus, by varying his usual course, may mislead him- self, attributing the increased flow to abnormal conditions when they are not present. The following order is com- mended as offering the best advantages with the fewest variations. It is assumed that the external examination has been completed. Tlic Abdomen. — An incision is made from the interclav- icular notch to the pubes, passing to the left of the navel in order to preserve the ligament, and, in the new-born, the vessels which pass to the liver. The incision is carried entirely through the abdominal wall, care being taken not to wound the viscera ; the integument is then dissected from the chest wall as far back as the costal cartilages of both sides ; by forcibly stretching both sides of this incision, an abundance of room will be supplied without any trans- verse incisions, except in rare cases ; in stripping the chest wall care must be used to avoid the smallest opening of the thoracic cavity, as any contained fluids — blood, for example — may escape, or entering air may change the position of the diaphragm, which it may be important to obsei-ve. The abdominal cavity is now to be examined, noting the organs in detail. Note the fluid present ; is it clear or cloudy ; amount ; search for evidence of peritonitis, extravasation of blood or the contents of the stomach, THE INTERNAL EXAMINATION OF THE BODY. 65 intestine, gall-bladder, or urinary bladder, the finding of which will indicate that there has been a wound or rupture of some of the viscera. If such be found it must be closed, and the cavity carefully cleansed and dried before the chest is opened, as the foreign material in the belly cavity would immediately flow into the chest and complicate the examina- tion of the thoracic viscera. The height of the diaphragm is to be noted (especially in new-born children, where ques- tion of still-birth is likely to arise) before the chest is opened, as immediately after no inference can be drawn, as the posi- tion of the diaphragm after the chest has been opened may change. In cases of suspected poisoning the stomach should be ligated at both ends before opening the chest, as the gullet might be accidentally wounded, and the stomach contents thereby permitted to escape. The abdominal vis- cera are not to be examined until after the chest, as the removal of any organ will drain the blood from the heart, and thereby prevent an accurate examination of that organ. TJie Thorax. — The costal cartilages, together with the sterno-clavicular ligaments, should be carefully divided, avoiding the large veins of the neck, the pericardium and its contents ; the sternum is now reflected. Do the lungs immediately collapse, or do they fill the chest cavity to distention ? Examine pleurae for adhesions ; note character and quantity of fluid in each pleura sepa- rately ; remove all fluid from the pleurae in order to prevent the pericardium from being flooded when opened. Open the pericardium in the axis of the heart, being careful not to wound the heart ; this can be best secured by pinching up the sac and transfixing, with the back of the knife toward the heart, and, as soon as an opening is secured, introducing two fingers into the cavity, and thereby protect- 66 MEDICAL JURISPRUDENCE. ing the heart. Note the character and quantity of the pericardial fluid ; note the condition of the heart as to distention of cavities ; see that the great vessels given oft from the heart are in the normal relation to that organ ; open the heart in situ ; note in detail the contents of the cavities ; is the blood fluid or in clots ? are the clots white, black, or red ? This is important, as it may establish whether the death was sudden or prolonged. If the right side of the heart contain distinct ante-mortem clots, it is highly improbable that the death could have been sudden, as by drowning. A man was found in the water three months after his disappearance, and it was presumed that he was murdered and thrown into the stream. At the post-mortem evidence was found of ante-mortem injury, and clots were found in the cavities of the heart ; but no note was made of their character, and the plea of accidental drowning, set up by the defense, could not be refuted. Had the medical examiner been able to testify that the clots were undoubt- edly ante-mortem, it would have established that the death was considerably slower than could have been the case in drowning. Distinctly ante-mortem clots are posi- tive indications of the death agony not having been instan- taneous, and may, for this reason, be of the greatest im- portance in establishing the exact time at which the injury was received or the poison given. The heart may next be removed by cutting through the vessels at its base, and examined as to its weight, condition of its walls and tissue, and state of its valves. Sometimes a microscopic investi- gation may be required. The aorta should likewise be examined for atheroma and aneurysm. The lungs may be removed by passing the hand beneath them (noticing any adhesions), and cutting through the THE INTERNAL EXAMINATION OF THE BODY. 6/ bronchi and vessels at their roots. They should be in- spected as to their color, density, etc., as indicating disease ; the condition of the bronchial tubes and pulmonary artery (embolism) ; and the presence of foreign matters in the air passages (in case of drowning or of sudden death). A man in apparent health, while away from home, became sud- denly cyanosed and fell unconscious from his seat at the table after eating heartily. Relatives claimed that he was poisoned. A careful examination revealed the presence of an irregular fragment of a potato in each bronchus, com- pletely occluding the entrance of air ; and it was afterwards shown that he habitually bolted his food. A cud of tobacco or stump of a cigar might as easily give rise to the same difficulty. If blood has escaped into the thorax it should be removed by a sponge, so as to ascertain the color of the parts. The hydrostatic examination of the lungs in new- born children, in cases of infanticide, will be considered fur- ther on. The ribs should be examined in succession for evidence of fracture or other injury. The esophagus may be cut from its attachments in the neck, stripped from the chest, and left to be removed with the stomach ; a ligature, in case of suspected poisoning, should be placed at the car- diac end of the stomach to prevent regurgitation of the gas- tric contents ; the esophagus may be opened down to the ligature, and its interior examined for corrosion or other evidence of poison or injury. The organs of the abdominal cavity are to be next examined — the spleen, kidneys, and bladder. If any urine be present in the bladder, it should be carefully preserved in a chemically clean bottle, that it may be examined for albumin, sugar, or for poisons ; in. the latter case some of the alkaloidal poisons (atropin, strych- 68 MEDICAL JURISPRUDENCE. nin, etc.) can be physiologically tested for by injecting some of the suspected urine, hypodermatically, into sus- ceptible animals, or chemically, as will be discussed later. The internal and external genital organs are to be examined next, and, in the female, the uterus especially, for evi- dences of pregnancy, abortion, or delivery. The liver should be next examined. The Stomach should be examined by first ligating it at the cardiac extremity, and then by applying two ligatures at the pyloric end, and cutting between the latter. Note the general external appearance, and then open it along its lesser curvature. Examine the contents, as to quantity, character and odor, and reaction. Carefully inspect the Hning membrane with a lens for solid particles of phos- phorus, crystals or patches of arsenic, or other mineral poisons, fragments of leaves or seeds, or other foreign matters. Note any evidences of inflammation or ulceration. If an analytic examination of the stomach and its contents is to be made, it is better if it can be so arranged not to open the stomach until it is delivered to the chemist. Under ordinary circumstances, except in well-appointed morgues, no facilities are at hand for examining for crys- tals, fragments of leaves, etc., and hence this had better be deferred until the chemist has access to the organ. The Intestines, after inspection for twist, strangulation, or hernia, should next be examined, by removing them from their attachments, and slitting them throughout with an enterotome ; looking for inflammation and ulceration of the glands, and for any foreign matters ; also noting the condi- tion of the appendix vermiformis. In cases of poisoning, the stomach and its contents should be preserved for chemical examination in a separate jar. The intestines also THE INTERNAL EXAMINATION OF THE BODY, 69 (at least a portion of the small and large bowel, together with the rectum), and portions of the liver, one kidney and the spleen should be kept for a similar purpose. The jars containing the viscera should be securely stoppered and sealed with the private seal of the examiner, with a label affixed, stating the name of the deceased person, the date of death and of the autopsy. They should then be deliv- ered personally, by him, to a responsible party, from whom he should always take a written receipt. The preservation of each organ in a separate and well-cleaned — preferably new — jar is to be especially urged. Toxicologic examina- tions are often seriously hampered by the fact that stomach, liver, and kidneys have been placed in one large jar. Such a condition prevents determining the ante-mortem distribu- tion of the poison. The Head. — After a careful external examination for wounds or injuries, for which purpose the hair may have to be removed, the scalp should be separated by an incision from ear to ear across the vertex, down to the bone ; it should then be everted in both directions so as to expose the skull. Search for fractures, and do not mistake irregu- lar sutures for these. Blood along the line of a suture can be wiped off, along the line of a fracture it cannot ; gentle tapping on the bare skull may give a "cracked pot" sound in fracture. Notice any unusual thinness of bone ; follow out any fracture to its whole extent ; observe any extrava- sation of blood under the scalp. The skull should now be carefully sawed around, about half an inch above the opening of the ear, the calvaria removed (under no circumstances should the hammer or chisel be used), and the condition of the dura mater no- ticed. Look for hemorrhage, either extradural or sub- 70 MEDICAL JURISPRUDENCE. dural ; if the dura has come off with the calvaria, it should be stripped and the inner table of the skull cap closely in- spected for any fracture which may or may not show on the outside. This membrane should be carefully cut around with a probe-pointed scissors and the arachnoid and pia mater closely inspected. The upper part of the brain can now be examined before removal — as to congestion of its vessels, laceration, or ex- travasation of blood upon its surface. This latter is often seen on the side opposite to the external injury. The brain is to be carefully removed, by inserting the fingers beneath it and dividing the medulla oblongata. The base of the skull should be carefully inspected for fractures. The brain should be examined from above, slicing it hori- zontally; regarding specially its consistence, color, presence of extravasated blood or serum, of tumors or abscesses, disease of blood-vessels or of the membranes. In opening the skull of very young children a pair of strong scissors may be used instead of a saw. The Spinal Column should be opened through its whole extent, by sawing through on each side of the spinous proc- esses. The cord, together with the dura mater, should then be removed and examined. Note any fracture, dislocation or contusion. The Neck should be inspected for marks of violence by the fingers (garroting); by a cord (strangling or hanging), and for ecchymoses. Note should be taken as to the con- dition of the great vessels and nerves. The cavity of the mouth and nose should be examined ; also the condition of the larynx, trachea, pharynx, and esophagus. In case of disinterment of a body the inspectors should always view it before it is removed from the coffin ; at which THE INTERNAL EXAMINATION OF THE BODY. "] \ time, also, it should be properly identified by the friends or relatives of the deceased. In a medico-legal examination of a body, such as above described, there should always be present either a second inspector or a clerk to take down the notes as the autopsy progresses. These notes should comprise the appearances presented by the different organs, stating facts, not opinions. The notes should be read over by both examiners and, if necessary, corrected before sewing up the body. In many cases it will be expected that a report should be drawn up containing opinions of the case. The length and character of this report will depend on circumstances. CHAPTER IV. PRESUMPTION OF DEATH, AND OF SURVIVORSHIP. Presumption of Death. — This question may be raised when a given person is not heard of for a long period. The law, in that event, presumes death, and the adminis- trator or executor may proceed to settle the estate. This question is not often raised in life insurance cases, when the party insured has not been heard of for many years, and the lawful heirs demand the payment of the policy. It must also be considered in cases in which either married person leaves the other and remains continuously away. The length of time usually regarded by the law as war- ranting a presumption of death, in any of the above cases, is seven years from the time the person was last heard from ; so that in the case of married persons it is not regarded as bigamy if either party should marry again after the expiration of the seven years of continuous absence without communication or information of any kind on the part of the other. In cases of heirship and property, and in some cases of life insurance, it is often not considered necessaiy to wait the whole seven years, but settlements have been made by the courts or companies in two years. The presumption of death must depend on general evi- dence, being a presumption o{ fact to be determined by a jury. There are cases, however, of a special character, where the courts have decided the presumption of death to be sooner or later than the period of seven years, as, e. g., if the individual concerned was in feeble health when last 72 PRESUMPTION OF SURVIVORSHIP. 73 heard from. This question would involve medical evidence as to the probabilities of life in such a case. Presumption of Survivorship. — Questions relating to presumption of survivorship are much more frequently dis- cussed in the courts than those pertaining to presumption of death. There is, however, no general law upon the sub- ject, either in this country or Great Britain, every case in which the question is involved being decided according to its individual merits. When two or more persons perish by the same calamity, in the absence of all testimony the courts frequently refuse to assume that one survived the others, but have decided that all perished together. Yet momentous questions may be dependent upon a legal de- cision of the question of survivorship ; as when the parties dying are a father and a son ; if the son survive but for a moment, " his wife shall have dower, for the lands descended the instant the father died." So, in the case of a testator and legatee : if the latter die first, the legacy lapses ; but if he survives the testator for ever so short a time, his executors can claim. So, again, the husband of a woman possessed of freehold property (not specially settled) has a life interest in her estate, provided she has issue by him, born during the life of the mother, and which survives her even for a moment of time (tenancy by courtesy). The old Roman law upon this subject, upon which are based most of our modern decisions, enacted that when persons of different ages perished in battle, those under puberty were deemed to have died first ; but if the son was above the age of puberty, and both died together, the son was pre- sumed to have survived the parent. In the case of husband and wife, the husband was presumed to be the survivor (Beck). 74 MEDLCAL JURISPRUDENCE. According to Fodere and Beck, the French law, as con- tained in the Code Napoleon, is as follows : "I. If several persons, naturally heirs of each other, per- ish by the same event, without the possibility of knowing which died first, the presumption as to survivorship shall be determined by the circumstances of the case ; and in default thereof, by strength of age and sex. " II. If those who perished together were under fifteen years, the oldest shall be presumed the survivor. " III. If they were all above sixty years of age, then the youngest shall be presumed the survivor. " IV. If some were under fifteen, and others above sixty, the former shall be presumed the survivors. " V. If those who perished together were over the age of fifteen, but under sixty, the males shall be presumed the survivors, where the ages are equal or the difference does not exceed one year. " VI. If they were of the same sex, that presumption shall be admitted which opens the succession in the order of nature. Of course, the younger shall be considered to have survived the elder." According to Section IV. in the above Code, no distinc- tion is made between an infant and a man of sixty years ; yet certainly it may fairly be supposed (as remarked by Dr. Tidy) that the latter had a better chance of life than the former. The Prussian law on this question is about iden- tical with the Code Napoleon. These principles are not a part of the law in the United States or England, except in Louisiana, which has adopted many of the principles of the Code Napoleon. Although our laws are not decisive on questions of pre- sumption of survivorship, but treat them as questions of PRESUMPTION OF SURVIVORSHIP. 75 fact depending wholly on evidence, and in the absence of all evidence, regarding them as matters incapable of being determined, still, there are matters of importance connected with each case as it presents itself which deserve consider- ation in influencing the decision. These points may be considered under the following heads : 1. Probabilities Ajforded by the Age. — Between a father and a child under puberty, the English civil law decides the farther to be the survivor. Between the ages of fifteen and sixty there is no probabihty. Between a middle-aged man and one under fifteen or over sixty, the probabilities are in favor of the former. Between one under fifteen and one over sixty, the former is deemed the survivor ; but the same exception might be taken here as in the case of Section IV. of the Code Napoleon. Between two under fifteen, the older is considered the survivor. If the question is between a mother and infant, both dying in childbed, without assist- ance, the presumption of survivorship is in favor of the mother, because the child might be still-born, and also because, if large, its life might be endangered by delay, and it would be more exposed to danger without assistance, such as strangulation by the cord or suffocation in the discharges of the mother. 2. Presumption Afforded by the Sex. — The presumption is in favor of the male, when it is a question of physical strength and courage, as when a man and woman perish together by drowning, or some other casualty. But in particular cases, the question of the respective health of the two persons might have to be considered. When, how- ever, it is a question of passive endurance, especially where insensibility supervenes, then the presumption is in favor of the female. 76 MEDICAL JURISPRUDENCE. (3) The Cause of DeatJi, as affording a presumption of survivorship. In death from asphyxia (apnea), as in smothering, or breathing noxious gases, as women require less oxygen than men, the probabilities are in favor of the former, other things being equal. Thus, it is stated that in Paris, in one year, there occurred three hundred and sixty cases of poisoning by charcoal vapors ; of this num- ber there were nineteen instances where a man and a woman were exposed together, and of these only three survived, and all were females. Dr. Beck relates the case of a man, wife, and child, who were all asphyxiated while sleeping in a room which was exposed to the vapors of a coal stove. In the morning the man was found dead, the child dying, but the woman recovered. In drowning or shipivrcck, the question becomes very complicated, having to take into account the age, sex, strength, and opportunity. Thus, men being stronger, more likely to be able to swim, and in case of shipwreck, being more apt to be on deck, and, therefore, in a better position to escape, have the best probabilities for survival ; but, on the other hand, the buoyancy of a woman's clothes might support her in the water, and thus save her life, under possible circumstances. In case of two or more persons, all males, equally exposed, a presumption of survivorship can only be entertained by searching for bodily injuries, or other weakening causes, which would necessarily interfere with the individual's exertions to save his life. Here, also, their respective swimming capacities would have to be con- sidered. If the question be on the survivorship, in the case of several persons exposed to excessive cold, the amount of clothing, the physical condition, and the immoderate use PRESUMPTION OF SURVIVORSHIP. // of alcohol must all be considered before aniving at a con- clusion. The probabilities would here be in favor of the strong adult over the very young, or very old person, and of males over females. The debilitating effects of poverty, entailing a bad nutrition, and also of intoxication, as being especially obnoxious to the effects of cold, should not be overlooked. The perishing of drunken persons on a cold winter's night is a familiar occurrence. In relation to the effects of heat it may be remarked that, while the young and old suffer more from cold than adults, they seem able to withstand a greater amount of heat than the latter. In death by starvation, the general principle that the young require more food than the aged will determine the presumption of survivorship to be in favor of the latter ; also for the female, rather than the male. Certain circum- stances, however, should here be considered, such as prox- imity to water, which would aid in sustaining life for some time, even without food. CHAPTER V. PERSONAL IDENTITY. The medico-legal consideration of the subject of Personal Identity is much more important than it may appear at first sight. The question is often raised in trials and it may con- stitute the chief link in the chain of evidence. Cases of mistaken identity are constantly occurring and proofs abund- ant might be adduced to show that innocent persons have frequently been made to suffer judicial penalties, simply through an error of this nature. Should an alleged child, or other claimant, present his claim to an inheritance, he must first establish his identity before taking further steps in the suit. If an individual is assaulted or robbed, he will be required to identify his assailant before he can successfully prosecute him. Again, a person, after many years' absence in foreign climes, returns home to claim his rightful property or title ; but he is so changed as to be unrecognized by his nearest relatives ; he must be able to prove his identity before the courts before his claim can be sustained. In relation to persons found dead — whether in cases of recent death, where the body has undergone but little change, or years after the decease, where nothing re- mains but the skeleton — the question of personal identity acquires the most intense interest, especially in a trial for murder, where it becomes essential to estabhsh the identity of the alleged victim. The aid of the physician is not so frequently invoked for proving the identity of the living, since this can generally 78 IDENTITY OF THELIVING. 79 be established as satisfactorily by friends and neighbors. Still, there may be occasions of unusual complexity in which a professional opinion may become requisite, as, for example, to verify certain deformities, fractures, scars and other marks about the person, when these constitute the evidences on which the identification may depend. The subject will be considered under the two divisions of (i) The Identity of the Living and (2) The Identity of the Dead. I. The Identity of the Living. — This may usually be established by the direct evidence of witnesses who have known the individual sufficiently long to have a distinct recollection of his personal appearance ; such is the testi- mony of relatives, friends, and acquaintances. Although among the myriads of the human family it is very rare to find two persons exactly alike in all points, yet remarkable instances do occasionally occur where the personal resem- blance is so striking as to baffle even the skill of the detec- tive, and this resemblance has been made still stronger by the existence of similar marks, cicatrices or certain pecu- liarities of structure in both individuals. Some striking illustrations might be given of the extreme difficulty — amounting, at times, to an impossibility — of deciding the question, which also goes to show how easily witnesses may be mistaken in their evidence on this subject. Only two will be here referred to. In the year 1560, the celebrated case oi Martin Guerre and Armand dii Tilh was tried before the Parliament of Toulouse. Martin had been absent from his home for eight years, when the person named du Tilh appeared and represented himself as the long-absent man. So strong 80 MEDICAL JURISPRUDENCE. was the resemblance, that his statement was universally accepted by all of Guerre's family, including his wife, four sisters, and two brothers-in-law, among whom he lived un- suspected for three years. About this time, however, some- thing occurred to excite suspicions as to the true character of the supposed husband and brother, when he was arrested, and brought before the tribunal, on a charge of fraud. Upon his examination he gave satisfactory answers to the most minute questions in relation to Guerre's former life. Some one hundred and fifty witnesses were examined dur- ing the investigation, of whom between thirty and forty testified, from a life-long acquaintance, that the prisoner was Martin Guerre ; while about the same number swore positively that he was Armand du Tilh, whom they well knew ; and over sixty, who knew them both, declared that they were unable to say which the prisoner was. Finally, however, the real Martin appeared upon the scene, when he was immediately recognized. The four sisters who had previously testified that du Tilh was their real brother now admitted their error, and acknowledged the distinction. There being now no doubt of the guilt of the prisoner, he was condemned, and afterward executed. The other instance is afforded in the recent famous Tich- borne case, in which a person named Orton, with various aliases, undertook to personate an English baronet, heir to a large entailed estate. So successful was his scheme that " he was sworn to be Sir Roger Tichborne by eighty-five witnesses, among whom were Sir Roger's mother, the family solicitor, one baronet, six magistrates, one general, three colonels, one major, two captains, thirty-two non- commissioned officers and privates of the army, four clergy- men, seven tenants of the Tichborne estates, and seventeen IDENTITY OF THE LIVING. Ol sei-vants of the family." The claimant also gave proof of " a fish-hook wound on the eye, of a mark of bleeding on the ankle, and of a peculiar scar on the head," all of which the genuine Sir Roger possessed. The case, however, broke down on cross-examination, many circumstances being proved against the claimant, which need not be here enumerated. Suffice it to say that a verdict was taken against him, and that an indictment was found against him for perjury. Now, as a fair inference from the above two instances - and other remarkable cases, we may assume that appear- ances are not conclusive evidences of personal identity, because these appearances convey different impressions to • different observers ; and as a result of this discrepancy, we must admit the fact that " a large proportion of ordinary persons are very untrustworthy witnesses to identity when dependent on appearances alone. They are, from nature or habit, incapable of appreciating form, and form alone is the unerring proof of personal identity. The difficulties in the way of identification, more especially of the dead, are to them insuperable." To this inherent difficulty on the part of the witnesses may be added their want of previous training as minute observers, and also the well-known fact of the adroitness of criminals at personal disguisement. A second means of establishing the identity of the living, especially in a criminal, is by certain peculiarities in the appearance, which are noticed at the time of the commission of the crime, and which are, therefore, apt to leave a strong impression on the senses, such as (a) size, when the indi- vidual is very tall or very short, very corpulent, or very slim ; whether lame, or otherwise deformed ; (d) dress, when a portion — sometimes a mere shred — of the prisoner's dress 7 82 MEDICAL JURISPRUDENCE. is discovered near the seat of the crime, or which may have been retained in the grasp of his victim, and which exactly corresponds with the rest of the garment found on his person, or in his own house. A third means of identification is afforded by the voice. Peculiarity of the voice (such as depth or shrillness, lisping or stammering) always makes a strong impression upon those who hear it, and constitutes a valuable aid in personal identification. Fourthly, the presence of certain peculiar marks, either natural or acquired, about the person, often affords material aid in establishing identity. These marks compnse moles, nevi, scars, cicatrices, deformities, fractures, tattoo-marks, etc. Such marks are usually well known and remembered by relatives and friends of the individual, who can usually identify them. Some of these remain upon the body during life ; others gradually decline and fade away. In relation to tattoo-marks, Casper's experience leads to the inference that some of them (the red ones) are gradually obliterated by time, while the black and purple ones are more perma- nent. A cicatrix is permanent during life, if there has been any original loss of substance. Even the cicatrix made by the lancet in venesection, at the bend of the arm, usually remains during life. It may not always be distinguished from the surrounding skin, unless the part be smartly rubbed, when the white scar is immediately manifested on the red surrounding surface. Caution should be observed against too strong reliance upon scars as a means of iden- tity, since these may, at times, be discovered upon another, precisely similar, both'as to form and situation. Under this head may be mentioned the appearance of the hands (whether hard and horny, or soft and pliant, or IDENTITY OF THE LIVING. 83 whether stained in a peculiar manner), as often indicating the nature of the occupation of the individual. In no small number of cases now recorded, the teeth have been essential links in the chain of identification. Es- pecially in this the case when the individual has been under the care of a dentist, teeth extracted, irregularity of tooth- line, fillings, and artificial teeth all being identifiable by the dentist who did the work. Photographs and other portraits of the suspected person are sometimes useful aids in the identification of the living, as well as of the dead ; but caution is requisite here, since the art of the photographer in the touching up of the pic- ture frequently makes it an unfaithful representation of the features. As bearing upon this subject, it may be proper to say a few words upon vision and hearing. The limits of normal vision or healthy sight, unassisted by instruments, in a per- fectly clear atmosphere, are stated to be as follows : 5 feet, the range of distance is 2.96 miles. 5.91 " 9-35 " 13.2 29.5 41.8 94 It follows from this that a man of ordinary height may be seen on level ground at a distance of two or three miles on a clear day ; but this is very different from recognition of the person so as to identify him. The effects of age upon the acuteness of vision are considered by Dr. De Gueret to be as follows : At fifty years it is diminished one fifth ; at sixty years, At a height of 5 20 50 100 500 1000 5000 84 MEDICAL JURISPRUDENCE. one fourth ; at seventy years, one third ; at eighty years, one half. In other words, if a man of thirty or forty could distinguish an object at one hundred feet distance, at sixty years of age he could not recognize it further off than seventy-five feet, or at eighty years at fifty feet. The recognition of persons at a nearer or greater distance is afforded by their stature, gait, complexion, color of the hair and eyes, and peculiarities of appearance. According to the above authority, the best-known persons can be recogized often with difficulty, in broad daylight, at one hundred meters, or about one hundred and nine yards. Less known persons may be recognized, in broad daylight, at sixty to one hundred yards ; and people who are almost strangers, and who have no personal peculiarities, at twenty-' seven to thirty-three yards. By the clearest moonlight, the best-known persons cannot be recognized further off\^ than sixteen or seventeen yards. By starlight, recognition ' cannot be effected beyond ten to thirteen feet. The light of a flash of lightning enabled a lady, on her passage home from India, to see distinctly the features of a man who was robbing her trunk in the cabin of a vessel, on a very dark night ; and authentic instances are given where, by the flash of a pistol or gun, sufficient light was momentarily afforded to enable not only an assailant to be recognized, but like- wise the color and appearance of his horse. The distance at which sounds (such as the report of a gun or pistol) continue to be audible cannot be determined with accuracy, since it depends upon the direction of the wind, the condition of the atmosphere as to moisture, and other disturbing sounds. The velocity of sound may be stated to be, on an average, 1,135 feet per second, which is about 13 miles a minute, or one mile in about 4^ seconds. IDENTITY OF THE LIVING. 85 II. The Identification of the Dead. — This may have ref- erence (i) to the body recently dead, but entire; (2) when the body has been mutilated and only parts of it are sub- mitted, and (3) when the soft parts have disappeared by putrefaction and the skeleton only remains, or where de- tached bones merely have been discovered. When the death has but recently occurred and the body is unmutilated, most of the same general methods of estab- lishing identity are available as have already been mentioned in the case of the living — such as the testimony of relatives and acquaintances as to the personal appearance of the de-' ceased, certain marks upon the person, as nevi, moles, cica- trices, tattoo-marks, fractures, deformities, etc. Photographs and other portraits are here also admissible, although by no means always reliable proofs. If the body has been subjected to mutilation after death and the several portions removed to a distance from one another and some of them even destroyed, as is sometimes done by a murderer with a view to escape detection, the difficulty of identification is, of course, very much increased. Nevertheless, if the disconnected parts can be recovered, or even a portion of them, it will always be possible for a skilled anatomist so to readjust them as to reconstruct the body, so to speak, by making the proper allowances for the missing parts and comparing these with other average specimens of a similar kind. Several striking examples of this character have been recorded. One of these is the well-known case of Dr. Parkman, who was murdered by Dr. Webster, in Boston, Mass., about forty years ago. After the death of his victim Dr. Webster attempted to de- stroy all evidences of the deed by cutting up the body into fragments, some of which were burned in a grate, some im- 86 MEDICAL JURISPRUDENCE. mersed in chemicals, and others packed away in boxes in distant parts of the building. On the discovery of these remains, a week after the murder, the portions of the body were accurately examined by a skilled anatomist. It was proven that they were human remains, belonging to one and the same body ; of the male sex ; and that they had not been dissected for anatomic purposes, but cut and hacked in different directions, for the object, evidently, of mutila- tion. On restoring these disjointed parts in situ, and sup- plying the deficient portions, it was found that the proper measurements agreed closely with those of the missing Dr. Parkman. This circumstance, together with the discovery of certain marks of identity about the teeth and jaws (the head had been almost completely destroyed by fire ), afforded sufficient evidence of the personal identity of the missing man to enable the jury, on the trial of Dr. Web- ster, to find a verdict of guilty. Another instance of a somewhat similar nature is recorded by Professor Taylor. A number of years ago a murder was committed in London, on the river Thames, and shortly afterward a package con- taining mutilated human remains was discovered on one of the abutments of Waterloo Bridge. The murderer had no doubt, intended to throw the bundle into the river ; but it had lodged on the projection in its descent. Dr. Taylor was requested to examine and identify these mutilated remains ; and when, after great difficulty, the parts were brought together and found to fit, the body was identified as that of a man who had recently disappeared from a vessel on the river — a Swedish sailor. One of the most remarkable cases of this class was recently (1897) tried in Chicago, 111. The defendant, Luetgert, was a sausage- maker, and was accused of having murdered his wife and IDENtiFicATiON OF THE DEAD. 8/ destroyed her body by solution in caustic soda in a vat in his manufactory. Some small bones and articles of jewelry were found in the vat. The trial lasted many days, but ended in a disagreement of the jury. The contention of the prosecution that the bones found were human was com- bated by experts called by the defense. When the question of identity relates to the skeleton merely, or only to portions thereof, the answer cannot be always satisfactory, and the medical jurist has need of much caution and reserve before giving a positive opinion. The very first thing for him to determine is whether the bones submitted to his inspection are human bones or those of some of the inferior animals. Doubtless, if the entire skeleton be discovered, there need be no uncertainty about the matter ; but if only a single bone or two be found, a mistake may easily be made, except by a practiced anatomist and osteologist. Indeed, many ludicrous blunders are re- corded of persons, of otherwise good medical education, mistaking the bones of the ox, horse, dog, pig, and goat for those of the human subject. But may not something be learned by the aid of chemistry or the microscope ? The reply must be generally in the negative. Certainly, the bones of the aged do contain more calcareous matter than those of the young, and consequently present a somewhat different appearance under the microscope. But human bones have the same general chemical composition as those of the lower animals. Bone-cells or corpuscles vary some- what in size in the different orders of animals, being largest in reptiles, smallest in birds and mammals, and intermediate in fishes. In this respect there is an analogy with the size of the blood corpuscles in these different orders ; but these are only generalizations, and would be of little practical use 88 Medical jurisprudence. in individual instances. To be sure, the microscope will enable us to determine the fact of any specimen submitted being bone, or not, by the presence or absence of the bone- cells ; but it can go no further, inasmuch as it cannot dis- tinguish the bone-cell of a man from that of a mouse or of an elephant. If the skull is the only portion of the skeleton submitted for examination, there can usually be no difficulty in recog- nizing it as human ; the only doubt that might arise would be the possibility of its belonging to one of the higher order of (anthropoid) apes ; but even here there are important differences which would not be overlooked by one skilled in comparative anatomy and osteology. The further ques- tion, whether from the examination of a skull simply, it is possible to decide to what race the individual belonged, — Caucasian or otherwise, — we do not thing can be answered with absolute certainty. Doubtless, well-marked typical skulls may be identified as belonging to some particular race, c. g., the Negro or Caucasian ; but we must remember that the points of distinction, which in well-marked speci- mens serve to separate these, shade away in many instances so as to make it extremely difficult, if not impossible, to give a medico-legal opinion in an isolated case. Another important point is to ascertain whether all the bones submitted for inspection belong to one and the same skeleton. The mere fact of their being discovered together does by no means necessarily prove it, since they might have been so placed either accidentally or with the design of eluding detection of some crime. In the identification of the dead by means of the skele- ton or by detached bones, the three leading points to deter- mine are (i) the age, (2) the sex, and (3) the stature. IDENTIFICATION OF MUTILATED REMAINS. 89 I. The Age. — This can generally, in young subjects, be pretty accurately determined by the development of the teeth and by the progress of ossification in the different bones. In the skeletons of new-born children, and before the teeth have appeared, it may become important for the medical jurist to be able to decide upon the age in order either to rebut or confirm a charge of infanticide. It is authoritatively stated that in the jaws of a child at full term there will always be found the rudiments of twenty- four teeth — twenty primary teeth and four permanent molars. Hence, if only the jaws of an infant be discovered, medical evidence of its probable age may be given. The average date of the eruption (cutting) of the teeth is, ac- cording to Mr. Bell, as follows : The four central incisors appear from^e^^ to eight months after birth; the four lateral incisors, from se'ven to ten months ; the four anterior molars, from tzvelve to sixteen months ; the four cuspidati, from fourteen to tzventy months ; and the four posterior molars from eighteen months to three years. Between six and seven years the jaws contain forty-eight teeth — twenty temporary ones in a perfect state of development, and twenty-eight permanent ones imperfectly developed and placed behind the temporary teeth which they are to re- place. According to Mr. Saunders, the order in which the permanent teeth make their appearance is as follows : At seven years, the four anterior molars ; at eight- years, the four central incisors; at nine years, the four lateral incisors • at ten years, the four anterior bicuspids ; at eleven, the four posterior bicuspids ; at twelve to twelve and a half years the four cuspids ; and at thirteen to fourteen years, the four second molars — making the whole number of permanent teeth at this period tiventy-eight. The four remaining (pes- go MEDICAL JURISPRUDENCE. terior molars) teeth — called wisdom teeth — do not usually appear until from eighteen to twenty-one years of age. As a rule, the teeth of the lower jaw are cut first, but there are many exceptions ; nor must it be forgotten that irregu- larities often occur as to the order of their appearance. The above description is intended to apply only to the average cases. To cite one or two examples in illustration of the medico- legal application of the foregoing rules : suppose the skull of a child was discovered, in the jaws of which were /ze'^/?7£' permanent teeth — eight incisors and four molars; we should decide the age to be about 7/zne years. If the jaws contained twcnty-foiir permanent teeth — eight incisors, four molars, eight bicuspids, and four cuspids, we should conclude the age to be about thirteen years ; and so on. It is proper here to remark that there are two diseases which affect the growth of the teeth, viz., rickets and syph- ilis. In a rickety child the first teeth do not usually appear until after the twelfth month, whereas in cases of congenital syphilis the teeth appear prematurely — before the sixth month ; but they present a peculiar notched ap- pearance, and they are apt to be brittle and to crumble away easily. The progress of ossification in the different bones of the skeleton affords an additional test of its age, especially in early life. According to Beclard, the degree of ossification in the lower epiphysis of the femur affords the most certain criterion of the age of the fetus and of the new-born child. Thus, if no ossific deposit' can be seen in this cartilaginous epiphysis, it is certain that the fetus has not attained to the eighth month of uterine life. If the osseous deposit is as large as a poppy-seed, it is probably in the ninth month of DETERMINATION OF THE AGE. 9I fetal existence ; and if it has acquired the diameter of a line and a quarter, to one and a half, it has reached the full period. If the point of ossification measures three lines or more, it may be assumed that the child had survived its birth some little time. The average length of the skeleton of a new-born child is about sixteen inches. At the end of the first year, ossi- fication has commenced at the extremities of most of the long bones ; and this progressively advances from year to year until the whole process is completed, and the epiphyses of all the long bones become united to their shafts at full maturity, which, in the male, may be considered to be twenty-four years, and in the female, twenty-two years. After this period, or when ossification is once completed, it is difficult to determine the precise age by an examina- tion of the bones of the skeleton. It should, however, be remembered that the different bones of the sternum do not unite until about the fortieth or forty-fifth year ; and union between the sacrum and os coccygis is not usually com- pleted until fifty-five or sixty years of age. In old age, the bones become lighter in weight and more brittle, from the loss of animal matter. They are also darker in color ; and the flat bones become thinner, from the absorption of the diploe. In the skull of the aged, the sutures are more or less obliterated ; and the remaining teeth present a worn appearance, and a yellowish color. If the teeth have been lost (as is usually the case, at least in this country), the alveolar processes become absorbed, and the lower jaw undergoes a well- marked change in its appear- ance, consisting of the widening of the angle at its neck, and the shortening of the vertical diameter of its body, or width, which imparts the characteristic senile expression to the 92 MEDICAL JURISPRUDENCE. mouth of the aged. The discovery of such a jawbone would positively determine the age to be about seventy years or over. The presence or absence of certain teeth in the head has frequently been the means of determining the identity of the body. So, also, the presence of artificial teeth, with their mechanical appendages, has at times furnished the strongest corroborative evidence in such identification, as in the celebrated Parkman-Webster case, already alluded to, in which the artificial teeth, discovered undestroyed by the fire in the grate, where the head had been burnt up, were positively identified by the dentist who had manufactured and fitted them some years before. So, likewise, the remains of the Marchioness of Salisbury, discovered among the burnt ruins of Hatfield House, were identified by the jaw- bone having gold appendages for artificial teeth (Guy). The importance of the teeth as a means of identification is shown in the case of the late French Prince Imperial, killed in battle ; his body had been so much disfigured by his savage assailants that its identification would have been extremely difficult but for certain peculiarities about his teeth, II. The Sex. — This can usually be determined from the skeleton, if entire, without much difficulty. The male and female skeleton present many well-defined points of differ- ence, which are described in all anatomic works. The corresponding bones of the two differ in size, weight, strength, and prominence of their ridges and protuberances which mark the points for the insertion of muscles. There are also certain recognized differences in the head and thorax ; but it is in the pelvis that the most characteristic distinctions are observed. The male pelvis is narrower and DETERMINATION OF SEX. 93 deeper than that of the female. In the latter, the iliac bones are more spread out, and flatter, which renders the superior part of the pelvis more capacious ; the sacrum is broader, and turned more backward ; the arch of the pubis is much wider. The greatest diameter is the bilateral ; whereas in the male, the antero-posterior is the greater. The foramen ovale is triangular in the female ; in the male, it is more oval. Owing to the greater breadth of the female pelvis, the acetabula are farther apart than in the male. It is to be understood that these peculiarities in the female pelvis are not clearly exhibited before the period of puberty. From a fragment of a bone it would certainly be hazardous to undertake to determine the sex ; and care should be exercised in giving an opinion in such a case. III. The Stature. — If the whole skeleton has been pre- served, and none of the ends of the long bones have been lost by decay, the original height may be calculated with tolerable accuracy by arranging the bones in situ, and adding an inch and a half to two inches to the entire length of the skeleton, to supply the loss of the soft parts. But even here perfect accuracy cannot be attained, chiefly on account of variations in the curve of the spinal column in different indi- viduals. Dr. Dwight assumes, as the result of numerous observations, that the total height of the intervertebral carti- lages is 25.6 per cent, of the entire length of the spine. As a collateral aid in estimating the stature, we may regard as correct the generally accepted rule that the top of the symphysis of the pubes is about the center of the body in average women ; while in men, the center is a little below the symphysis. The attempt has frequently been made to estimate the 94 MEDICAL JURISPRUDENCE. height of the body from a study of the individual long bones of the skeleton ; but no reliance can be placed upon such comparisons, inasmuch as there is considerable varia- tion in the length of these bones in skeletons of the same stature. The so-called "rules of proportion " of certain writers cannot be regarded as by any means certain or authoritative. In case the skull is wanting, the rule laid down by Dr. Gould is "to find the height of the spine of the seventh cervical vertebra from the ground, and add to this 9.95 inches, which is the average height from this point to the top of the head." De St. Lucca states that there is a general proportion between the different bones of the body and the stature, and that an approximate esti- mate of the stature may be had by measuring the length of the first phalanx of the middle finger, thus : this phalanx is equal in length to one fourth that of the whole hand, in- cluding the carpus ; and the carpal and metacarpal bones together represent one half of the hand. The arm may be divided into five parts, of which two were included in the humerus, two in the fore arm, and one in the hand. The total length of the hand is, therefore, one fifth of the arm. Double the length of the arm (or the two arms stretched' out horizontally), added to the length of the two clavicles, together with the transverse diameter of the sternum, is equivalent to the whole length of the body. In applying this rule to practice, however, we must not forget that the length of the hand, and especially that of the fingers, varies materially in persons of the same height ; and so trifling a variation in the first phalanx of the middle finger as the one sixteenth of an inch would, according to this method of calculation, figure up as great a difference in the total result, for the height of th? whole body, as two and a half inches, IDENTIFICATION OF THE STATURE. 95 The existence of fractures, deformities, and callus in a skeleton sometimes affords valuable aid in its identification, even many years after death. In relation to the produc- tion of callus, it is well understood that this substance is the result of the reparative processes in bone, and that its presence is a certain indication that some time must have elapsed between the injury to the bone and the death of the individual. On the other hand the total absence of callus on a fractured bone, indicating that no time had been given for the process of repair, would be very good evi- dence that the injury was the immediate precursor of death, and if on the skull, the probable cause of death. An in- structive illustration of this is given by Taylor in the case of an Englishman, who was tried in India for the murder of a native who had been beaten with a stick, the allega- tion being that a rib had been broken, thereby causing his death. To substantiate this charge, a skeleton was pro- duced which had been dug up three months subsequent to the decease of the alleged murdered man, which was almost completely denuded of flesh ; the bones clean and dry ; one rib fractured, with a deposit of callus around the fracture. The identity of these bones with those of the missing man was attempted to be established by the prose- cution, but unsuccessfully, in consequence of their dry and denuded state — a condition altogether incompatible with so short a period of time as three months since death. More- over, the amount of callus thrown out made it evident that more than a week must have elapsed before death took place, which event was alleged to have occurred immedi- ately after .the injury. Other notable instances might be mentioned of the iden- tification of the skeleton by means of the above-mentioned 96 MEDICAL JURISPRUDENCE. marks, or peculiarities, and even where it was possible to determine the actual cause of the violent death. In the year 1823, a soldier living in the south of France suddenly disappeared under suspicious circumstances. Two years, however, elapsed before any investigation was instituted by the proper authorities. Some human bones were then dis- covered in digging in the garden of the deceased soldier. Of course, it became necessary to identify these remains. It was remembered that the deceased had a singular per- sonal deformity, in possessing a sixth finger on the right hand, and a sixth toe on the left foot. On examination, it was ascertained that the fifth metacarpal bone of the right hand was shorter and broader than the corresponding bone of the other hand, and further, that there were two articu- lating surfaces on its digital end, indicating clearly the ex- istence of a supernumerar}' finger. In the same way the fifth metatarsal bone of the left foot showed two distinct articulating faces on its digital extremity, indicating the existence of a supernumerary toe. Besides this, the age, sex, and stature of the skeleton corresponded with those of the missing man. But even further than this, a close inspection of the skull revealed the distinct marks of a de- pressed and radiated fracture of the temporal bone, which showed no sign of reparation by the formation of callus. Evidently, then, death had occurred very soon after the fracture of the skull, and in all probability as the direct result of violence. Upon this evidence, the suspected par- ties were tried and executed, having previously confessed their crime. Sometimes, on the exhumation of bones, the question arises as to how long they have been buried. After all the soft parts have disappeared, which commonly requires IDENTIFICATION BY SKELETON. 97 about ten years, it is only possible to give an approximate estimate. In a dry soil, bones will resist decomposition for thirty or forty years after burial ; and if preserved out of the ground, as in the crypts of old churches, they may last for hundreds of years. As the process of decay pro- gresses they become lighter in weight, in consequence of the loss of animal matter, and the color externally grows darker. The ends gradually become brittle and crumble away, and finally the shaft of the bone undergoes a similar disintegration, the mineral matter alone remaining unal- tered. Devergie states that the bones of King Dagobert were found in a state of tolerable preservation, enclosed in a leaden coffin and sarcophagus, at St. Denis, after the lapse of twelve hundred years ; and Dr. Taylor mentions that the skeleton of William Rufus was found in a stone coffin at Winchester nearly perfect, after seven hundred and eighty years' burial. The bones of Abelard and Heloise were so well preserved that after a lapse of five hundred years the female skeleton could readily be distin- guished from the male. Even if the bones have undergone calcination, as when a body has been burned with a view of destroying its identity, especially in cases of infanticide, it may still be possible to determine whether the remains are human, provided the bones preserve their proper form and have not been re- duced to powder. Other means of personal identification are afforded by a microscopic examination of the hair and the fibers of various sorts of fabrics, such as cotton, wool, and silk. Human hair discovered on a weapon, along with blood stains, affords strong presumptive evidence of murder or violence. So, also, fibers of cotton, or of other material, found on 98 MEDICAL JURISPRUDENCE. weapons supposed to have caused death, or else on the person of the accused, suggest a strong suspicion, if these fibers correspond to the clothes of the deceased. Thus a case is mentioned by Taylor, where the discovery of some cotton fibers, accompanied by a blood stain, upon the edge of a razor, found near a woman, whose throat had been cut while in bed, led to the subsequent detection of the mur- derer. In the same manner, the discovery of a few hairs upon the handle of a knife, on which also were marks of blood, enabled a London microscopist to declare that these hapfs were squirrel hairs ; which circumstance further led to the identification of the murderess of a child, whose throat had been cut with a knife, which, in the death wound, had passed through a victorine made of squirrel fur worn around the child's neck. In case of rape, the examination of the hair about the female genitals will be likely to show the presence of seminal spots and of spermatozoids. In all cases, except when hairs are to be examined for spermatozoids, they should be washed in warm water and then thoroughly dried, afterward steeped in turpentine and finally mounted in Canada balsam. They should then be examined with a magnifying power of about 200 diameters. To examine hairs for spermatozoids, moisten first of all with a drop of ammonium hydroxid solution, and examine under a microscope after the liquid has evaporated. For the identification of hairs, human or other, it is de- sirable to have at hand specimens of various kinds of these, properly mounted for comparison. Hairs resist putrefac- tion for a long time. It should also be remembered that hair is affected differently by different reagents. Strong alkalies dissolve it ; acids roughen it ; alcohol causes it to look clearer ; chlorin water bleaches and rots it. IDENTIFICATION OF HAIRS. 99 The size of hairs from different parts of the human body, as well as from different individuals, varies considerably ; thus, the hairs from the head are finer than the eyelashes, but coarser than the hairs from the arm. There is also considerable difference in the size of the hairs of the various lower animals. The main medico-legal questions connected with the identification of hairs are : (i) Is the hair human, and from what part of the body ? (2) Does it correspond with the hair of the murderer or of the victim ? (3) Has its color been naturally or artificially changed ? It should be re- membered that gray hair is not infrequently found on com- paratively young persons, and that undoubted instances have occurred of the sudden bleaching of the hair through fright or grief As regards the artificial coloring of the hair, it is well known that this is one of the means of dis- guise most commonly adopted by criminals in order to elude detection. Many common hair dyes for coloring light or red hair black or brown, are composed of the salts of lead, silver, or bismuth, but organic colors are also used. Colors may often be detected by soaking the hair in nitric acid, which dissolves out the mineral, which may then be identified by the appropriate tests. It is more difficult to bleach the hair than to darken it. This is usually effected by washing it in an alkaline solution to remove grease, and then soaking it in chlorin water or hydrogen dioxid solution, which will lighten the tint in a few hours. Chlorin water renders the hair very brittle and imparts an odor to it. In all artificially colored hair, the fraud can be detected by closely watching the new growth, which will be of a different color from the other portions ; and also by chemical tests. lOO MEDICAL JURISPRUDENCE. The fibers of cotton, linen, wool, and silk all present well- marked differences when viewed under the microscope. The cotton fiber is in the form of a flattened band, with thickened borders, and is spiral or twisted upon itself. Linen consists of round fibers, having a firm consistency, with jointed transverse markings at unequal distances, some- what resembling those on the India cane and tapering to a point. Silk fiber has the appearance of straight, well- defined cylinders, free from all markings and refracting light powerfully. Wool fiber is irregular, wavy, and of unequal thickness. The fibers of hemp resemble those of flax (linen), but are coarse ; and when boiled in nitric acid they exhibit no spiral streaks, but swell and become brittle. The identification of blood stains and seminal spots will be treated of later. CHAPTER VI. CAUSES PRODUCING VIOLENT DEATH. The third important question requiring decision in every case of violent death is the cause of the death. These causes are numerous and diversified, but may be considered under the following heads : — ( v!i Wounds. Burns and Scalds. Suffocation. Strangulation. Hanging. Drowning. Electricity. Heat and Cold. Starvation. Poisoning. VIOLENT DEATH FROM WOUNDS. A wound is a solution of continuity, in any tissue, pro- duced by violence. It may be subcutaneous — that is, be- neath the skin — or it may be open ; further, wounds may be superficial or deep ; they may be incised, punctured, { contused, lacerated, poisoned, gunshot, etc. Penetrating io ] wounds enter cavities, but do not emerge ; perforating ^ wounds both enter and emerge from the cavity. A distinction is sometimes made between mortal and non-mortal wounds, or between wounds dangerous and not dangerous to life, and the medical witness is asked to give an opinion on this subject. He should be guarded in his '' answer, since it is well known that many wounds at first considered as comparatively trivial, may assume a danger- ous and even fatal character. Of course, in many cases lOI I02 MEDICAL JURISPRUDENCE. there would be no difficulty in pronouncing upon the dan- gerous or mortal character of a wound ; for instance, wounds of the heart or the great vessels or internal viscera, or compound fracture of the skull. The danger of a wound depends upon many circumstances, all of which should be considered, such as : position ; relation to the great vessels and nerves ; weapon by which it was inflicted ; amount of hemorrhage ; age ; constitution and general health of the subject ; circumstances (favorable or unfavor- able) for treatment. Medical testimony is usually required only in case of a fatal termination, except in the case of assault, when the character of the injury (whether dan- gerous or trivial) might decide as to the propriety of ac- cepting bail for the prisoner. In case of death from a wound, the medical examiner should never theorize as to the manner of its causing the death ; and he should give his opinion only after a very careful post-mortem examination of the body. Moreover, as before mentioned, the examination should not be con- fined simply to the wounded portion of the body, but all the cavities and organs should be inspected, since it may be affirmed that a natural cause of death might have existed in that very part which was neglected by the examiner. Such neglect has often occasioned a doubt in the minds of the jury as to the real cause of death. It may be necessary to examine the stomach for poison, as shown by the oft- quoted instance recorded by Wildberg, of the girl who was beaten by her father for stealing, and who died shortly afterward, apparently from the effects of the blows, but in whose stomach a considerable quantity of arsenic was found. She had swallowed the poison soon after commit- ting the theft, fearing her father's anger. The accused was WOUNDS A CAUSE OF DEATH. IO3 discharged. In a similar manner it sometimes happens that a person, after taking poison with suicidal intent or after stabbing himself through the heart (death not being instantaneous), may destroy himself by another means, as by a gunshot wound, by drowning, or by throwing himself from a window or a precipice. The examination of the wound includes the observation of its situation, extent, and direction ; the presence or ab- sence of effused blood, whether liquid or coagulated, and the presence of ecchymoses ; the condition of the edges of the wound, whether everted or not ; whether adhesion has commenced ; the presence of granulation, inflammation, suppuration, or gangrene ; whether it was inflicted before or after death ; whether there is loss of substance, or hernia of the viscera. The clothes of the deceased should be inspected to ascertain if the rents or perforations in them correspond with the wounds of the body. If the weapon, say a knife, with which the wound is alleged to have been made, is at hand, it should not be used in the examination or comparison with the wound. Another instrument ex- actly like the one in question, or a piece of wood shaped like the supposed weapon, may be substituted. The fol- lowing recent case is in point : An old man was found dead, with his throat cut, and the butcher-knife with w^hich the wound was alleged to have been produced was fitted into the wound in the neck. Later it was found that this particular knife had been used a short time previously by the defendant in killing poultry, and he maintained that the blood found on it at the inquest was that of a chicken or turkey. The microscope afterward showed the presence of both mammalian and oviparous blood ; but the knife having been placed in the wound post-mortem, rendered I04 *rEDICAL JURISPRUDENCE. the evidence adduced by the microscopic examination of no value. In cases of severe injur}' it sometimes happens that death results from internal lesions, A\ith few or no external marks. According to Casper, this is of frequent occurrence in severe internal lacerations occasioned by violence. He cites an illustrative case : A Avagoner, in guiding a team drawing a loaded wagon down a hill, was accidentally crushed against a tree on the road. He w^as found dead the next morning. The onl}- external injuries Avere a slight abrasion upon the left arm, and one upon the right temple. On opening the bod}-, however, the most striking CAidences of A'iolence were discovered. From the spinal canal about a quart of blood escaped. The spinous proc- esses of the first thoracic vertebrae were broken off. The left pleural ca\dt}^ contained about thirt}' ounces of fluid blood. The pericardium was torn completely across ; and the heart, severed from its large vessels, la}* almost entirely loose in the ca\dty of the thorax. The open ends of the aorta and pulmonar}'- artery w^ere distinctl}- visible. The left lung was entirely torn through its middle portion ; and in the right lobe of the liver was a laceration two inches long and half an inch deep. The distinction between wounds made before and after death must be carefully noted. Wounds inflicted before death ma}^be recognized by the folloAving signs : (i) Incised wounds exhibit everted edges, arising from the elasticit}' of the skin and subjacent muscles, witli considerable hemor- hage, usually of an arterial character ; spots of arterial blood Avhich have spouted on to neighboring surfaces are of a peculiar comet-like shape. Coagula are more or less WOUNDS BEFORE AND AFTER DEATH. IO5 abundant in the wound, and around it. The surrounding tissues are more or less infiltrated with blood. If some days have elapsed before death, evidences of vital reaction will be shown, such as partial healing, granulation, suppura- tion, or sloughing. If the wound was made immediately after death — within a few minutes — there may be some retraction of the skin and some slight bleeding, with few or no coagula, which are of loose texture. There is little or no staining of the surrounding tissues, and never any attempt at repair. If the wound be made ten or twelve hours after death, there will be no eversion of its edges, no hemorrhage, except of a slight venous character, and no surrounding infiltration. The experiments of Taylor and Aston Key upon amputated limbs confirm the above de- scription. The amount of hemorrhage accompanying an incised wound affords a pretty good criterion as to whether it was inflicted before or after death. Comparatively little bleeding, chiefly venous, accompanies wounds made after death ; while in the living, the hemorrhage is chiefly arterial. In a case of murder reported by Casper, as also in the case of Greenacre, in England in 1837, in which the head of the victim was severed from the body, the fact that the head was completely drained of blood led to the conclusion that the decapitation had been done during life, and that there must then have been a copious hemmorhage to account for the absence of the blood after death. (2) In lacerated and contused wounds the distinction is not so obvious as in incised wounds. Lacerations are not always accompanied by bleeding, but there will always be more or less coagula present ; and if the person survives a few days, there will be evidences of vital reaction, such as suppuration and granulation, sloughing or gangrene, 9 I06 MEDICAL JURISPRUDENCE. all of which are absent in such wounds inflicted after death. Contused wounds made during life are chiefly distin- guished by the amount of effused blood in the cellular tissue under the skin (ecchymosis). This arises from the rupture of small vessels, and is manifested by the well- known " black-and-blue " discoloration produced. If the effusion of blood is rapid, the spot is dark red at first ; if slower, the discoloration is deep blue or violet. In some cases of even violent contusion, there may be no appear- ance of external ecchymosis. Again, it is not always mani- fested immediately over the seat of the contusion, but at a little distance from it, especially if the surrounding tissue is loose. Familiar illustrations of this are afforded in the case of a blow over the eye, producing an ecchymosis of the lower lid ; and of a blow over the lower portion of the abdomen being attended with ecchymosis of the scrotum. The presence of ecchymoses, then, in cases of contused wounds, may be regarded as pretty good evidence of the ante-mortem character of the injury, while its absence is not necessarily an indication that the wound is post- mortem. The experiments of Christison upon the dead body go to show that if the contusion be made very soon after death, and while the body is still warm, the resulting appearances strongly resemble those produced by ante- mortem contusion — so much so as to be easily mistaken for the latter ; with this difference, however, that the effusion is usually immediately beneath the skin, and not in the areolar tissue ; also that there is an absence of coagula and of swelling. Ecchymosis is usually superficial, and may appear very shortly after the. injury ; or it may be deep-seated and not ECCHYMOSIS. 107 visible at all. In some instances it is not manifested until after death, as in the case of a man who died from rupture of the bladder resulting from the kick of a horse, thirty- five hours after the injury ; no discoloration of the abdomen was obsei'ved until after his death. Neither can the quan- tity of blood effused nor the extent of the injury be always estimated by the amount of the discoloration. This is well illustrated in Casper's case of the wagoner who was crushed to death. Another important fact relative to ecchymoses is the change of color which accompanies them, since this may serve to indicate the probable date of the contusion. In about twenty-four hours the blue or livid margin of the bruises becomes lighter, or of a violet color, which gradu- ally changes to green and yellow. During these alterations of color the spot may become larger, but the central por- tion remains always darker than the margins. The color is finally absorbed and entirely disappears. In general, the ecchymosis shows itself within twelve hours after the contusion ; the violet color within three days ; the green, from the fifth to sixth day ; the yellow, from the eighth to tenth day ; and, in healthy persons, the complete disappear- ance of the spot occurs from the twelfth to fourteenth day. The changes are more rapid in the young than in the old, and depend also on the degree of the contusion. The above changes of color never appear in contusions on the dead, which circumstance constitutes another diagnostic mark. It is also important not to mistake the ecchymosis pro- ceedmg from natural causes, such as scurvy, petechia, and purpura, for that occasioned by blows. The former may usually be distinguished by being confined to the super- ficial layers of the skin, and by their presence also on the 108 MEDICAL JURISPRUDENCE. internal mucous membranes, together with the absence of swelling and the fluidity of the blood. According to Devergie, ecchymoses are often concealed on the bodies of the drowned when first they are removed from the water, owing to the sodden state of the skin ; they may become apparent only after the body has been exposed for some days and the water has evaporated. (3) In punctured and penetrating wounds, the diagnosis between those inflicted before and those produced after death is usually not difficult. The former are attended with hemorrhage, and often exhibit signs of vital and reparative reaction, such as inflammation and suppuration, or gangrene. The latter are destitute of all these. For example, a stab made into the left ventricle of the heart after death is fol- lowed by no hemorrhage. Where inspection does not satisfactorily prove the ante- mortem characteristics of a wound, the microscope, in the absence of advanced decomposition, will be found invalu- able. Suitably made sections will show the presence of the processes of repair and the dissolution of blood thrown out during the injury. In the case of the Commonwealth vs. Schmidt, the question of homicide or suicide turned upon the age of certain bruises upon the body of the deceased. Microscopic examination showed the subcutaneous tissue to be far advanced in the process of repair, and positively excluded their having been produced a few hours before, or immediately preceding death. As regards the particular weapon that may have caused the wound, it is not always possible for a medical witness to give a decided opinion ; but it is desirable, if possible, to establish the relation of the injury with its supposed Punctured wounds. 109 cause ; thus, an incised wound would naturally h6 feferred to a cutting weapon ; a penetrating wound to a pointed one, a bullet or missile ; and a contused wound to a blunt instru- ment ; but caution should be observed in giving an opinion on this subject, especially in case of contused wounds. Incised wounds are characterized by the regularity and evenness of the cut. This usually serves to distinguish them from wounds made by glass and crockeiy ware or nails, which are generally irregular and uneven ; but in some instances the cuts produced by broken glass or china exactly resemble incised wounds. In stabs the shape of the wound may often indicate the character of the weapon, whether double-edged or not, but when the weapon has penetrated obliquely through the tissues, and when these have been stretched, the shape of the wound will not ex- hibit this correspondence. So, also, a wound made in parts where the skin is wrinkled may suggest the idea of several distinct wounds, as in the neck. It must not be overlooked that superficial incised wounds may give rise to dangerous or even fatal hemorrhage ; and, also, that it is not always possible, in such cases, to determine the direction of the incision — z. e., whether made from right to left or the re- verse ; and yet, as remarked by Casper, this fact might have a most important medico-legal significance in determining the question whether the wound, as in cutting the throat, was homicidal or self-inflicted. The attendant circumstances, however, might throw some light upon it, such as the pres- ence of blood on the right or left hand, or cuts on certain parts of the clothing of the deceased. Lacerated and contused wounds do not afford the same facility for identifying the weapon as incised wounds. From simply inspecting them it will not generally be possible to no MEDICAL JURISPRUDENCE, indicate the precise weapon or cause. It may, Indeed, be possible to say that it was not produced by a cutting instru- ment ; but a blow made by a blunt weapon upon the skull or over the zygoma may give rise to a cut which strongly resembles an incised wound, though, as a rule, the division of the parts is not as straight and regular as in the latter and the angles of the wound are less acute. Moreover, in the contused wounds there is more or less swelling, and extravasation of blood into the adjoining parts ; and, at times, the existence of irregular fracture and internal hemorrhage. In the case of a fatal contused wound of the head, it has been judicially decided that it makes no difference as to the guilt of the accused whether he produced the death of his victim by a direct blow upon the head, or indirectly by causing him to fall upon a stone or other hard substance which produced the fracture or contusion. As before mentioned, rupture of the internal organs — the liver, spleen, heart, lungs, and kidneys — is a frequent result of contusions. Fracture of the base of the skull is some- times caused by severe contusion of the head. Wharton and Stille allude to the fact that spontaneous wounds some- times occur in the labia and vagina of pregnant women, which might give rise to suspicion of assault. Also, that in such women accidents of different kinds are frequently attended with profuse hemorrhage from the pudenda. It is evident from what has been said in reference to the difficulty of always connecting a contused wound with the precise instrument that caused it, that the witness should avoid committing himself upon the question. In some instances, however, the shape of the contused wound, espe- cially a depressed fracture of the skull, will enable us to LACERATED AND CONTUSED WOUNDS. 1 I I come to a correct conclusion on the subject. Some years ago Dr. Reese was called upon, as an expert, to testify as to the probable cause of a depressed fracture of the tem- poral bone of a man who had been struck during a general fight. The question was whether the injury had been inflicted by the fist merely, as was alleged, or by an instrument like a loaded cane or billy. From the private confession of a comrade of the prisoner there was good reason for believing that the latter instrument, in the hands of another person, was the real cause of his death. The fractured bone was produced in court. The depression was well marked, a quarter of an inch deep, exactly cor- responding to the loaded end of the billy. Radiating fis- sures (as would probably have resulted from a blow of the fist) were not seen. The opinion of Dr. Reese, founded on the above facts, was that the fatal blow had not been inflicted by a fist, but by a billy, but two physicians on the other side opposed this view. The judge dexterously solved the mooted question by asserting that, in such cases, one expert was about as good as another, and inasmuch as in the present trial there were two against one, he would decide in favor of the majority ; and so he did, and the prisoner (possibly an innocent man) was convicted and sent to the penitentiary. The examination of the clothes of the deceased consti- tutes an important part of the physician's duty, as this may throw light upon the mode in which the wound had been made, from the character of the cuts or stabs observed upon them. So, likewise, marks of blood, dirt, grass, or other substances on the clothing may afford valuable indi- cations in the same direction. The same remark applies to fragments of the clothing of either the deceased or the pris- 112 MEDICAL JURISPRUDENCE. oner discovered near the dead body and agreeing with the clothes worn at the time. Contused wounds by blud- geons may, however, occasion considerable laceration of the muscles, or even severe fractures, without tearing the dress. Taylor mentions an instructive case, showing the impor- tance of comparing the articles of dress with the injuries which may have proved fatal. A woman, aged sixty, was found one morning dead in her bed. She had been seen in her usual health on the previous night. On inspection, there were found two indentations in the right parietal bone, and a large clot of blood in this situation, beneath the skin, together with a fracture of the bone four inches in extent. Beneath the bone on the dura mater were found nearly three ounces of clotted blood. On the evening before her death she had been suddenly knocked down on the public road by a man accidentally running against her. She fell heavily on the back of her head, appeared stunned, was raised upon her feet, and, after drinking some brandy, recovered sufficiently to walk a mile and a half and eat supper. There was a suspicion of murder, in this case, against a fellow-lodger ; but when the bonnet worn by the woman was produced at the inquest, two indentations were discovered on the back part of it corresponding to those on the skull of the deceased. The indentations on the bonnet, moreover, contained dust and dirt, thereby confirming the statement of witnesses who had seen her fall, and rendering it highly probable that this fall was the real cause of the fatal fracture and effusion of blood. It also illustrates the well- known fact that a person may receive a fracture of the skull, ending in effusion, which may not prove fatal for many hours after the accident, and which may not have prevented EXAMINATION OF THE CLOTHES. II 3 the individual from walking a considerable distance after the injury. Was the wound homicidal, suicidal, or accidental? This important question cannot always be settled by medical testimony alone, though there are many points in which it is of the greatest aid. These are as follows : 1. The Sittiatiou of the IVoimd. — Suicidal wounds are usually inflicted upon the most accessible parts of the body, such as the head, neck, breast, and abdomen. If by fire- arms, the part usually selected is the head (mouth, forehead, or temple) or over the heart ; if by a cutting instrument, the throat or heart. The discovery, therefore, of wounds on a part of the body difficult to reach by the individual himself, as the back, would certainly not be suggestive of suicide ; but an exception must be made here as regards the insane, who are well known to destroy themselves by self-inflicted wounds of the most extraordinary character on the back of the head and neck, by striking the head against some solid substance, or by precipitating themselves from a height. An insane person (as also the sane) has been known to shoot himself with a pistol fired from behind the ear. The situation of the wound is, therefore, only suggestive of its origin, since it is quite possible that an assassin might inflict a death wound upon his victim in such a situation designedly, in order to deceive, and thus elude the suspicion of homicide. Accidental wounds are usually met with on exposed parts of the body. 2. Nature and Extent of the Wound. — Suicide is rarely inflicted by contused wounds, but usually by incised or penetrating ones. Exceptions occur, as when a person throws himself out of a window or from a height ; and, in some remarkable instances of self-destruction in the in- 114 MEDICAL JURISPRUDENCE. sane, by butting the head against a wall, and subsequently chopping it with a hatchet. In the case of the insane, there is no accounting for the variety in the nature and extent of the wounds inflicted for the purpose of self- destruction. This fact ought to be remembered, since, if the bodies of such persons should afterward be discovered, and nothing be known of their previous histories, serious errors in relation to the real origin of the wounds might result. Incised ivoiinds of the throat are often regarded as indi- cating suicide ; but it is well known that murderers fre- quently destroy their victims by cutting their throats. As to the extent of the wound, it is commonly supposed that a suicidal incision of the throat does not reach as deeply as a homicidal one of the same character ; but instances are not wanting where a determined suicide has severed the throat down to the vertebrae. Again, irregularity in the cut of the throat has been deemed by some as indicating homicide rather than suicide, under the idea of resistance on the part of the victim ; but it is evident that the irregu- larity might have resulted equally from nervousness or in- decision in inflicting the wound on the part of the deceased. The nature and extent of the wound or injury may serve to distinguish accident from homicide. Thus, if numerous wounds or bruises are discovered in opposite sides of a dead body, the presumption would be in favor of homicide ; and when the accused attempts to ascribe the death of his victim to a fall, the nature of the wounds might be such as positively to contradict his assertions. 3. Direction of the Wound. — This will often enable us to distinguish between a homicidal and an accidental wound rather than to decide upon its suicidal character. Thus, if DIRECTION OF THE WOUND. I I 5 death has occurred from a stab, inflicted downward from the upper part of the thorax and penetrating the heart, as did happen in a certain case, and it was attempted on the part of the prisoner to show that the wound had been acci- dentally occasioned by the deceased falling, while drunk, downward upon the knife which the prisoner had held in his hand sloping upward, the downward direction of the wound would prove the falsity of the statement. Two other cases may be quoted from Wharton and Stille of a similar character. One is that of a man discovered dead, with a deeply-punctured wound of the neck, which, on examination, showed that the weapon had been partially turned and withdrawn, and again plunged into the neck in a different direction, after the manner of the German butchers. This circumstance proved not only that the death was not accidental, nor probably suicidal, but pointed to a homicide, and also indicated the occupation of the murderer. The other occurred in England, some years since, where a murder was fixed upon a man from the fact that the wound in the neck of the deceased had been evi- dently made by a knife cutting from within outward, as is done in, slaughtering sheep. In most suicidal wounds of the throat it is found that the cut has been made from left to right ; in punctured wounds the direction is commonly from right to left and downward. In left-handed persons the direction would, of course, be the reverse. These facts, however, can only afford moderate presumptive evidence, since it is obvious that a murderer might inflict an incised wound in the throat of his victim from behind, which would exactly resemble that made by the suicide. In all such doubtful cases par- ticular attention should be directed to the surrounding Il6 MEDICAL JURISPRUDENCE. circumstances, such as the position of the body and the weapon, the presence or absence of blood upon the hands and person of the deceased, etc. If the death has been very sudden, from hemorrhage (in a case of suicide), the weapon will most probably have fallen from the hand, on account of the relaxation of the muscles ; but if it has been caused by a pistol, the weapon may be found tightly grasped in the hand of the deceased. If the throat has been cut suicidally, blood will be found on one or other of the hands ; but if homicidally, and no resistance has been made, the hands will probably be unstained. As regards the position of the body, if the death be very sudden, from loss of blood, the body will be found lying on the back ; if less sudden, the face and trunk will be turned toward the ground. If the body be found upon the back, in death from hemorrhage, and the weapon at a distance from it, the act was, in all probability, homicidal. The position of the weapon in relation to the dead body, although at times strongly suggestive, can never afford absolute evidence as regards the question of homicide or suicide. Thus, Casper mentions the case of a man who cut his throat with a razor, which was found bloody and closed, two feet distant from the body. Also, of another suicide by a pistol-shot in the breast, where the pistol was found in the pocket of the deceased, who had afterward terminated his life by drowning himself. From what has been said above, it is manifest that the witness can rarely venture to give a positive opinion as to the homicidal, suicidal, or accidental cause of death, apart from a consideration of the circumstances accompanying it. These circumstances vary in every case, and it requires the utmost experience and tact on the part of the medical POSITION OF THE BODY. I 1 7 examiner to recognize and apply them in each individual instance. Some of them have already been noted : they include the position of the body and the weapon ; the con- dition of the ground where the wound was inflicted ; the presence of footprints ; the condition of the clothing of the deceased ; the condition of the hands, whether showing wounds or cuts on their palms (indicating resistance), or the hands holding portions of hair or fragments of the assailant's clothes ; the adherence of certain fibers to a weapon, such as cotton, woolen, linen, silk, or fur ; marks of blood upon clothing or furniture ; state of the mouth and throat ; marks of blood or other matters on the person of the assailant ; rifling of the pockets and tearing of the dress, etc. These cannot be further enlarged upon here ; but their medico-legal importance cannot be too strongly enforced. When two distinct wounds are found upon a dead body, either of which is sufficient to have caused death, the ques- tion may arise whether this was a case of suicide or homi- cide. Is it possible for a person to inflict upon himself, consecutively, two mortal wounds, say by shooting one bullet through his brain, and another immediately afterward through his heart ? There can be, it seems, no question about the possibility of the self-infliction of two mortal wounds, provided the first one was not instantaneously fatal. It is well known that a stab or bullet through the heart or a pistol-shot through the brain is not immediately fatal, so that ample time is allov/ed for the repetition of the fat^l act on the part of the suicide. Moreover, it is within the bounds of possibility that, after the first fatal shot from a self-cocking pistol, a second Il8 MEDICAL JURISPRUDENCE. discharge from the weapon may have been a mere auto- matic act — the victim's finger being at the time on the trigger and thus producing the discharge unconsciously. It might even happen that this second unconscious and chance shot might produce a fatal wound upon another person, and thus give rise to the question of an intentional or accidental homicide. Gunshot wounds differ from other wounds chiefly in the fact that the vitality of the part struck is lost, and that there is a consequent slough or loss of substance. They are dangerous to life on account of their involving vital portions of the body, death occurring either from hemor- rhage or from shock to the nervous system. The hem- orrhage is seldom great, except when large vessels are wounded. Often, from the form of the wound, there may be but little external bleeding, while a fatal internal hemor- rhage may be going on. They differ much in appearance, according to the distance from which the piece was fired, and the nature of the projectiles. If the explosion occurs in close contact with the body, usually less than nineteen inches, the wound is large and circular, the skin denuded, blackened, and burned by the half- consumed grains of powder. The hair and clothes also in the vicinity of the wound are more or less scorched. It may be of vital importance to determine the position in which the revolver was held. The follow- ing points will serve if powder-burns are present : The wound of entrance is not in the center of the powder-burn, there being a very much greater zone of powder-mark at that area of the burn which coincides with the cock or hammer side of the pistol ; e. g., if the cock or hammer be upward, the most of the powder-burn will be upward, and whichever meridian of the powder-burn shows the greater GUNSHOT WOUNDS. II9 quantity of powder, marks the direction of the cock or hammer. The entrance orifice of the ball is livid and depressed, and is larger than the point of exit. When the piece is fired from a distance, the blackened and burned appearance of the skin is not seen, but only the mark of the entrance of the missile, and sometimes that of the exit. The aperture of entrance of the ball when fired from a dis- tance is, according to most authorities, always smaller than that of exit. Nealton says that when the wound is recent, the entrance orifice is depressed and contused, while the exit aperture is lacerated and everted. In the former, there is an actual loss of substance ; in the latter, there is merely a solution of continuity. After some days, however, the contused margins of the entrance wound slough away, thereby enlarging the orifice, while those of the exit par- tially adhere, causing the latter wound to appear smaller than the former. Casper declares that the entrance aperture is always the larger. Very possibly this discrepancy of views may arise from not distinguishing between the early and the later stages of the two orifices. If the ball enters a very fat portion of the body, this often protrudes between the edges of the wound and completely changes its appear- ance. Again, the character of the entrance will depend very much upon the nature of the projectile and its veloc- ity, as well as the distance from which it was fired. If the ball is conoidal, and traveling with great speed, the wound is Hnear and resembles a puncture producing little external harm, but causing very considerable external injury. A rifle-ball makes a large and ragged wound, caused by the spiral direction given to the missile. It is evident that several wounds may be made by a single ball, as this may chance to traverse different parts of the body and limbs. It I20 MEDICAL JURISPRUDENCE. may also happen that the piece may have been loaded with two or more balls, which may account lor the number of the wounds. The deflection of a ball from its straight or direct course after entering the body is easily produced by its striking obliquely against any resisting surface, such as a bone, tendon, aponeurosis, or even muscle. In this way it often happens that a ball, striking the chest or abdomen, may be caused to pass almost entirely around the body, and after- ward be extracted close by the extrance point. Wharton and Stille relate the case of a wound by a ball striking on the larynx obliquely, and passing around the neck so as to lodge on the opposite side of the thyroid cartilage. It was thence removed by simply cutting through the skin. It is not uncommon for a ball to travel half way around the chest or abdomen and lodge in the back, giving the appear- ance of having passed directly through the lungs or intes- tines. If the wound be caused by a load of shot, its appearance will depend chiefly on the distance from which it was dis- charged. If fired very near the body, so as to enter it as a single charge before separating, it will produce a single large and ragged wound, much contused and blackened by the powder ; and as the shot diverge after entering the body there will be considerable laceration of the parts beneath. For the opening to be single, the experiments of Dr. Lachese, of Antwerp, indicate that the charge should not be fired at a greater distance than ten to twelve inches, although this is undoubtedly influenced as much by the construction of the barrel and the charge as by distance up to twenty or thirty inches. When the distance is so ex- tended as to allow the scattering of the shot, each grain GUNSHOT WOUNDS. 121 will make its own individual wound. It is quite possible for a single shot to cause a mortal wound, as when it hap- pens to strike the heart or aorta. The newly-invented forms of small arms, most of which throw bullets at very high velocity and are efficient at long range, produce wounds that are somewhat different from those made by the older weapons. These weapons often make cleaner cuts than the older forms. The fatality is said to be less with the recent weapons, but this is evidently influenced by the modern methods of treatment. Wounds made by the wadding and gunpowder alone may prove serious or even fatal. A pistol thus loaded, fired at twelve inches, tore the clothes and abraded the skin without penetrating it ; at half this distance the wadding penetrated to the depth of half an inch ; at two inches it entered to the depth of two inches, causing a ragged and blackened wound ; and at one and a half inches the wadding entered the thorax between the ribs, and in one experiment carried away a portion of the rib. Taylor mentions an instance of a man sitting in the gallery of a theater, who had part of his hand completely blown away by a piece of greased news- paper, tightly rammed, discharged from a small cannon on the stage of the theater. Even gunpowder alone is capable of producing very serious wounds, if fired close to an exposed part of the body. The wound will present a lacerated appearance, and be blackened and burned by the partially consumed powder. If the grain of powder be coarse, the wound may have the appearance of having been caused by very small shot. The question of the homicidal, suicidal, or accidental character of gunshot wounds must generally be settled by 122 MEDICAL JURISPRUDENCE. the appearance of the wounds, and also by the particular circumstances. Thus, if it be on the forehead or temple, behind the ear, in the mouth, or over the heart, and if it be blackened or lacerated (indicating the close proximity of the weapon), it may be regarded as almost certainly a suicidal act. If, on the contrary, the wound be on the back or side of the head (except in the case of the insane), or of the body, without the blackened and lacerated appearance above alluded to, it may be considered as the act of a homicide. Accidental gunshot wounds bear the marks of near wounds, as they are mostly the result of the accidental discharge of the piece, either in the hands of the deceased at the time, or else in close proximity to his person. The possibility of a bullet glancing from a hard surface, and thus entering a point at which the weapon was not aimed, must not be overlooked. Out of 368 cases of suicide by firearms, in France, 297 were from wounds in the head ; of these, 234 were fired into the mouth ; only 7 1 were from wounds inflicted on the chest or abdomen. In a medico-legal case it may become important to ascer- tain the real cause of death occasioned by a wound — whether immediate, or from hemorrhage or shock, or remote, result- ing from subsequent complications. In a trial, this question might have an important bearing, since, if the cause of the death could be shown to have been remote, this might in- volve certain contingencies, for which the prisoner might not be responsible. When the death is directly traceable to hemorrhage, its rapidity depends upon the amount and suddenness of the bleeding ; and this again is dependent on the size and nature of the vessel wounded. Exhaustion follows much CAUSES OF DEATH FROM WOUNDS. 1 23 more rapidly from a sudden hemorrhage than from a more copious flow of blood, if gradually lost. Again, arterial hemorrhage is more rapidly fatal than venous. It should also be remembered that some persons have a constitutional tendency to bleed very easily from the slightest superficial wound. Such a tendency, termed a hemorrhagic diathesis, is sometimes hereditary, and exposes the individual to great danger, in case of being wounded. This circumstance might also have weight in the trial. Age and disease also increase the danger of death by hemorrhagic from wounds. Internal hemorrhage, as the result of a wound, is often as fatal as the external ; the danger is here further increased by the pressure exerted by the effused blood upon a vital organ, such as the brain, as is witnessed in effusion of blood within the cranium, produced by a fracture of the skull. It is also exempHfied in a wound of the intercostal arteries, causing effusion of blood into the chest, and producing fatal pressure on the lungs ; and also in wounds of the throat, resulting in asphyxia, from the flow of the blood into the windpipe. Shock is the result of a violent impression made on the nerve centers. It often is the immediate cause of death, after a severe injury, without leaving any trace or lesion discoverable on a post-mortem examination. Shock is most apt to follow extensive lacerations of the body, such as result from machinery or railway accidents, or from ex- tensive burns. The remote causes of death from wounds are numerous and varied. The following may be regarded as the most common : I. Tetanus or Lockjaiv. — This is generally the result of lacerated and punctured wounds, and is now known to 124 MEDICAL JURISPRUDENCE. be due to the introduction of a specific bacillus into the tissues. It is always a serious complication, and is mostly fatal. It does not usually appear before the seventh day after the receipt of the wound, though sometimes earlier, and rarely later than the twentieth day. Tetanus is a frequent result of slight wounds of the hand and face by toy pistols and small cannon. The manner of infection is not known. 2. Erysipelas is another complication of wounds, which may cause a fatal issue. It is apt to accompany wounds of the scalp ; and it sometimes assumes an epidemic char- acter, especially in hospitals, where it may occasion great mortality among the wounded patients. 3. Hospital gangrene is another occasional result of wounds. It, likewise often proves fatal, and may assume an epidemic type. It is, however, rarely seen except in militaiy hospitals. 4. Surgical Interference, Including the Use of Anesthetics. — In wounds dangerous to life, the question of the propriety of a surgical operation becomes paramount ; the patient will certainly die without the operation, and, on the other hand, he may die from shock as the immediate result of the operation. The question of the legal responsibility of the death then becomes a serious one, and, in a trial, counsel may endeavor to show that the death was not really the result of the wound, but rather owing to the surgical operation. Such an argument will not likely avail, unless it can be proved that the original wound was not of a dan- gerous character, and that the surgical interference was unwarrantable and unskillful. The same remarks will apply to the use of anesthetics. Their employment in operations has now become so general that the occasional SURGICAL INTERFERENCE. 125 fatal results attending their administration should be re- garded as exceptions, in nowise inculpating the attending surgeon ; consequently, the fatal result that might happen to follow their use should not be considered as offering any extenuation if a dangerous or fatal wound has been in- flicted. The only medico-legal point at issue would be — Was the administration of the anesthetic a necessary and proper part of the treatment, and was it skillfully ad- ministered ? The question of the responsibility of the surgeon in not employing the antiseptic method will be discussed later, under Malpractice. It will be proper to devote a brief consideration to the subject of Wounds in different regions of the body, inas- much as these present certain individual peculiarities, which give to them special medico-legal importance. Wounds of the Head. — Scalp wounds are not usually attended with danger, except when followed by erysipelas, or when the blow has been so severe as to produce concus- sion of the brain. Fracture of the skull may exist without any wound of the scalp ; and fatal effusion of blood upon the brain may be produced by a blow on the head, without caushig either a visible wound of the scalp or a fracture of the skull. Concussion of the Brain may result either from a direct blow upon the head, or from a violent fall upon the feet or buttocks. Sometimes death ensues immediately from con- cussion, leaving no perceptible lesion. Such fatal concussion may occur without either fracture of the skull or a wound of the scalp. The symptoms of concussion are faintness, nausea, vomiting, pallor, feeble pulse, partial or complete ; loss of consciousness, with confusion of ideas and tendency 126 MEDICAL JURISPRUDENCE. to sleep. Concussion may be confounded with intoxica- tion, compression of the brain, opium poisoning, sun- stroke, etc. It is particularly important to distinguish between con- cussion and intoxication. Many cases of supposed drunk- ards, arrested in large cities at night, and left unattended in the station-house till morning, are, in reality, cases of con- cussion or compression of the brain, which may prove fatal for want of timely relief. Difficulty of diagnosis is increased by the fact that the two conditions are frequently coinci- dent in the same individual. It is the drunken man who is most apt to engage in a brawl, which results in a broken head. Generally, the history of the case (if it can be obtained) and the odor of the breath will afford us the best means of diagnosis. In intoxication, the temperature is usually below 96° F., — sometimes below 90°; the loss of power and sensation is not unilateral, as in compression ; the bladder is generally full of limpid urine, which will fur- nish evidence of the presence of alcohol. The pupils are sometimes contracted and at other times dilated. Fracture of the Skull is the result either of a direct blow or a fall upon the head, striking a stone or other hard body. The usual consequence of such a fracture is pressure on the brain by the depressed bone or by extravasated blood. Fracture of the base of the skull is nearly always fatal, and unless carefully looked for in the autopsy, may escape notice. It may result from a fall or jump, the person land- ing on his feet or buttocks, and be, therefore, unattended by any injury of the scalp or face ; such cases not uncommonly escape notice in carelessly conducted post-mortems. Compression of the Brain may result either from effusion of blood or serum upon or within the brain, with or without COMPRESSION OF THE BRAIN. 12/ fracture or depression of the bone ; also from suppuration or tumors in the brain, from congestion of the cerebral vessels, and, likewise, from narcotic poisoning. The symp- toms are essentially those of apoplexy, viz., loss of con- sciousness, paralysis (usually hemiplegic), dilated pupils (except where the effusion is on the pons Varolii, when, according to Wilks, the pupils are contracted), stertorous breathing, a full, slow pulse, and coma. It is important to remember that the effusion of blood resulting from a blow may be gradual, so that the person seemingly recovers from the first shock, and may be able even to resume his ordi- nary occupation for some hours, or even days, before the fatal termination occurs. The distinction between the effusion from violence, and that resulting from disease, is, as a rule, that in the former the extravasation is nearly always between the skull and the dura mater, or between this mem- brane and the brain, while in the latter it is usually in the brain substance. Moreover, in the first there is frequently a fracture of the bone and ecchymosis of the scalp, either immediately over the effusion or on the oppo.site side of the head (counter-stroke). Another important point is that a fatal effusion of blood may take place simply from great excitement, especially if associated with intoxication. This may be urged as the probable cause of death where there has been an assault by a blow upon the head which terminated fatally. In such a case it may be difficult to decide how far the fatal effusion was due to natural causes, such as atheroma of the cerebral arteries (which, in a habitual spirit-drinker, might also be connected with diseased liver and kidneys), or how far it was to be attributable directly to the effects of violence. However, if the assault can be clearly proven, either in 128 MEDICAL JURISPRUDENCE. connection with a direct blow upon the' head, or, indirectly, by a fall upon a stone or other hard body, the mere fact of the preexisting disease of the arteries or the other organs should not lead to the view that the violence had no relation to the fatal result ; but if the autopsy show that the effused clot, or serum, was of older date than the alleged injury, this would certainly be a strong argument for regarding the death as due to the diseased condition. Wounds of the substance of the Brain are not always fatal. It is well known that considerable portions of the cerebral substance have escaped through the skull, not only without loss of life, but without serious discernible impairment of the mental powers. Wounds of the Face are not usually dangerous unless they involve the orbit ; a penetrating wound of this part may readily reach the brain, with a fatal result. So, also, a severe blow upon the nose may so injure the ethmoid bone as subsequently to involve the brain. Wounds of the Neck are attended with much danger, owing to the presence of the large vessels and nerves. In cut throats, the great danger arises from the sudden and profuse hemorrhage. The section of the larynx and trachea is not necessarily fatal, the chief danger arising from suffo- cation from the flowing back of the blood. A division of the esophagus is almost necessarily fatal, chiefly because of its involving the section of the great vessels of the neck. Wonnds of the Spine are dangerous in proportion to the degree in which the spinal marrow is involved. In concus- sion of the spine, death sometimes takes place instantly. If the spinal cord be wounded high up, above the region of the phrenic nerve, the function of respiration is immediately arrested, and death ensues. Wherever the injury occurs WOUNDS OF THE SPINE. 1 29 to the Spinal cord, it is understood that there is a complete suspension of the functions of the parts below. In fracture of the vertebrae, the great danger arises from pressure on the spinal marrow. Sudden death has been produced by the spontaneous luxation of the second cervical vertebra, arising from the fracture of the odontoid process, through disease. Sir Astley Cooper's case was of this character. These fractures have an important medico-legal bearing. Wo7mds of the Chest. — The great danger here lies in the hemorrhage from the heart, great vessels, and lungs ; hence, such wounds often prove rapidly fatal. The hemorrhage in wounds of the chest is nearly always internal. Wounds of the lungs, though they may not prove immediately fatal, frequently so terminate after a lapse of time ; this is espe- cially true of gunshot wounds, if the bullet or other foreign substance happens to be retained. IVoinids of the Heart, if the cavities be penetrated, always terminate fatally and rapidly. Gunshot wounds of the heart do not necessarily cause immediate death ; cases are recorded where the patient survived several months ; after death the ball has been found in the substance of the organ. Even where the cavities of the heart have been perforated by a cutting instrument, there have been instances where the person survived for several days. Rupture of the heart may be the result of a violent blow upon the thorax, or it may follow any intense excitement, exertion, or emotion, if this organ happens to be in a diseased condition. Where death has resulted in a brawl in which the deceased received a severe blow on the chest, if the preexisting disease of the organ can be estab- lished, it would be a question how far the violence and how far the disease was to be credited with the result. The case is very similar to the one where death follows a blow II 130 MEDICAL JURISPRUDENCE. upon the head, terminating in compression of the brain, and where a diseased condition of the cerebral vessels existed. Wounds of the Abdomen. — Even a superficial wound of the abdomen may prove fatal by dividing the epigastric artery. A severe blow upon the epigastric region has fre- quently produced immediate death, by action upon the solar plexus of nerves. Blows upon any part of the abdo- men may be followed by peritoneal inflammation, which often proves fatal. Penetrating or perforating wounds may terminate fatally from the same cause. Wounds of the stomach and intestines, though more satisfactorily treated of late years by the improved antiseptic methods, are dan- gerous and often fatal, either from hemorrhage or inflam- mation or both. Wonnds of the Liver are dangerous, according to their extent and depth. If the gall-bladder is involved, death is apt to ensue in consequence of the peritonitis. The danger from Wounds of the Kidneys arises from the effusion of urine, and the consequent inflammation. In relation to Wonnds of the B'adder, it should be re- membered that this organ may be ruptured spontaneously from over-distention. It is sometimes ruptured by a blow or kick of a horse upon the lower part of the abdomen. In a case of death produced by rupture of the bladder, it might be sought to set up the plea of spontaneous rupture of the organ. Frequently there is no external injury to indicate the true nature of the case, the autopsy alone re- vealing it, and disclosing, also, extensive peritoneal inflam- mation, resulting from the escape of urine. Wounds of the Genital Organs are, in the male, usually self-inflicted, and they are met with most generally among WOUNDS OF THE GENITAL ORGANS. I3I the insane. They comprise castration, more or less com- plete, and amputation of the penis, partial or entire. The danger to life is great in proportion to the hemorrhage and injury to the organs. In certain other cases, where the injury has been inflicted by others, and when in a state of erection, the urethra has been found violently torn across, and the corpora cavernosa and spongiosa divided. In females, the chief point of medico-legal interest is to discriminate between wounds of the genitals inflicted by another, and spontaneous hemorrhages from a ruptured vein in the labia. Here, of course, a rigid inspection of the injured parts will be needed. Examination of Blood Stains. — The identification of blood stains not infrequently constitutes a most important link in the chain of evidence in a trial for homicide. It is a very common practice for a murderer to attribute certain sus- picious red stains discovered upon his garments or imple- ments, to spots of red paint, fruit stains, or to the blood of some domestic animal or bird. To the naked eye -blood stains will vary in size, shape, and color. They may be mere films or smears, but gener- ally present the form of distinct spots of different sizes ; and if the blood has spurted from an artery obliquely upon a surface, the spots will have assumed a comet-like shape, terminating in a bulbous tail. The color of the satin will depend : ( i ) Upon its freshness : if recent, it will have a bright red hue ; if old, the color will be brownish, or brown red. (2) Upon its thickness ; being darker in proportion to the density of the stain. (3) Upon the material on which it has fallen : if the latter is porous, as soft wood, or linen, or cot- ton fabrics, the tint will be rather dull ; but if on polished and hard substances, such as metals, glass, or polished 132 MEDICAL JURISPRUDENCE. wood, the spots have a darker and shining appearance, and on drying they are apt to crack from the center, and may thus be easily removed. When dried upon linen or cotton, they usually have a stiffened feel, like a spot of dried albu- min or gum. If the stains be upon a colored substance, they can best be distinguished by artificial light ; indeed, they may be entirely invisible in bright daylight. While it is not always possible to even proximate the age of a blood stain, conclusions of great value may be drawn from a care- ful examination. If a clot or stain has been worn it will be polished, not uncommonly, greasy, and intermixed with dirt. If it is old and unworn, it may be dry and fragile ; unless mixed with dirt and grease recent clots are flexible and fracture with difficulty. We possess several methods of identifying blood stains : (i) the chemical ; (2) the microscopic ; (3) the spectroscopic. But previously to employing these methods, it will be always proper to examine the suspected spot, if not too much covered with dirt, with a good magnifier ; the spot, if a blood stain, will frequently exhibit minute coagula or clots of a shiny hue, intermixed with the fibers of the ma- terial on which it is fixed. I. The Chemical Tests. — Before noticing these, it will be proper to remark briefly on the solubility of the coloring matter of blood. Modern research has shown that the col- oring matter of blood (hemoglobin) when quite recent, is very soluble in cold water ; but when so old as to have changed to a brown color, it is converted into hematin, which is insoluble in water. This is a fact of considerable importance. For if a garment or other article is washed in cold water immediately after being stained with blood, CHEMICAL TESTS FOR BLOOD. 1 33 the blood will probably be discharged so as to leave no trace ; but if the garment be kept for some time before the attempt is made to remove the stain by washing, the soluble hemoglobin will have become more or less associated with the insoluble hematin, and enough of the blood will remain upon the article to suffice for future identification. Hot water will not remove a recent blood stain as effectually as cold water, on account of the action of the heat upon the hemoglobin, changing it into hematin. If the blood-spot be recent, and there be sufficient ma- terial, the examiner should cut out a small piece of the stained fabric, and suspend it by means of a thread in a test-tube containing cold distilled water. In a few minutes the coloring matter will be observed to separate from the material and to descend to the bottom of the water, form- ing a bright-red solution. If the stain is a little older, more time will be required to effect the solution, which will have a browner hue ; and if the stain is very old, there will be no solution whatever. If the stain be upon a porous substance, such as wood, brick, etc., it should be cut or scraped out, reduced to powder, and then soaked in cold water for some hours and afterward filtered. If the spot be upon a hard metallic sur- face, as a knife, sword, etc., it should be carefully dried, when it will be apt to crack off; if not, it may be scraped off with a knife. The scraping should be soaked for some time in cold water and filtered. If the solution should not be complete, a little dilute ammonium hydroxid may be added, and, if this should fail. Tidy recommends using a trace of citric acid to effect the solution. Having procured the clear red solution, the next step is to heat it in a test-tube over a spirit lamp ; the following 134 MEDICAL JURISPRUDENCE. results are thus obtained: (i) the red color disappears; (2) coagulation takes place ; (3) a brownish-green precipi- tate is formed. If there is sufficient quantity of this pre- capitate, it may be collected, dried, and heated with a weak ammonium hydroxid solution, which will dissolve it ; the solution will appear dark green by reflected and red by transmitted light. (4) Dilute ammonium hydroxid added to the original solution either produces no change of color, or it merely intensifies it ; it never changes it to green or crimson, as it does with cochineal and red fruit colors. Tannin gives a red precipitate with the original solution. A solution of chlorin causes no change. The above tests will suffice to distinguish blood from many red solutions, such as cochineal, kino, madder, log- wood, and the various red fruit-juices, none of which coagu- late by heat, and all of which are changed in color by the addition of ammonium hydroxid. The stain produced by lemon or orange juice on the blade of a knife, after exposure to the air, may bear some resemblance to an old blood stain ; but the tannin test of the solution would immediately detect the difference. So, the stain from red paint (which con- tains iron) or from iron-mold is easily identified by its solu- bility in dilute dydrochloric acid, and subsequent indication of iron. T!ie Guaiacum Test constitutes a beautiful and satisfac- toiy chemical test for blood. It depends upon the follow- ing conditions : A freshly-prepared tincture of guaiacum, if dropped into water, precipitates the resin, which, if exposed to the air, gradually acquires a bluish color. If it be exposed to a jar of oxygen gas, the bluing process is more rapid ; and if brought in contact with ozone, the blue color is instantly produced. Hence, the bluing must be owing to THE GUAIACUM TEST. 1 35 oxidation. Moreover, while the resin is blued by a variety of mineral and organic substances, the coloring matter of the blood has no effect upon it. The guaiacum test de- pends, then, upon the fact that while the blood has no power to oxidize or blue the resin, the presence of hydrogen dioxid, which itself has no power to oxidize the guaiacum, causes the resin then to be oxidized by the blood, and the blue color appears. According to Taylor, an excellent way of showing the experiment is to add a few drops of the tinc- ture (freshly prepared from portions of the resin taken from the center of a lump) to a small quantity of water ; this will precipitate the resin. Divide the water suspending the resin into two portions ; into one of them pour a little solu- tion of red coloring matter of blood ; to the other add a (ew drops of hydrogen dioxid solution (see below) ; no change of color is observed in either portion. Now, to the first portion add a few drops of the hydrogen dioxid solution, and to the second a few drops of the red solution ; in both cases the sapphire-blue color will soon be seen. In case the solution is turbid from an excess of the resin, the addi- tion of a few drops of alcohol will instantly clear it and bring out the fine blue color distinctly. If the simple addi- tion of the blood solution to the guaiacum produces a blue color, we may be certain that some oxidizing substance is present besides blood, and which conceals its presence. The force of the experiment consists in the fact that blood, of itself, will not blue guaiacum ; but in the presence of hydro- gen dioxid the blue color is speedily produced. Care should be taken to use a good quality of hydrogen dioxid solution. There is much sold which is practically worthless. Objections have been raised against this test on the 136 Medical jurisprudence. ground that other substances besides blood will produce a blue color in the presence of guaiacum and hydrogen dioxid, such as saliva, bile, and red wine ; but as regards the two former, their color should at once distinguish them from blood, while the latter substance requires exposure for some hours to produce the same result ; whereas, in the case of blood the effect is immediate. This test is as avail- able for old as for fresh blood, for concentrated or diluted blood ; hence, for a washed-out blood stain — wherever, in fact, a particle of red coloring matter remains. If no bluing occurs in the presence of the guaiacum and the dioxid, it will be safe to affirm that there is no blood present. With an old blood stain, or one that is too small to afford a suffi- cient solution, or where there may be some doubt of its presence on a colored material, a very good plan is to moisten the spot first with a few drops of water, then with a sufficient quantity of the guaiacum tincture, and afterward with a few drops of the dioxid, and then press upon it a piece of white tissue or filtering paper ; immediately there will appear upon the paper the characteristic blue stain. A number of such impressions may thus be taken from one spot, by simply adding a little more of the guaiacum and the ether, and repeating the pressure upon the paper. It is known that many substances other than blood will cause the reaction. Among these are compounds contain- ing iron (ferric), copper, manganese, and gold, also glue, casein, and potato skin. It is obvious that many of these substances will not be encountered in actual medico-legal work and with others the interference can be easily avoided. It is also stated that cloth dyed with indigo will simulate blood. The test is not to be relied on by itself It is an excellent preliminary test. A negative result shows that HEMIN CRYSTALS. l^^ blood pigment in a soluble form is not present ; a positive result will not prove the presence of blood. Heniin Crystals. — The production of these (known as Teichmann's test) is proof of the presence of blood, but does not distinguish human from other blood. A small portion of the material to be tested is placed on a micro- scope slide, a drop of water added, and a minute fragment of sodium chlorid. The slide is then heated to diyness on the steam bath, the residue covered with a cover-glass, and a drop of glacial acetic allowed to run under this. The slide is again heated until bubbles arise under the cover- glass. It is then allowed to cool, when the hemin crystals will form. (E. S. Wood, WittJiaus and Becker, Med. Jur. and Tax.) Serum Test. — The following account of this test is taken from an article by Prof E. S. Wood, of Harvard College, in Boston Med. and Surg. Jour., April 24, 1902. If a rabbit is treated with about half a dozen injections of ten c.c. each of human blood or blood serum, the injections being into the peritoneal cavity and performed at intervals of several days, the blood of the animal develops a substance which has been termed "precipitin," that causes a precipitate in human blood or blood serum, but not in that of any other animal except possibly some of the apes. For a description of the method of preparing the animal reference may be made to a paper by Dr. W. F. Whitney in the journal quoted above. After the rabbit is " humanized," it is allowed to rest for about a week and then some blood drawn from it. A little from one of the large veins of the ear will serve. This is placed in a cool place and allowed to coagulate, the serum being used. If fresh blood is to be tested, it is to be diluted to abf 138 ' MEDICAL JURISPRUDENCE. i-ioo with normal salt solution. The liquid thus obtained should have a Hght pink tint and if not clear should be allowed to settle completely and the supernatant fluid de- canted. Dry blood stains should be scraped off on to a watch glass if upon non-porous materials ; if on a porous material, a small piece of this should be cut out. The ma- terial is treated with a few drops of distilled water until all soluble matter has been taken up. The clear solution is transferred to a very narrow test-tube and mixed with an equal volume of double normal salt solution. The liquid is then tested by adding to it a few drops of the humanized serum. If the solution contains human blood serum there will be obtained promptly a precipitate, at first very slight but in about thirty minutes it will be distinct. The reaction occurs best at blood heat. The manipulation is best per- formed by allowing the rabbit serum to flow down the side of the tube and underlay the liquid to be tested. The pre- cipitate can then be seen at the point of contact. It should be observed that the chemical tests will not dis- tinguish arterial from venous blood. II. The Microscopic Test. — This consists in the identi- fication of the blood corpuscles — especially the red ones — by means of the microscope. The class of stains adapted for microscopic examination are those in which decomposition has not taken place. If the stain upon the garment has been moist, or submerged in water for a considerable time, decomposition may have led to the dissolution of the corpuscles, and hence interfere with the microscopic examination of the blood. Such materials containing blood will offer the best results to the chemical and spectroscopic methods. Of the other class THE MICROSCOPIC TEST. 139 of stains submitted for examination, they will be either (i) fresh, that is stains which have not died, and in which the blood may or may not be coagulated, and (2) dry stains, which will be hereafter referred to as " old stains." In the examination of the fresh stains, it will only be necessary to make a thin spread upon a glass slide and allow it to dry. This is usually best accomplished by placing the moist blood upon the slide and sweeping the edge of another slide over it, thus scattering the blood in a thin layer, which must be allowed to dry and can be examined at leisure and preserved indefinitely. For the examination of dried stains, the following re- agents and apparatus will be needed : — Chemically clean sHdes and cover-glasses, an alcohol lamp, a sharp knife of solid metal (so-called antiseptic handle), a microscopic needle, and a small oiler with clean oil. A moist chamber, such as is used in bacteriologic work, may be of use. The reaeents will be — (ist) Water (2d) Potassium hydroxid. . I part. Water 2 parts. (3d) Miiller's fluid : — Potassium dichromate I part. Sodium sulphate . . 2 parts. Water. ...... 100 parts. (4th) Muller's fluid Glycerol, q. s. The glycerol is added until a sp. gr. of 1028 is obtained, (5th) Glycerol i part. Water 6 parts. (6th) Sodium sulphate. . . 6 parts. Water 8 parts. The blood stains to be examined will be upon bibu- lous materials or non-bibulous materials. The first includes clothing, wood (unvarnished or unpainted), carpets, and similar materials. The second includes metallic weapons, 140 MEDICAL JURISPRUDENCE. buttons, glass, chinaware, highly polished and painted woodwork, etc. In searching for the stains upon bibulous materials, an ordinary hand glass or a two-inch objective may be used to advantage. The light demanded will depend upon the color and character of the goods, so that it may be neces- sary to try bright and diffused daylight and artificial light. The blood spots, when found, may consist of distinct drops, smears, or smudges, and stains which have been influenced by the dilution of the blood, such as by washing the stain or stains which have fallen upon a wet garment, or a gar- ment which has been made wet before coagulation or diy- ing of the blood took place. It is to be remembered that the more rapidly the blood dries, the better it will be pre- served, and for this reason the best cells will be obtained from the smaller clots or diffused smudges, or stains which have dried rapidly. To prepare a slide for examination, the suspected spot in clothing, for example, is bent and laid upon a glass slide, which has previously been breathed upon, in order to make it sufficiently moist to cause the adhesion of the small par- ticles which may fall upon it. The knife blade is then passed through the flame of an alcohol lamp, in order to destroy any organic material which may adhere to it ; then the surface of the cloth is gently scraped with the knife blade, until a thin layer of the broken-up stain is distinctly visible to the naked eye upon the slide. A cover-glass is then dropped on this, and one of the above solutions allowed to flow under from the margin until it has dispersed the air from beneath the cover-glass, at least most if not all the air. The slide may be examined immediately ; but, if it is THE MICROSCOPIC TEST. I4I necessary to allow it to soak for any length of time, the evaporation of the fluid may be prevented by running around the margin of the glass a small quantity of oil — ordinary machine oil being applicable for this purpose. The fluid containing glycerol and the potassium hydroxid solution do not, as a rule, require this precaution except in very warm and dry weather, or when the slide is placed in a moist chamber and allowed to digest. It is better to pre- pare a series of slides from each stain, using different fluids, because some stains will react differently with different fluids. The stains on non-bibulous surfaces may be chipped off by means of a knife or small needle, placed upon a slide and broken up, a cover-glass dropped on, and then treated as already described for stains on bibulous materials. Be- fore preparing any slide, and between the examination of any two spots, the knife or needle should be heated in order to destroy any corpuscles which may have adhered from a previous examination. The time necessary for the corpus- cles to resolve will vary from a few minutes to twelve hours, in most cases, and rarely be twenty-four or forty-eight hours. During the interval, however, frequent examina- tions should be made, lest the corpuscles swell up and oval ones become round, and round ones entirely disappear. In all cases it is proper to make a measurement of the cor- puscles, and in order to do this, two micrometers will be needed — one known as the the stage micrometer, ruled in ToVo" *-*^ ^^ inch, and the other an eye-piece micrometer, ruled with equidistant parallel lines, usually yig- of an inch apart, although this is not a matter of any great importance, as the eye-piece micrometer must be standardized before each observation. To accomplish this the eye-piece micrometer 142 MEDICAL JURISPRUDENCE. should be placed in the eye-piece, and the stage microm- eter upon the stage of the microscope, and the lens and length of tube so adjusted as to give thirty-two lines of the eye-piece micrometer between the lines of ^^o" °^ an inch ruling on the stage micrometer, or ten of the -^-^qq of an inch, which is, of course, equivalent. Artificial light is best, as it can be regulated. Very accurate measure- ments can be made by this method. The blood corpuscles of man and most of the mammals are circular, biconcave disks without nuclei. The excep- tion to this is in the corpuscles of the camel and llama, which are oval but without nucleus. The blood corpuscles of reptiles, birds, and fishes are oval and have a nucleus, with the exception of the lamprey, in which the corpuscles are circular, but nucleated. By reference to the accom- panying table, there will be little difficulty in differentiating corpuscles belonging to mammals from those of reptiles, birds, and fishes. That human corpuscles are altered by some diseases, does not militate against the microscopic examination. There is no disease in which the mammalian characteristics are entirely lost, and in which an expert microscopist would be hkely to be misled. In pernicious anemia, leukemia, pur- pura, yellow fever, and allied diseases, the blood undergoes important changes, but this does not disguise the character- istic appearance of blood corpuscles. It is not deemed necessary to go into any discussion over the question whether the expert can differentiate the blood of a human being from that of other mammals ; sufficient to say that all the expert can consistently do, in the present state of our knowledge, is to say that the blood is mammalian blood, and from his examination and measurements it is consistent with human blood. THE MICROSCOPIC TEST. I43 Sources of Error. — In making the examination it is to be remembered that solutions of the same specific gravity of the blood, or lighter, will lead to the eventual swelling up and dissolution of the corpuscles, and that from long soaking oval corpuscles may become circular from the imbibition of water. Certain vegetable structures, notably sporules and some algae, may resemble blood cells ; but the vegetable cell is not biconcave and has not the translucency of the animal cell, and prolonged soaking does not alter it as it does the blood corpuscle. The following tables present a synopsis of recent trust- worthy measurements of the blood corpuscles of various animals : 144 MEDICAL JURISPRUDENCE. COMPARATIVE SIZE OF BLOOD CORPUSCLES. (The figure is the denominator ; the numerator is always tinity.) Observer. Animal. J &• •d 2.§a 2 3 Appearance of Cell. > O 1 i 3200 Man .... 3200 3250 3200 Biconcave disk nucleus. without Guinea Pig . 3538 3223 3400 3500 n Wolf .... 3600 3422 3450 3600 " Dog . . 3532 3561 3580 3500 " Rabbit . 3607 3653 3662 3600 " Ox . . . 4267 4219 4200 4200 " Pig . . 4230 4268 4250 4200 <( Horse 4600 4243 4310 4500 <( Sheep 5300 4912 5000 5000 (( Goat 6366 6189 6100 6100 li Monkey . 3412 3382 3400 3400 If Kangaroo 3440 3410 3400 3400 " Beaver . 3325 . . 3325 3300 " Seal . . 3281 3200 3200 11 Walrus . 2769 2700 11 Elephant 2745 2738 2700 " Great Ant-] Eater 2769 2700 " Capybara 3190 3164 3100 " Sloth . . 2865 ■ • 2800 " Whale . 3099 3000 " Opossum 3557 3145 3500 " Cat . . 4404 4372 4400 << Musk Rat 3550 3282 3500 " ^ , f Long diameter C^-^1- {short " 3361 3201 3300 ] Oval, biconcave with- 6229 6408 6300 J out nucleus. ^, . , f Long diameter Chicken J. „, Short " 2102 3466 2080 3483 2100 3500 [ Oval, with nucleus. ^ , r Long diameter ^""^^^^^ {short " 2045 3598 1894 3444 2000 3500 } ■• (< COMPARATIVE SIZE OF BLOOD CORPUSCLES. 145 Comparative Size of Blood Corpuscles. — (^Continued.) (The figure is the denominator; the numerator is always unity.) Pigeon Quail . Dove . Goose , Duck . Tortoise (Land) Turtle (Green) Viper . Frog . Toad . Trout . Perch . Eel . Lamprey r Long diameter i Short ' f Long diameter I Short f Long diameter I Short " f Long diameter i Short ' Long diameter Short ' Long diameter Short ' Long diameter Short ' Long diameter Short ' Long diameter Short " Long diameter Short " Long diameter Short " r Long diameter 1 Short " f Long diameter 1 Short nucleus of Observer. S 6 S > 1 Hi fa 1973 1892 1900 3643 3804 3700 2347 2300 3470 3500 2005 2000 3369 3300 1836 1800 3839 3800 1937 1955 1900 3424 3504 3500 1252 1250 1200 2216 2200 2200 I23I 1200 1882 1900 1274 1200 1800 1800 1 108 1089 IIOO I82I I80I 1800 1043 1000 2000 2000 1524 1500 2460 2400 2099 2100 2460 2500 1745 1700 2842 2800 2134 2100 6400 6400 Appearance of Cell. Oval, with nucleus. Disk with nucleus. 146 MEDICAL JURISPRUDENCE. III. The Optical or Spectroscopic Test. — The applica- tion of the spectroscope to the identification of blood depends upon the fact that various colored solutions possess the power of absorbing different portions of the spectrum, pro- ducing in the latter certain dark spaces, called absorption- bands. Blood produces a very decided effect, even in minute quantities. When fresh hemoglobin is examined by the spectroscope, it will be seen to produce two absorption-bands of different widths in the green. When hemoglobin is acted upon by acids and alkalies, or kept for a long time, especially in a damp place, it acquires a brown color, becomes deoxidized, and is finally changed into hematin. The spectrum of deoxidized hemoglobin, or of venous blood, shows a single broad absorption-band, visible in the green. After a short exposure to the air it gives a spectrum with the two bands of oxidized hemoglobin much weakened, with a third band visible in the red (methemoglobin). The spectrum of de- oxidized hematin, or of blood after prolonged exposure to air, shows two well-defined bands in the green, but stronger than with fresh hemoglobin and with disappearance of the band in the red. Struve's process for the extraction of blood stains is recommended by Klein. It consists in placing the stained spot in a test-tube and covering it with a small quantity of cold water, through which a slow stream of carbon dioxid is made to pass. If the stain is fresh (within a day), the solution will be complete in about ten minutes ; if a month old, about thirty minutes will be required ; if two months old, one hour's exposure may be necessary. The clear solution thus obtained is to be examined spectroscopically. In the case of very fresh stains, the two absorption-bands THE SPECTROSCOPIC TEST, 1 4/ of oxyhemoglobin are alone visible ; but in proportion to the age of the stain, the methemoglobin-band in the red portion becomes more and more decided, and in stains six to eight months old this is the only band visible. A dilute solution of hydrogen cyanid (i to 2 drops of a I : 1000 solution) has the effect of changing the methemo- globin-band in the red into the two characteristic bands of hemoglobin in the yellow and green portions ; whilst solutions of fresh blood stains are apparently unchanged. Hence the action of this reagent may possibly afford a means of determinmg the age of a given stain. The form of apparatus best adapted for spectroscopic examination of blood is that suggested by Sorby, to whose researches we are largely indebted for our knowledge in this branch of investigation. It is a combination of the microscope and spectroscope. The micro-spectroscope has the advantage over the ordinary spectroscope in that a comparison prism is inserted, by means of which a fluid of known composition may be compared with the fluid under investigation, the two spectra appearing under the micro- scope side by side. The fluid prepared for micro-spectro- scopic examination is the same as that used for the ordinary spectroscope, which has been previously described. By using cells made from the segments of barometer tub- ing, a very thick layer of blood, one inch in depth, may be used in the spectroscope, when only four or five drops of the suspected fluid are obtainable. The important question in this connection is — Do other substances give similar spectra to those of blood ? Accord- ing to Sorby, nothing gives a spectrum precisely similar to that produced by oxyhemoglobin, although certain other bodies produce absorption-lines somewhat resembhng the 148 MEDICAL JURISPRUDENCE. former, but easily distinguishable by a practiced observer. Thus, the coloring matter of the petals of Cineraria give two absorption-bands ; but they are easily distinguished by the action of ammonium hydroxid. Cochineal, madder, and other red dyes, dissolved in alum, although affording bands somewhat resembling those produced by blood, may be distinguished from the latter by the use of ammonium hydroxid and potassium sulphite. We must, therefore, admit that the spectroscope affords a valuable and deHcate test for the presence of blood. It cannot, however, discriminate between human blood and that of any of the lower animals ; in this respect, therefore, it is inferior to the microscope, as a test. BURNS AND SCALDS. A burn is an injury to the body, caused by heat applied either in the form of a heated solid substance, or by flame, or by radiant heat. A scald is an injury produced by a heated liquid applied to the body. Burns and scalds are not, strictly speaking, wounds ; though legally they are comprised under the term, bodily injuries. The effects of corrosive liquids, such as sulphuric and other mineral acids, and the strong alkalies, closely resemble burns, and they are so regarded in law. Boiling liquids taken internally may produce internal scalds. The intensity of a burn is dependent upon the degree of heat applied : it varies from a slight redness to a complete charring of the tissues, Metals heated to redness produce very severe burns, even to the destruction of the flesh ; but if in a state of fusion, the injury is yet more serious, in con- sequence of the partial adhesion of the molten mass to the DID THE BURN OCCUR BEFORE OR AFTER DEATH? 1 49 skin. Boiling oils produce as decided effects as hot solids or molten metals. Boiling water causes scalds, more or less severe, attended with vesications containing serum ; but it never chars or destroys the tissue. According to Dupuytren, burns may be classified as fol- lows, according to their degree or extent : 1. Superficial inflammation of the skin, without vesi- cation. 2. Vesication, or blisters, containing serum, sometimes clear, and sometimes opaque and bloody. If the cuticle be removed, the true skin is very red and granulated, and secretes pus. 3. Destruction of the external surface of the true skin, forming an eschar, which may be soft and yellow if made by a liquid, or hard and brown or black, if resulting from a solid. The surrounding skin is red and blistered. This form of burns leaves ugly cicatrices, which are white and shining. 4. Disorganization of the whole skin ; these differ from the last only in the deeper destruction of the parts, and in the thickness of the sloughs. The resulting scars are puckered, and depressed below the level of the skin. 5. The destruction here extends through the skin, and includes the cellular tissue and a portion of the muscles. The general character is the same as in 4. 6. Complete carbonization of the burnt part, as when a portion of the body is roasted by the fire. The important medico-legal question to determine is — Was the burn upon the body made before or after death ? It is evident that an assassin might murder his victim, and then set fire to the house, hoping thus to escape detection. If a body be found completely charred, it will be impossible 150 MEDICAL JURISPRUDENCE. to determine whether it was living or dead when acted upon by the heat ; but if the burn be less extensive, it may be possible to form an opinion. As regards vesications which result from moderately heated solids, or from scalding liquids, if they contain serum their presence, as a rule, indicates that the burn was in- flicted during life. The experiments of Christison Taylor, and Tidy go to show that, although the application of heat to a body within a few minutes after death may sometimes produce a blister, this, however, does not contain serum, but only gas ; serous exudation must be regarded as vital. There may be an exception to the above rule in the case of dropsical subjects, in whom it is stated on good authority that serous blisters may be produced after death, by the application of heat. But, on the other hand, the absence of vesication should not be regarded as a proof that the burn was not inflicted during life, since vesication is not always a necessary result of a burn ; besides, it is quite possible that only the more serious results may be visible. It is recom- mended, in all doubtful cases, to examine the cuticle mi- nutely, with a lens, for minute apertures through which the serum may have escaped. Another sign of burning during life is the presence of a red line around the burn, which gradually merges into the color of the surrounding skin. This red border remains after death, and cannot be produced, according to Christison and Taylor, by the application of heat to the dead body. Tidy's conclusions, based upon a series of his own experi- ments, are that " when serous blisters are seen on a dead body, the serum being thick and rich in albumin, and the blisters surrounded by a deeply injected red line, the true skin, after the removal of the cuticle, also presenting a DID THE BURN OCCUR BEFORE OR AFTER DEATH ? I 5 I reddened appearance, the evidence is strong that the burn was produced during the life of the person ; while it is con- clusive that it was caused during the life of the part. But if the blister contains air, the true skin, after the removal of the cuticle, appearing dry and unglazed, of a full white color, or grayish ; or, if the bhster contained a Httle thin, non-albuminous serum, there being in neither case any red surrounding line, nor any injected condition of the cutis vera, the evidence is strong that the burn was inflicted after death." The danger of burns depends more on their extent than their depth. The reason of this is that extensive burns involve a greater number of sensory nerves, and a greater extent of surface is prevented from performing the function of excretion and heat regulation. Thus, a large superficial scald, especially in young children, is very apt to prove fatal, the symptoms being stupor, somnolence, pallor of face, and feeble pulse, with slow and stertorous breathing — very similar to those of narcotic poisoning, for which, in- deed, they have sometimes been mistaken. It has been ascertained that if one half to two thirds of the entire skin be involved, the burn will certainly prove fatal ; but practi- cally, one involving one third of the body, if severe, would be very likely to cause death. But here, many circum- stances will have to be considered, such as the age, consti- tution, the part affected, and the character of the burn. Burns are more dangerous in the young ; more so on the trunk of the body than on the limbs ; and more so if in separate patches than if continuous, provided they are of equal extent. Gunpowder burns are considered more dan- gerous than those produced by steam. The Causes of Death from burns are various: as (i)'Y 152 MEDICAL JURISPRUDENCE. bodily injury ; as in the case of conflagrations of buildings, where instantaneous death may result from the fall of tim- bers, walls, etc., or from leaping out of a window, or from a roof. (2) Suffocation, either from the smoke, or from the want of air. (3) Shock ; this is probably the most frequent cause of death after extensive burns. (4) Coma, convul- sions, or tetanus. (5) Bronchitis, pneumonia, and other thoracic symptoms. (6) Enteritis and peritonitis. (7) Exhaustion. (8) Gangrene, pyemia, etc. Post-mortem Appearances. — These are often not well marked, the most constant lesions being a capillary injec- tion of the mucous membrane of the alimentary canal and bronchi, and serous effusion into the ventricles of the brain. In cases where the death has occurred from injury, or from suffocation, the usual lesions would, of course, be discov- ered after death ; but if the body has been completely charred or roasted, it will probably be impossible to distin- guish anything to enable us to form an opinion as to whether the death had preceded the burning or not. The means of identifying the charred remains of a burnt body have already been pointed out. Wounds upon the Burned. — From the fact that murder is frequently committed and the body subsequently burned by a criminal, with a view of destroying the traces of his crime, it is important for the legal physician always to ex- amine the body for wounds. There are certain mechanical effects produced upon the body by fire which might possi- bly be mistaken for wounds made before death, such as fissure in the thorax or abdomen, or in the neighborhood of the large joints. These fissures are generally irregular in form ; and as the blood-vessels, by their elasticity, are apt WOUNDS UPON THE BURNED. 1 53 to escape being torn, these may be seen intact, stretching across the fissure. This appearance is always indicative that the opening was caused by heat, and was not a real wound, A case is mentioned in which two old persons were found burned in their house ; the fact of their having been previously stunned, if not killed, by blows on the head, was ascertained by the existence of fractures of the skull, under which coagulated blood was found upon the dura mater. Where the heat has been excessive, the bones of the de- ceased may be found more or less cracked or split, and sometimes even crumbled to pieces. Ordinary incised, punctured, or contused wounds, made before death, could not be identified in a body completely charred by fire. As to the question of the burning being accidental, sui- cidal, or homicidal, it may be assumed that death by burn- ing is nearly always accidental ; and such cases are, unfor- tunately, of frequent occurrence. Death, in such accidental instances, mostly occurs at some distance from the fire, in consequence of the removal of the injured person ; although of course it may take place at the time and place of the conflagration. The fact that a dead body is found near the fire may veiy naturally suggest the idea of accident, since an intoxicated or a diseased person may have caught fire and been unable to move. In all such cases, it is important to examine the body for marks of violence, with the pre- cautions given above. Furthermore, a case might present itself where severe wounds were found on a burnt body, and the question might arise whether the wounds or the fire had been the cause of death. No general rules can be given for guidance in such cases ; each one must be deter- mined by the attending circumstances. The question of Spontaneous Combustion of the human 13 154 MEDICAL JURISPRUDENCE. body presents itself here for a brief notice. It has occa- sioned considerable discussion in the scientific world for many years past ; but although some remarkable instances are related of apparent spontaneous combustion of the human body, originating while alive, on close investigation it will be found that some source of fire had invariably been present, from which the combustion took its origin, such as a lighted pipe or candle, and that the body was that of a habitual spirit-drinker, and nearly always that of a very fat person, conditions highly favorable for the process of com- bustion when once originated. From the known composition of the human body — nearly 75 per cent, being water — it would seem to be impossible even to burn it up, except by the application of a high degree of heat, and for a long time, such as is required by the process of cremation. Certainly, the weight of authority is against the belief in spontaneous combustion of the human body ; no person of position or authority has ever witnessed such a phenomenon. It is, of course, an admitted fact that various organic and mineral substances undergo rapid combustion, through the action of oxygen, especially when exposed to the action of the air, in a state of fine powder or extended surface, as in flour-mills and other places where much fine dust is evolved. Conflagrations of large buildings have frequently thus orig- inated, involving important questions as to incendiarism and fire insurance. DEATH FROM DIFFERENT FORMS OF APNEA (ASPHYXIA). This includes death from Suffocation, Strangulation, Hanging, and Drowning, in all of which life is destroyed chiefly, is not exclusively, by apnea or asphyxia. All VIOLENT DEATH FROM APNEA. 155 these modes of violent death possess certain points in com- mon, while, at the same time, each of them is distinguished by individual peculiarities, which render a separate consid- eration desirable. Their common properties will be first briefly considered. In all cases of apnea, death begins in the lungs, and this is brought about simply by excluding the air from these organs. This is brought about in various ways : mechanical pressure upon the throat or thorax, as in throttling; by ligature around the throat, as in hanging and strangling; by the flow of water into the windpipe, as in drowning ; by foreign bodies getting into the larynx and trachea, as in choking ; by being shut up in a box, entombed alive, or buried under ruins, or in a sand bank, or snow drift ; or by some disease of the throat, as edema and spasm of the glottis, membranous croup, etc. ; — all of which produce death by simply arresting the function of respiration. Likewise, there are exhibited certain signs or phenomena, both before and after death, which indicate death by apnea. ' These are lividity of the lips, fingers, and other extremities, and generally of the whole face, together with a swollen appearance of the countenance ; convulsive movements of the arms and legs, at 'first partly voluntaiy, but soon becoming spasmodic and involuntary, as seen in the f- u struggles to breathe ; the veins become turgid ; the pulse, at first full and rapid, soon becomes feeble ; there is often frothing at the mouth, which may, at times, be tinged with blood from wounding of the tongue ; there is frequently turgescence of the genital organs, and involuntaiy dis- charges of semen, urine, and feces. Abortive attempts at respiration are made for a while, but finally these cease, and , the heart at last ceases to pulsate. 156 MEDICAL JURISPRUDENCE. Consciousness is lost veiy early, although in the earliest stage there may be remarkable activity of the senses. This stage lasts only for a veiy brief time ; such is the testimony of persons who have been rescued from drowning, or who have been cut down from hanging, and of those who have experimented upon themselves by partial strangulation. This kind of death is rapid, not requiring more than three to five minutes, though there are some apparent exceptions in the case of drowning. These will be referred to hereafter. The post-mortem appearances in all these varieties of death by apnea are, in the main, very similar. These are lividity of the lips, fingers, and other parts of the body, as seen before death ; in drowning, the face is apt to be pale ; sometimes, likewise, in hanging. The venous system is generally full of blood. The right side of the heart, together with the lungs, is usually gorged with dark blood ; if death has been rapid, post-mortem clots will be found in the heart cavities ; if it has been slow, ante-mortem or white clots may be found ; the mucous membrane of the bronchial tubes deeply congested. In young persons, the blood- vessels of the lungs will often be found empty, and the lungs emphysematous, from the violent efforts made to respire. Minute extravasations of blood (ecchymoses) are found in the mucous and serous membranes, as the pleura, pericardium, endocardium, peritoneum, etc. The veins and sinuses of the brain are usually turgid with blood, and the brain itself filled with bloody points. The solid viscera, as the liver, spleen, and kidneys, will generally be congested. The blood itself is mostly fluid and dark-colored, except in suffocation from carbon monoxid, when its color is bricrht red. SUFFOCATION. 1 57 Suffocation, properly speaking, includes every variety of death resulting from an impediment to respiration. But as Strangulation, Hanging, and Drowning are considered separately, the term is here restricted to the other modes of death by apnea. Cases of accidental suffocation are numerous. Infants have thus perished by being too closely wrapped up, or by being overlaid by their mothers. Young children, feeble persons, epileptics, and drunkards, have been suffocated by falling into ashes, soft mud, feathers, and similar articles, from which they have been unable to extricate themselves. Mechanical pressure on the thorax, as occurs in vast crowds of people, has destroyed life by suffocation. The accidental slipping into the larynx of small bodies, such as peas, grains of corn, marbles, etc., from the mouth, particu- larly in children ; the lodgment of a piece of meat in the air passages (choking) ; the detachment of a bronchial gland which becomes impacted in the larynx ; the escape of a lumbricus from the stomach, and its entering the larynx ; the passing of vomited matters and of blood into the windpipe ; various disorders of the throat, as edema and spasm of the glottis, croup, diphtheria, abscess, etc.; — all of these are examples of accidental suffocation. Suicidal suffocation is extremely rare, though a few remarkable cases are mentioned by authors. In one case — that of a young woman — death was caused by a ball of hay, which she had thrust down the throat in the pharynx, behind the larynx, and which was just visible when the mouth was widely opened. Homicidal suffocation is usually practised upon infants, the aged, or those who are otherwise helpless. Suffocation is undoubtedly a very common mode of destroying new- 158 MEDICAL JURISPRUDENCE. born children ; it is very easily effected, and may leave be- hind it no characteristic traces ; death, in such cases, being usually attributed to convulsions. The notorious Edin- burgh murderers, Burke and Hare, destroyed their victims by suffocation, forcibly closing the mouth and nostrils of the person, and at the same time bearing their whole weight upon the breast. A curious Scotch case is recorded, in which an intemperate woman, over sixty years of age, was found dead, with a wound upon the scalp, emphysema in the chest, and seven ribs fractured. The face was pale and composed, the eyes closed, and the tongue slightly pro- truding. On examination, the cork of a quart bottle was found in her larynx, the sealed end being uppermost. The epiglottis, trachea, and larynx were considerably injected. It was attempted, on the trial, to show that the deceased had drawn out the cork with her teeth while she was drunk, but that it was suddenly forced into her windpipe ; this was negatived by the fact that the sealed end of the cork was uppermost, and also by the marks of the cork- screw. It was decided that the cork had been forcibly pushed into her windpipe, when by reason of intoxication she was unable to resist. Another case of homicidal suffocation is that of a Russian sentry, found dead in his watch-box, with a large piece of meat in the lower part of the pharynx, pressing upon and partly in the glottis. His death was, therefore, supposed to be accidental. Some years after, his superior officer, in dying, confessed that he had first suffocated the man, and then placed the piece of meat in his throat, in order to divert suspicion from himself Post-mortem Appearances.— ~\l\\^\\.y and swelling of the face and lips are usual, but in accidental cases the face may ASPHYXIA FROM CHArCOAL VAPOR, I 59 be placid ; the eyes are congested ; minute ecchymoses appear on the neck and chest ; with mucous froth, some- times bloody, about the mouth and nose ; the lungs and right side of the heart may be gorged with dark blood ; but in some cases, especially in young children, the lungs may be empty of blood and emphysematous. Hence, the con- dition of the lungs and heart, as it varies so much, cannot be relied on in a diagnosis. Stress has been laid upon the presence of minute punctiform ecchymoses, especially en the lungs of new-born infants who have been suffocated. These spots are also found on the pleura, lining membrane of the heart, membranes of the brain, peritoneum, and mucous lining of the windpipe, but their value is not uni- versally acknowledged. The blood is dark and very fluid. The kidneys are deeply congested. As these post-mortem signs are also found in other forms of death by apnea, they cannot be considered as characteristic of death by suffocation. Consequently, the examiner should be cautious in expressing his opinion as to the cause of death. If a dead body be discovered in sand, earth, ashes, or similar substances, the question whether it was placed there before or after death must be decided by a careful examination. If the substances be found in the air passages, and especially in the esophagus and stomach, it may be concluded that the person was alive at the time. Asphyxia from Gas from Charcoal. — The gases evolved by burning charcoal consist of carbon dioxid and carbon monoxid ; the relative proportion of them will depend on the air-supply. If this be abundant, the former gas will be considerably in excess ; if imperfect, the latter gas will be l60 MEDICAL JURISPRUDENCE. in greater quantity. Charcoal burning in the open air pro- duces but a small amount of monoxid. An atmosphere containing 5 per cent, of carbon dioxid and ^ per cent, of monoxid has been said to be fatal to man. There is, however, some uncertainty as to the limit at which carbon dioxid is fatal. Symptoms and Post-mortem Appearances. — Headache, with a sense of pressure on the temples, vertigo, ringing in the ears, and tendency to sleep, complete loss of muscular power, troubled vision, difficulty of breathing, rapid and feeble pulse, sometimes vomiting, coma, and death, occa- sionally preceded by convulsions. Death takes place in from one to two hours after exposure ; and experience shows that this may occur even when the external air is not completely excluded. The post-mortem lesions vary, depending upon the rapidity of the asphyxia, and the time elapsed between the death and the autopsy. Sometimes the face is injected, the eyes bright and staring, and the limbs supple ; again, there is a general pallor of the surface and complete rigidity of the muscles, coming on very soon after death, and disappearing in a few hours. According to Lutaud, the most characteristic sign is the presence of large rosy-colored spots, more or less pro- nounced, over the thighs, chest, and abdomen. "These rose- colored spots are not seen in any other variety of asphyxia and they remain even after the commencement of putrefac- tion." The apoplectic nodules in the lungs, and the sub- pleural ecchymoses, so common in strangulation and suffo- cation, are rarely seen. There is more or less congestion of the brain. Another important sign is the fluidity and bright redness of the blood. This is owing to the stronger affinity of the hemoglobin for carbon monoxid than for oxy- ASPHYXIA FROM CHARCOAL VAPOR. l6l gen, in consequence of which the former is retained through- out the circulation. The spectrum furnished by such blood very closely resembles that shown by arterial blood in the spectroscope. This affinity of the hemoglobin for carbon monoxid will satisfactorily explain the presence of the rose- colored spots above alluded to. In case of death from gases from charcoal, spectroscopic examination of the blood should be made. By this means, Brouardel was enabled to demonstrate the existence of carbon monoxid in the blood of one of the victims of the burning of the Hospital of Saint-Antoine, in 1887. The absorption-lines of carboxy- hemoglobin, that is, blood con- taining carbon monoxid, are so similar to those of ordinary (oxy) hemoglobin that distinction by observation alone is difficult. The two spectra may be at once distinguished by the fact that the addition of a reducing agent, such as a drop or two of ammonium sulphid to the blood, will pro- duce at once a reduced hemoglobin in the case of normal blood and change the spectrum, while that of carboxy- hemoglobin will not be affected. The extensive introduc- tion of water-gas for illuminating and heating purposes has caused a material increase of cases of carbon monoxid poisoning in American cities. This gas, made by the action of steam upon hot fuel, consists largely of carbon monoxid. Illuminating gas made by the distillation of bituminous coal consists mostly of hydrocarbons, and is far less poisonous. The cases of asphyxia produced by carbon monoxid are not readily amenable to artificial respi- ration, since the chemical affinity of the gas for the hemo- globin is not overcome by the oxygen. Slowness of putrefaction is often noticed in cases of death from this form of asphyxia. 14 1 62 MEDICAL JURISPRUDENCE. Various chemical tests for carboxy-hemoglobin have been proposed, but they are of little value. The spectroscopic test seems to be the best, but even in undoubted cases of poisoning, as where the gas has been directly inhaled with suicidal intent, the results of the examination will sometimes be unsatisfactory. It may be well to remember that the body of a murdered person may have been so disposed of by an assassin, as to simulate death from charcoal asphyxia ; of course all the signs of any such antecedent violence should be carefully sought. When illuminating gas forms about one eleventh of the atmosphere, it becomes explosive on contact with a flame. It requires, however, a less proportion than this to render the air incapable of supporting life. The so-called " sewer- gas " explosions are due to the leakage of illuminating gas into sewers and drains. The gases evolved from sewage do not possess the power of forming explosive mixtures. Many instances of sickness and death may be due to the unconscious breathing of deleterious vapors arising from leakage of gas-pipes, and escapes of the gas into the apart- ments. The introduction of acetylene as an illuminating and heating agent will doubtless give rise to cases of fatal poisoning, but there are no data yet at hand to permit a satisfactory presentation of the medico-legal relations. Asphyxia from Emanations of Cesspools. — These contain hydrogen sulphid and ammonium sulphid, together with other sulphur compounds of unknown composition. The symptoms are a sense of fullness and pain in the head and stomach, vertigo, nausea, sudden loss of muscular DEATH BY STRANGULATION. 1 63 power and of consciousness. There is often an escape of bloody froth from the mouth. The body is cold, the face livid, the pupils dilated and immovable ; convulsions and coma usually precede death. In the examination of cases of asphyxia from the emana- tions of cesspools or sewers, the expert should seek to isolate the toxic agent (hydrogen sulphid) from the blood. Strangulation is produced either by pressure upon the neck by means of an encircling cord, or by direct pressure made by the hand on the windpipe, as in throttling. The means by which the constriction is produced are various : sometimes a rope is used, sometimes a strap, a handkerchief, a ribbon, or a strip torn from a sheet or the clothing. In Spain, the usual mode of execution of criminals is by the garrote — a steel collar tightened by a screw ; in Turkey it is by a bow string. Death results, in most cases, from the combined effect of the deprivation of atmospheric air, producing apnea, and from congestion of the brain due to the pressure upon the jugulars, preventing a return of blood from the brain. Sudden and violent compression by the hand upon the windpipe will produce unconsciousness sooner than if the constriction be made by a band. Stran- gulation differs from hanging chiefly in the obliquity of the cord around the neck in the latter, while in strangulation the cord is wound horizontally around the neck. It is im- portant to distinguish between death from strangulation and death from hanging, as the former is nearly always the result of homicide, while the latter is usually suicide. The first question that presents itself is : Was the death caused by strangulation ? The appearances of one strangled are usually very distinctly marked : These are livid and swollen 164 MEDICAL JURISPRUDENCE. face ; staring eyes, with dilated pupils and protruding tongue, which may be bitten ; livid extremities ; flattened larynx ; blood may issue from the nose, mouth, or even ears ; the face, neck, chest, and eyes are studded with ecchymoses ; the genital organs are frequently turgid ; and there may be an escape of urine and feces, as in hanging. Internally, the right heart and venous system are some- times gorged with blood ; but this is less frequent than in other forms of death from apnea ; this is also true of the congestion of the liver and kidneys. Tardieu states that the lungs are seldom veiy full of blood, but he places great reliance upon the emphysematous appearance of these organs, arising from a rupture of the pulmonary vesicles. The subpleural ecchymoses, which he regards as charac- teristic of suffocation, he says, are rare in strangulation. There are also extravasations of blood in the lungs, but none in the brain, whereby it is distinguished from apo- plexy, which it resembles in a few of its symptoms. Among the external signs, the marks of the cord, and of the fingers on the neck, deserve special attention. These are more evident and reliable here than in hanging, because in homicidal strangulation very considerable force is gener- ally employed by the murderer in order to accomplish his object. If the hand has been used, as in throttling, the marks of the fingers will be found upon the front of the throat — sometimes of two or more fingers and the thumb, so that even the particular hand employed may be deter- mined. If a cord has been used the mark will be horizontal, not oblique, as in hanging ; sometimes there may be two or three parallel marks, where the cord has been wound around the neck several times. The mark of the cord is apt to be less deep than in hanging, and subcutaneous ex- ACCIDENTAL STRANGULATION. 165 travasation is not always found ; but the parts beneath may show considerable infiltration of blood. Fractures of the hyoid bone and of the ossified thyroid cartilage are reported as having occurred. Where great violence has been used to the neck, blood may escape from the mouth and nose. The interior of the larynx and trachea is congested, of a uniform red or violet color, and is coated over with a frothy, bloody mucus, which extends also into the smaller air tubes. This internal discoloration of the windpipe should not be mistaken for the early signs of putrefaction of this organ. The mark of the cord around the neck may unquestion- ably be produced on the dead body, if the attempt is made within a few hours after death, and while the body is still warm, but according to Casper, not after six hours. There- fore, this particular sign should never be relied on to the exclusion of the other characteristic evidences of death by strangulation, such as the livid, swollen countenance, the protruded tongue, the staring eyeballs, etc., none of which are produced by strangulation after death. Hence, although a murderer may place a cord around the neck of his dead victim, with a view to make the case simulate a suicide, there will be little difficulty in detecting the ruse. Was the strangling accidental, suicidal, ox homicidal ? Cases of accidental strangulation not infrequently occur. Taylor records two : one of a girl carrying fish in a basket, which was strapped around the upper part of her chest in front. She was found dead, sitting on a stone wall. The basket had probably slipped off while she was resting, and had thus raised the strap, which firmly and fatally com- pressed the trachea. The other case was that of a boy, whose silk necktie, knotted and tightly twisted around his 1 66 MEDICAL JURISPRUDENCE. neck, was caught in the band of an engine, and his neck drawn down against one of the revolving shafts. He was rescued after his neck had been compressed at least one minute. He became black in the face, and blood escaped from the mouth and ears. For several minutes after the removal of the ligature he was insensible, but ultimately recovered. Another instance is related by Dr. Gordon Smith, of a lad who used to carry a heavy weight sus- pended from his neck by a string. One day he was found dead, sitting in a chair. He had probably gone to sleep, the weight had slipped, and drawn the cord tight around his neck. Suicidal strangulation is comparatively rare, except among the insane, with whom it is by no means uncommon. The facility of effecting their purpose by such simple means as a garter, a ribbon, a handkerchief, or a strip torn from a garment, may readily account for such occurrences, and still further, when it is remembered how very rapidly and insidiously unconsciousness steals over the senses under a pressure of the windpipe, thereby taking away from the individual the will and the power to escape. A case men- tioned by Taylor will illustrate this. An insane man, with suicidal tendencies, was placed in a private asylum, with special directions to watch him closely to prevent his taking his life. Two attendants were placed over him. These attendants remained at his bedside ; but on his requesting them to retire to a little distance, they complied, still keeping a close watch upon him. Two hours afterward, the physi- cian on visiting the patient, was informed by the attendants that he had been sleeping quietly for some time. On ap- proaching the bed they found, to their surprise, that the man was dead. He had strangled himself simply by tear- HOMICIDAL STRANGULATION. 1 6/ ing off a strip from the bottom of his shirt, rolled it into a cord, and tied it around his neck. Other cases of determined suicides are recorded, in which the cord was found coiled around the neck several times ; in one instance, the ligature had been tightened by a stick thrust in and twisted like a tourniquet ; and in still another, a sabre had been used for the same purpose. Homicidal strangulation, as already mentioned, is the most frequent variety of this form of violent death. It is usually recognized by the marks upon the neck and else- where, indicating a greater amount of violence employed. Thus, the impression of the Hgature on the neck will be deeper and more ecchymosed than occurs in a suicide ; it may also be accompanied by the marks of the fingers on the throat, which latter are never found either in a suicidal or accidental case. Besides these, there will frequently be seen contusions, or injuries of other parts of the body, and evidences of a struggle. It should not be forgotten that the marks of homicidal strangulation may often be discovered many weeks, or even years, after burial. One is mentioned by Wharton and Stille, where, after thirty -eight days' interment, the evidence of strangulation was obtained chiefly from the striking con- trast of the integuments of the neck with those of the rest of the body. There was a white, shriveled space over the larynx, half an inch broad ; also a groove around the neck, of a blackish-brown color and parchment-like appearance ; this condensed skin was difficult to cut, and its section was perfectly dry and yellowish-white. Another remarkable case occurred in Paris, where the body had been buried several years, and was reduced almost to a perfect skeleton. Several of the cervical vertebrae, together with the right 1 68 MEDICAL JURISPRUDENCE, clavicle, were found held together by a blackish mass, in the composition of which no tissue could be recognized. This mass was surrounded by several twists of a cord two lines in diameter. The cord was much decayed, showing no knots, and its direction was horizontal. The above facts enabled Orfila and others to decide that the woman had per- ished by strangulation. Another remarkable case is reported in which a body partially burned showed evidence of pre- vious homicidal strangulation in the peculiar horizontal mark encircling the neck, and in the protrusion of the tongue. The case of the Commonwealth of Pennsylvania vs. Cutaire, tried in 1 896, in Philadelphia, is interesting in this connection. A carpenter, in repairing a house in the north- ern part of the city, found a skeleton under the kitchen floor. There were some fragments of clothes and jeweliy and a silk handkerchief which had been tied around the neck in a double knot. The bones were promptly identified as those of a woman who had disappeared some fourteen years before. As a result of careful detective work, a man was arrested, tried, and convicted of the murder. He was a boy of about fifteen at the time the woman disappeared. He made a confession declaring that he buried the body, but denied that he killed her. Much legal controversy occurred in regard to the case and the prisoner up to the present time (July, 1902) is still in jail. Hanging is that mode of death caused by suspension of the body by the neck, the weight of the body acting as the constricting force. Physiologically, it is the same as stran- gulation, and, like the latter, the cause of death is partly apnea and partly cerebral congestion, and more frequently a combination of the two. HANGING. 169 If the cord encircles the neck below the thyroid cartilage the death is more rapid, and is to be ascribed to apnea ; but if higher up, as in executions, where it is apt to slip under the chin, some little space on either side may escape constriction, so as to admit a slight amount of air into the lungs ; in this case, the death will be slower, and be due rather to cerebral congestion. In the great majority of cases, however, as shown by the above table, the cause of death is of a mixed nature. In some cases of public execu- tions, in which the fall was very considerable, and in which a violent rotary swing was given to the body of the criminal at the moment of the drop, the odontoid process of the second cervical vertebra has been found either fractured or dislocated, causing immediate death, owing to pressure on the spinal cord. But death, in hanging, from fracture of the vertebra, is far less frequent than is supposed. Orfila states that in the bodies of fifty persons who had been hanged, he met with a fracture of the os hyoides in only one case, while he had never met with a fracture or luxation of the vertebrae. Unconsciousness very speedily supervenes in hanging, from the circulation of unaerated blood, especially if the trachea is compressed, and death occurs in a very few minutes. Persons who have been cut down after a few minutes' suspension are very rarely resuscitated. And even after an apparent partial recovery, death often follows from secondary effects, especially from congestion of the brain. The insidious manner in which the loss of consciousness steals upon the brain in hanging deserves especial notice, because it satisfactorily explains the facility with which death takes place, even when the suspension of the body is not complete, but when there has been simply a pressure I/O MEDICAL JURISPRUDENCE. of the ligature against the windpipe, the person meanwhile resting on the knees or toes, or being in a semi-recumbent posture. Post-inortcm Appearances. — In the main, they resemble those attending death from strangulation. Externally, swell- ing and lividity of the face, congestion of the eyelids, dilated pupils, eyes red and protruding, tongue swollen, livid, often protruded, or compressed between the teeth, lower jaw re- tracted ; often a bloody froth escaping from the mouth and nostrils. There are frequently petechial effusions on the neck, shoulders, arms, and hands. In many cases, how- ever, especially in suicides, the countenance is calm, the face pale, the eyes and tongue natural. Sometimes there is turgescence of the genital organs, and an involuntary escape of the urine, feces, and semen ; but these signs are by no means peculiar to death by hanging. The position of the head varies according to the part of the neck where the knot was placed. As the latter is usually behind the neck, the head is generally flexed forward. If the knot were in front, the head would be found extended backward (Tardieu). The hands are generally closed, often tightly ; the legs ex- tended, and often livid. The neck is nearly always stretched, owing to the weight of the body, and it presents very decided marks of the cord, varying, however, somewhat according to the nature of the latter and its mode of appli- cation. Thus, the mark may be deep or superficial, single or double, according to the strain made upon it, and the thickness, roughness, or duplication of the cord. The skin under this mark becomes very dense and tough, and of a yellowish-brown color, and has been aptly compared to old parchment. This appearance is more marked if the body has remained suspended for some hours or days ; and the SIGNS OF HANGING. I/I cellular tissue underneath is also condensed, and has a silvery appearance. Besides the above, there is often a livid mark (ecchymosis), where great violence has been used, as in executions ; but the latter is quite distinct from the true mark of the cord, with which it has been con- founded. The livid Hne is much less frequently met with than was formerly supposed. The groove or furrow in the neck, in the great majority of cases, will be found between the chin and larynx. Lu- taud states that it is above the larynx in nearly four fifths of the cases, and over the larynx in the other fifth. Only twice has it been found below the larynx. Its direction is obhque (which distinguishes it from strangulation) ; it may also be double (arising from a double fold of the cord), and irregular or interrupted. It is more marked in front, less so at the sides and below the ears, and ceases behind. In general, the narrower the ligature, and the longer the sus- pension, the deeper the furrow. A broad leather thong, pressing only by its borders, might produce a double mark. Internally, the appearances usually accompanying asphyxia are met with, such as engorgement of the lungs, right side of the heart, and venous system, with dark fluid blood. Both ventricles of the heart contain blood, if the death has been caused by apoplexy ; if by asphyxia, the left cavities are found empty, while the right side of the heart and the large vessels are engorged with blood. The subpericardial ecchymoses of Tardieu are not observed. The lining membrane of the larynx and trachea is deeply congested, as in strangulation, and is sometimes coated with a bloody froth, though less so than in strangulation and suffocation. The vessels of the brain are generally congested, but extra- vasation of blood into the brain or upon its membranes is 172 MEDICAL JURISPRUDENCE. extremely rare. The brain itself, when cut into, presents numerous bloody points. The kidneys are usually con- gested ; the stomach frequently presents evidences of such deep congestion as to suggest the idea of an irritant poison. The same is true also of the intestines. Yellowly found coagulated blood on the mucous membrane of the stomach in two out of every five cases of death by hanging. An exception to the engorgement of the lungs in hang- ing is recorded by Dr. Wilson, of Birmingham, Ala. The case was that of a negro aged 22 years. The heart ceased beating twelve minutes after the drop fell. The post-mor- tem, made one hour afterward, showed the lungs to be completely collapsed, though otherwise normal ; the pleural cavities entirely free from fluid ; right heart distended with dark blood. Stomach deeply congested, and containing a small amount of blood. Liver and kidneys engorged, and brain congested. The above appears to be the second recorded case of collapsed lungs in death from hanging, the other case being that mentioned by Dr. Massey, of Not- tingham, England, of an executed criminal, whose lungs were found in a state of extreme collapse. Among the occasional lesions may be mentioned fracture of the hyoid bone and thyroid cartilage, and rupture of the internal and middle coats of the common carotid artery. An important question is — Was the death caused by hanging ? This cannot always be satisfactorily determined by mere medical evidence, since there are no positive or characteristic signs of this kind of death. The mere sus- pension of the body is no proof, since a murderer might easily suspend the body of his victim, in order to divert suspicion from the true cause of death. The mark of the cord can be imitated by suspending a dead body by the HANGING SUICIDAL, HOMICIDAL, OR ACCIDENTAL. 1 73 neck immediately after death, and, according to Casper, even up to seventy-two hours after, especially if the body be forcibly pulled downward. The livid or ecchymosed line is less likely to be found under these circumstances than the brownish, parchment- like furrow. Hence, it follows that the mark of the cord cannot be regarded as positive evidence of death by hanging ; and the other usual signs, such as turgescence and lividity of the face, congested eyes, swollen tongue, etc., are all met with in strangling and other forms of death, while these very signs may be absent in certain cases of hanging. Dr. R. F. Hutchinson states that an invariable sign of death from hanging is the flow of saliva out of the mouth, down the chin, and straight down the chest. The appearance is unmistakable and invariable, and could not occur in a body hung up after death, the secretion of saliva being a living act. To determine the question whether the hanging was sui- cidal, homicidal or accidental, regard must be had to the attending circumstances ; remembering always that hanging is a frequent method of suicide. Out of 368 cases of suicide occurring in Berlin, 189 resulted from hanging. Hence, the presumption is always in favor of suicide ; besides the difficulties that would attend an attempt at mur- der by this means. If, however, the body exhibit evidences of great violence externally, denoting a struggle and the presence of several persons, or marks of the fingers about the throat, or of internal laceration, these would be more consistent with homicide. The position of the body will throw very little light upon the question, since it is fully demonstrated that complete suspension is not necessary to produce death. In numerous instances the body has been found, after death, resting upon the knees, the toes, or the 1/4 MEDICAL JURISPRUDENCE. buttocks, or semi-recumbent, and in one case entirely sup- ported by the bedstead, while the neck rested in a loop of leather. Even if the hands and feet are found tied, the inference is not warranted that the act was homicidal, since determined suicides have been known to perform this very act previous to hanging themselves. Nevertheless, if a person be found with his hands and feet tied, and suspended from a position which obviously he could not have reached himself, the presumption of homicide would certainly be justified. The age of the deceased might be supposed to assist in solving the question. If a very young person were discovered dead from hanging, it would naturally be attrib- uted to homicide or accident ; yet numerous instances have occurred in this country, within the last few years, of sui- cidal hanging in children not over twelve or fourteen years of age. Cases of accidental hanging are of occasional occurrence, especially among children, who have, while swinging or otherwise playing, accidentally become entangled in a noose or loop of cord, which was then drawn tightly enough around the neck to strangle them. Drowning is that special form of death by suffocation in which the breathing is arrested by water, or some other liquid, and even more effectually than by a ligature drawn around the neck. It is not necessary that the whole body should be submerged in order to cause death by drowning. This may be accomplished by merely immersing the face, so as to keep the nose and mouth under the Hquid, as is witnessed in the case of drunkards, epileptics, and very young children falling with their faces into very shallow DROWNING. 175 pools, and perishing from inability to extricate themselves. In drowning, in addition to the usual cause of death by asphyxia — the deprivation of air — there is superadded the physical impediment of the introduction of water into the minute air-tubes and vesicles of the lungs by aspiration, in the violent efforts of the person to breathe. This is demon- strated by the experiments made by the Committee of the Medico-Chirurgical Society of London. Two dogs of the same size were submerged at the same moment, but one had his windpipe plugged, so as to prevent the ingress of both air and water, while the other had not. After two minutes they were taken out together ; the one with the windpipe plugged recovered at once on removing the plug ; the other died. In three experiments dogs with their wind- pipes plugged were kept under water four minutes, and re- covered perfectly on being taken out. On inspecting the bodies of the animals, the difference was at once manifest. In those that were simply deprived of air by plugging the windpipe, the lungs were congested ; but in those that had been submerged in their ordinary condition — /. e., actually drowned — the lungs, besides being congested, exhibited in their bronchial tubes and air vesicles a bloody, frothy mucus, which completely filled the air vesicles and small tubes, forming a mechanical impediment to the ingress or egress of air. The lungs were sodden with water, heavy, soft, and doughy to the feel, and pitted on pressure of the finger. In the lungs of animals that recovered after a short submer- sion, very little, if any, of this mucous froth was found ; its amount was always proportionate to the time of submer- sion. There is no doubt that this froth is produced by the violent efforts to breathe which are made within a minute after submersion. 1/6 MEDICAL JURISPRUDENCE. Hence, the probability of recovery after drowning is mainly dependent upon the quantity of this mucous froth existing in the air-tubes and vesicles of the lungs, and also of the water that has penetrated into the substance of the lungs. If the quantity is large, the result is almost cer- tainly fatal ; if it is small, there is always good hope of re- covery. Asphyxia occurs in a minute to a minute and a half after submersion, being occasioned by the circulation of the unaerated blood, though actual death is postponed for a minute or two longer until the heart ceases to beat. If the submersion has been complete for four minutes, the case may be considered hopeless, unless syncope had oc- curred at the moment of entering the water. This, by par- tially suspending the attempts at respiration, would un- doubtedly tend to prolong Hfe for some minutes longer. Cases are reported of resuscitation after being fifteen minutes under water ; but these are exceptional, and were probably cases of syncope, occurring at the moment of submersion. It should be remembered that the heart may continue to beat some minutes after respiration has ceased ; but, in the present instance, the pulsation of the heart is no criterion of the power of recovery, on account of the physical im- pediment in the lungs just alluded to. Taylor gives the following excellent synopsis of the cir- cumstances attending a case of drowning : " When a person falls into the water and retains his consciousness, violent at- tempts 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 swallow. In his efforts to breathe SIGNS OF DROWNING. 177 while his head is below the 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 per- son ; but the result is that the blood in the lungs is imper- fectly aerated, the person becomes exhausted, and insensi- bility follows. The mouth then sinks altogether below the level of the water ; air can no longer enter the lungs ; a portion of that which they contained is expelled, and rises in bubbles to the surface ; an indescribable feeling of deli- rium, with a ringing sensation in the ears, supervenes ; the person loses all consciousness, and sinks asphyxiated. In the state of asphyxia, while the dark-colored blood is circu- lating, 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 the other cases of asphyxia, if the per- son recovers, there is a total unconsciousness of any suffering." Even after resuscitation from drowning, death frequently takes place within a few hours or days from secondary causes, as exhaustion, obstruction to respiration from the condition of the lungs, convulsions, and spasm of the glottis. Signs of Death by Drotvning. — i. External. These vary, according to the length of time the body has been in the water, and the intei-val after it was taken out. Supposing the immersion not to have been over two or three hours, and the inspection to be made immediately, the face will be found to be pale, the expression placid, the eyes half open, the eyelids livid, and the pupils dilated, the mouth 15 178 MEDICAL JURISPRUDENCE, half closed or open, the tongue swollen and congested, often indented by the teeth, and perhaps lacerated ; the lips and nostrils covered with a mucous froth, which issues from them. The skin is cold and pale, and generally contracted so as to present the appearance called " goose-skin." This, being a vital act, is a pretty sure sign that the body was living when immersed in the water. It is not dependent on cold, as was at one time supposed. Cadaveric rigidity usually comes on early in the drowned, hence the body is often found with the limbs stiffened. Retraction of the penis is considered by Casper and Kanzler as a positive sign of drowning. Besides the above, there are sometimes seen marks of abrasion on the body, especially on the hands, together with sand, gravel, or mud under the nails, weeds, pieces of wood, or other matters locked in the hands, all of which would seem to indicate that the person had been alive when first immersed in the water ; although the abrasions might very possibly have resulted from the body rubbing against some rough substances after death. After several days' immersion, the palms of the hands and soles of the feet become white, thickened, and sodden, the result of imbibi- tion. If putrefaction has commenced before the body is re- moved from the water, the face will have assumed a reddish, or bluish-red coloration. 2. Internal. — Along with the usual evidences of death from asphyxia (in an early examination) the following signs will be observed : the lungs are distended, overlapping the heart, and are in a flabby condition ; this latter is owing to the water taken in by aspiration, during the struggles for breath, which penetrates even the air vesicles, and renders SIGNS OF DROWNING. 1/9 them sodden and doughy. When cut into, the lungs exude a bloody, mucous froth. The presence of this froth in the smaller tubes and air cells, together with the sodden con- dition of the lungs, is regarded as one of the most positive signs of death by drowning. Nevertheless, its absence should not be accepted as a proof against drowning, since it has not been found in the bodies of persons who have sunk at once in the water, and never risen to the surface to breathe. Ogston states that in 48.7 per cent, of cases, no water was found in the lungs, and he accounts for its ab- sence by its transudation from the lungs into the pleural cavities, where it was found in quantities varying from one to thirty-four ounces. In a case examined by Dr. Reese a few years ago, the body of a woman taken out of the Delaware, there was an absence of this characteristic froth in the minute bronchial tubes, and also of the peculiar flabby condition of the lungs. The absence of these pecu- liarities in the lungs of the body of Jennie Cramer, at New Haven, created a feeling in the minds of many that it was not a case of suicide by drowning, but that the girl was murdered before the body was thrown into the water. The discovery of a considerable amount of arsenic in the body of the deceased was sufficient to account for the death. These peculiar conditions of the lungs of the drowned have not yet been sufficiently determined. It is quite pos- sible that some cases of bodies taken out of the water, and reported by coroners' juries as " found drowned," may in reality have met their death by other means, prior to their immersion. It is important to remember that the presence of this mucous froth in the air passages is not seen after putrefaction, nor after long exposure of the body to the air, nor after long immersion. It is also stated to be absent l80 MEDICAL JURISPRUDENCE. in those who remained under the water without rising to the surface. These circumstances may account for the fact of its occasional non-observance in the bodies of the drowned. Devergie and other authorities state that this froth is occasionally found in the trachea and bronchi, in deaths from other causes. Another important indication of death by drowning is the presence of water in the stomach, which had been swallowed in the act of drowning, especially if this corre- sponds with the water in which the body was found. The value of this is enhanced if, along with the water, there be discovered in the stomach fragments of weeds, sand, mud, or other articles, corresponding with the like substances existing in the pond or river where the drowning occurred. The quantity of water in the stomach varies considerably ; it was found to be greater in an animal that was allowed to come to the surface frequently than in one kept completely submerged, because in the latter the power of swallowing was sooner lost, in consequence of the early occurrence of asphyxia. The absence of water from the stomach is not to be con- sidered as disproving a case of drowning, inasmuch as it is not present (because not swallowed) in cases where either syncope or apoplexy had occurred at the moment of im- mersion. The mere discoveiy of water in the stomach is not of itself a positive indication of death by drowning, since it may have been swallowed before immersion ; but with this allowance, and with the restrictions above mentioned, it does constitute a very important sign, inasmuch as it has been ascertained by experiment that water will not penetrate into the stomach after death, unless putrefaction has advanced SIGNS OF DROWNING. l8l to a great extent ; consequently, its pfesetic^ indicates pretty certainly that it had been swallowed in the act of drowning. Orfila's experiments prove that water may penetrate into the larger bronchial tubes after death, but not into the air vesicles of the lungs ; besides, in such cases, there is no accompaniment of mucous froth in the air tubes. The condition of the heart affords no positive indication of death by drowning. In the majority of cases, the right cavities are full, and the left ones empty, as in asphyxia generally ; but very often the two sides are equally full. The brain exhibits no characteristic post-mortem sign. There may be some general fullness of the vessels, but never extravasation of blood, unless a sudden apoplexy had supervened, as when a person plunges suddenly into cold water after eating heartily, or by striking the head against a hard body in the act of diving. The blood is usually dark and fluid. The fluidity of the blood, according to Brouardel, is owing to the water ab- sorbed into the circulation through the pulmonary 'tissue ; and this is much more decided in cases where the person dies slowly, after coming to the surface frequently, than when, through syncope, apoplexy, or drunkenness, he im- mediately sinks to the bottom, Brouardel regards the fluidity of the blood, the empty condition of the heart, the infiltration of the lungs with water and froth, and the presence of broad, ill-defined subpleural ecchymoses as indicative of gradual drowning with struggling ; while, if the blood is not fluid, if there are punctated subpleural ecchymoses, and clots of blood in the heart, and rather an absence of pulmonary, watery infiltration, he would con- sider it a case of drowning in which there had been no I 82 MEDICAL JURISPRUDENCE. struggle made to breathe. The mucous lining of the stomach and bowels is usually congested and of a deep violet color if the body had been long in the water ; this might lead to the suspicion of irritant poisoning, as is seen also in hanging. Occasionally, in cases of drowning, after a full meal, vomiting occurs, and the contents of the stomach are found in the windpipe and lungs ; this is a conclusive evidence that the person must have been alive at the time. The time at which the bodies of the drowned will float varies with the temperature of the air, the water, the age, sex, and corpulence. As the human body is slightly heavier than water, it must remain submerged until it becomes lighter through the development of the gases of putrefac- tion. Hence, in summer the body may rise within twenty- four hours. In salt water it will float sooner than in fresh ; very fat bodies float sooner than lean ones ; the bodies of women and those of young children sooner than those of men. Hence, in infanticide by drowning, the infant's body speedily rises to the surface. To determine the time that has elapsed since the act of drowning, when the body is discovered in the water, is not always possible. After putrefaction has set in, it is mere guesswork. The most certain criteria to guide the ex- aminer are the presence of the mucous froth in the air- tubes and cells, and the presence of water in the lung tissue, both of which indications disappear after exposure to the air and after putrefaction. Hence, the importance of an early inspection. Devergie, who has given particular atten- tion to this subject, offers the following observations : During the winter, for the first three days there is no change. From three to five days there is cadaveric rigidity ; the SIGNS OF DROWNING. 1 83 palms of the hands begin to blanch. From four to eight days the limbs become supple, but still retain their natural color ; the palms of the hands are very white. From eight to fifteen days the face, at first pale, becomes red in places and bloated ; the skin on the back of the hands and on the feet is blanched ; a greenish appearance at the base of the sternum. In one month the skin on hands and feet is very white and in folds, the face reddish-brown, the eyelids and lips greenish, with a reddish-brown patch, surrounded by a greenish zone on the front of the chest. In two months the epidermis of the hands and feet to a great extent is softened and detached, the face generally swollen, and of a brownish color ; hair falHng out ; nails still adherent. In three months, commencing saponification, especially in women, about the face and neck, breasts, groins, and thighs ; nails loosened. In four months saponification has progressed on the face, neck, and thighs, and commenced in the brain ; general softening and destruction of the hairy parts of the skin. If the foregoing observations made in the winter were applied to the summer, the following allowances are to be made : five to eight hours' continuance in the water in sum- mer are equivalent to three to five days in winter ; twenty- four hours in summer, to four to eight days in winter ; four days, to fifteen days ; and twelve days, to one month, or six weeks. If marks of violence be found on the bodies of the drowned, of course suspicion will be aroused of foul play, unless these marks can be satisfactorily attributed to some post-mortem cause. A murderer may destroy his victim, and then throw the body into a river, pond, or well, with the intention to elude suspicion of the real cause of death. 184 MEDICAL JURISPRUDENCE. A close examination of the body for wounds and other injuries, together with the absence of the known signs of drowning, will generally enable the examiner to form a correct conclusion. Tardieu regards the presence of sub- pleural ecchymoses, together with subpericranial and sub- pericardial effusions, as indicative of a preceding suffocation. Throwing into rivers or pools is a very common method of disposing of bodies in cases of infanticide. The question of accident, homicide, or suicide, in the case of drowning, must claim the attention of the legal physician. Homicidal drowning is rare, except in the case of infants. It is denoted by the marks of violence on the body, which cannot be explained by any post-mortem influence. It should be remembered that determined suicides frequently inflict dangerous wounds upon themselves, and then termi- nate their lives by drowning. Such cases might possibly be mistaken for homicide. The presence of the usual signs of drowning would at least show that the body was alive at the time of immersion. Suicidal and accidental drowning cannot always be distinguished from each other ; inferences may, however, be drawn from the circumstances attending the cases, as the existence of a motive to suicide, or a ten- dency thereto through melancholia. The proximity of a precipice, or other dangerous place, to the water in which the deceased was found, would naturally suggest accident, especially in the case of a child. The tying of the hands and feet of a person found dead in the water is no proof of homicide, since many instances are recorded of suicides so binding themselves, and of attaching heavy weights, before throwing themselves into the water. The restoration of the drowned depends chiefly on excit- ing artificial respiration. The clothes should be immediately DEATH BY LIGHTNING. 1 85 removed, and the body quickly wiped dry and wrapped in a blanket ; clear the mouth and nostrils of mucus and water ; draw forward the tongue ; place the body with the face downward, the forehead resting on one arm, for a few moments, to allow the fluids to run out of the mouth ; apply ammonia cautiously to the nose. If respiration is not re- stored, place the body on the back, with the head raised, and adopt Sylvester's process of artificial respiration, by carrying the arms gently outward and upward above the head for a few seconds : this movement expands the chest. Then lower the arms and bring them to the sides of the chest ; by this action expiration is effected. These alter- nate movements should be made each about every two seconds. All rough handling, such as the vulgar plan of rolling on a barrel, should be avoided. As soon as any signs of respiration are manifested, warmth should be applied to the skin by a warm bath or stimulating friction. When able to swallow, the patient may take a little warm spirit and water, and then be put to bed and allowed to sleep. This treatment has been rewarded with success, after being persisted in for some hours. DEATH BY ELECTRICITY. Death caused by Lightning is often accompanied by results which resemble veiy strongly the effects of homi- cidal violence. Experience shows that persons out of doors, especially under trees, are much more Hable to be struck by lightning than those within doors. The fatal effects of lightning are usually instantaneous, death being caused by shock. At times, however, it pro- duces lesions of the brain and spinal cord, such as epilepsy, 16 1 86 MEDICAL JURISPRUDENCE. paralysis, effusion of blood, tetanus, etc., which may subse- quently prove fatal. Generally speaking, if death does not follow immediately, or soon after, there may be hopes of recovery. The visible effects produced by a fatal lightning stroke are remarkably varied. Sometimes, a deep, punctured or lacerated wound will indicate where the fatal blow was struck, upon the head, neck, or other part of the body ; the hair may be singed, or burnt off; the clothing may be burned or completely stripped off; the boot may be split open. Again, the course of the electric current may be marked by a deep or superficial burn, extending from the point of entrance, down and around the body, to the ground. If there should happen to be any metallic substances in con- tact with the body, such as chains, coins, a watch, etc., as these are good conductors of the electric current, it will be certain to include them in the circuit, and they will be fre- quently found to have been melted. In other cases of death by lightning, no external wound or burn may be visible. Sometimes there may be severe external injuries, while the clothes entirely escape. Again the clothing may be completely torn off the body, while the latter exhibits no injury whatever. The capricious action of the discharge is shown by the fact that out of a party of three or four sitting under a tree, one or two only may be killed, and the others escape. Again, it has occurred that persons under a loza tree have been struck, although high trees, and a lightning rod, and an iron bridge were near. Again, the same discharge may produce in one person wounds, and burns in another. The diversity of its action on the clothes may probably be explained by the circumstances of a portion of the clothing DEATH BY LIGHTNING. 1 8/ being wet, and a portion dry ; the former, being a good conductor, might escape the disruption which would be exhibited by the diy portion, which is a bad conductor. Post-mortem Appearances. — In case of instantaneous death, the body may be found in the exact attitude in which it was struck. Some remarkable instances of this are recorded in the books. In such cases, the rigor mortis occurs imme- diately after death. Hunter supposed that there was an absence of the usual rigidity after death ; but in this he was in error. Coagulation of the blood also occurs, although it is delayed. The face is often bloated and discolored, and putrefaction is usually very rapid. Wounds of various character are observed — contused, lacerated, and punc- tured ; also burns, vesications, and ecchymoses ; these latter sometimes exhibit a remarkable arborescent appearance. Occasionally, fractures of the skull and of other bones are noticed. The blood is dark and fluid. The brain and its membranes generally suffer most severely, the head being usually the first part struck. Con- gestion of the brain, effusion of blood under the skull and into the ventricles, and even complete disorganization of the brain substance have all been observed. The lungs are sometimes found congested and injured, and the air-tubes full of mucus. The stomach, intestines, liver, and spleen are also usually much congested. The heart does not exhibit any special alteration. The medico-legal interest, in cases of death from light- ning, is centered in the question of being able to identify such cases, and to distinguish them from those of homicidal violence. A close observation of all the circumstances of the case — such as the occurrence of a thunder-storm about the time of the death, the peculiar appearance of the wounds 1 88 MEDICAL JURISPRUDENCE. and burns, especially if the two co-exist on the same body, the half-melted appearance of metallic articles, such as buttons and coins, on the person of the deceased, etc., — will tend to throw much light upon it. The introduction of electricity into very general use, in civilized countries, as a source of illumination and as a motor force, has been the occasion of numerous fatal results, arising from the accidental contact of individuals with the detached conducting wires employed. These deaths have sometimes been accompanied with excessive burning of the bodies of the unfortunate victims, at the points of contact of the wires. Electric currents may be either continuous or alternating. In the former (sometimes called " direct ") the current flows constantly in the same direction ; in the latter, there are rapid changes in direction, usually more than one hundred a second. Sometimes the electric current is sent in rapid impulses ; these are called polyphase currents. It is gener- ally thought that alternating are more dangerous than direct currents of corresponding voltage. Incandescent systems are often run on no or 220 volts, and are not suf- ficient to do serious harm. Trolley-car lines are usually supplied with a continuous current at about 600 volts which is dangerous. Street arc-lamps are almost always supplied at high pressure, often several thousand volts, and alternat- ing currents are largely used in such installations. These are the most frequent causes of death. In Philadelphia, a man w^as instantly killed by accidentally touching the end of an umbrella to the lower portion of an arc-lamp. Subjection to currents of high intensity has been made the means of execution in the State of New York, and has been applied in a number of cases. The absurd term EFFECTS OF HEAT AND COLD. 1 89 " electrocution," invented by newspaper reporters, has been applied to this method. The prison authorities of New York are apparently satisfied with the system. It must be borne in mind that while telephone wires do not carry dangerous currents, they may at any time be charged to a fatal extent by contact with wires carrying heavy currents. Another source of danger is that alternating currents of high voltage used for indoor service, such as incandescent lights and fans, are reduced to very low voltage by transformers, but these may get out of order and allow the full pressure street current to pass into the house wires. DEATH FROM HEAT AND COLD. The effects of extreme Heat on the human system are familiarly witnessed in tropical and semi-tropical climates, during the heated term, in the mortality arising from what is popularly denominated sunstroke. In such cases, the dangerous and fatal results are attributable directly to solar heat. But effects equally serious are known to be produced by exposure to artificial heat, if too long continued, as is witnessed in those employed in engine-rooms, factories, etc., where a very high temperature is habitually maintained. There would seem to be, according to the observations of Wood, three distinct conditions of the human body occa- sioned by excessive heat ; in the first (which is rare), we have acute meningitis or phrenitis (sunstroke); in the second, we have heat-exhaustion with collapse, accompanied by a rapid, feeble pulse, a cool, moist skin, and a tendency to syncope; in the third, we have true thermic fever — that condition which results especially from exposure to artificial heat. But something more than mere heat is required to produce thermic fever. It does not occur in a perfectly 190 MEDICAL JURISPRUDENCE. pure and dry atmosphere, because the profuse perspiration which is immediately developed by its rapid evaporation keeps the temperature of the body down nearly to the nor- mal standard. If, however, the air is already saturated with moisture, this will prevent the evaporation from the body, and its temperature will rise to a dangerous height. The symptoms vary in intensity, from a mere headache with drowsiness, to complete insensibility, coma, and pa- ralysis. In many instances, death appears to be caused by paralysis of the heart. The post-mortem appearances are by no means constant. In some cases (true sunstroke) we find decided congestion of the brain and its membranes, with serum in the ventricles, together with congestion of the lungs and of the abdominal viscera generally, and the heart as in ordinary death from asphyxia. In other cases, there is anemia of the substance of the brain, along with distention of the larger vessels with dark, fluid blood, but the minute vessels empty. Cases of insolation do not often claim the attention of the legal physician, yet as they might occur remote from wit- nesses, and with a fatal termination, it is proper that the medical examiner should understand their nature, together with the ordinary accompaniments. The effects of Cold upon the animal body are immediately depressing ; but if it be of short duration, and the system is in good health, reaction takes place. The human body has the power to maintain its normal temperature of about 98.6° F. independently of the external temperature. It has been ascertained by actual experiment that a warm-blooded animal will not survive if its temperature is reduced down 16 to 20 degrees below the normal. There is no authentic account of the recovery of a warm-blooded animal, much EFFECTS OF HEAT AND COLD. I9I less a human being, after the whole body was frozen, al- though fishes and other of the lower animals are said to have been resuscitated from a frozen state. Death from cold is hastened by whatever exhausts the system, as fatigue, both bodily and mental, loss of rest, want of proper food and nourishment, mental depression, and particularly intoxication. A damp cold (such as wet cloth- ing) is more dangerous than a dry one. The fatal effects of exposure to cold are witnessed, even in comparatively temperate cHmates, during the winter, in the cases of the destitute, and especially where this condition is associated with intemperance. Cases of death from cold do not often require the atten- tion of the medical jurist. There are, however, certain conditions under which they may occur which demand a brief consideration. Every body in which it is assumed that death has taken place from exposure to cold should be examined as soon as found to determine the proofs of death. Herris records a case in which an infant was removed to an undertaker's establishment, presumably dead ; many hours afterward, — the exact time is not given, — when he called to make the autopsy and while in conversation with the undertaker in an adjoining room, their attention was attracted by the crying infant, which by energetic efforts was completely resuscitated. A not infrequent form of infanticide is the exposure of a new-born child to very cold air. Death will soon ensue under such circumstances, since the infant's power of resist- ance to cold is limited. In such a case it will be the physi- cian's duty to examine the body of the child and consider the accompanying circumstances, such as the place where 192 MEDICAL JURISPRUDENCE, it was found, the temperature of the air, the possibiHty of its being accidental, etc. As regards the body, he should notice if the pallor is extreme ; if frozen stiff, he should distinguish this rigidity from rigor mortis ; also the arterial color of the blood ; the accumulation of blood on both sides of the heart and in the larger vessels. There may also be marks of violence upon the body. Occasional instances of the exposure of young children to cold with homicidal intent are recorded. Such a case is related of two inhuman parents causing the death of a daughter, aged eleven years, by compelling her to get out of bed on a very cold night and place herself in a vessel of ice-cold water. In the treatment of the insane, the barbarous and im- proper use of the cold shower bath for reducing intractable patients to submission was formerly much more in vogue than at present. It need hardly be said that such treat- ment is extremely hazardous, and it has been followed by fatal results. Taylor records an instance of a lunatic, aged sixty-five, who was subjected to the cold shower at 45° F., and who afterward took a dose of tartar emetic ; he died in fifteen minutes subsequently. Cases of this character would very properly come under the notice of the legal authorities. Post-mortem Appearances. — These cannot be considered as very characteristic ; hence, the examiner should be cau- tious in deciding, in any given case, as to whether exposure to cold was the primary cause of death. All the circum- stances of the case here require special consideration, such as the season of the year, the temperature of the air, the place of exposure, etc. Rigor mortis generally sets in slowly and lasts a long time. According to Ogston, the four following appearances, in the absence of any other DEATH BY STARVATION. 1 93 obvious cause, would justify the conclusion that the death had resulted from cold, although the signs were not so well marked in children as in adults : 1. An arterial hue of the blood, except when viewed in mass within the heart ; some exceptions are, however, noted. 2. An unusual accumulation of blood on both sides of the heart. 3. Pallor of the general surface of the body and con- gestion of the viscera most largely supplied with blood. In some cases, the congestion of the brain and liver was only moderate. 4. Irregular and diffused dusky- red patches on limited portions of the exterior of the body, even in non-dependent parts (distinguishing them from suggillations). As putrefaction does not occur at a freezing temperature, the discovery of a decomposing corpse in the ice or snow would afford very strong, though not absolutely conclusive, evidence that the death was not the result of exposure to cold, but rather that the body had been frozen after death. DEATH BY STARVATION. Cases of death by Starvation are of sufficiently frequent occurrence to merit the notice of the medical jurist. Acute starvation implies the sudden and complete deprivation of all food. Chronic starvation is the result of a continued deficient supply of food, both in quantity and quality. Homi- cidal death from acute starvation is very rare; but cases of accidental death from this cause are sufficiently nu- merous, as in the instances of miners buried in the eaith, shipwrecked mariners, and others cut off from food. Oc- casionally, prisoners and lunatics will undertake to commit 194 MEDICAL JURISPRUDENCE. suicide by voluntary abstinence from all food ; in the majority of cases, however, courage fails after some days' experience and they give up the attempt. Many cases of voluntary fasting which have claimed the notice of the public during the past years have proved, on close examination, to be deceptions, food and drink having been supplied surreptitiously to the individuals concerned. Among these instances may be mentioned the case of Aim Moore, of Tetbury, England, who was alleged to have abstained from all food from 1807 to 18 13. Another case was that of the Welsh Fasting Girl, aged thirteen years, who is stated to have absolutely fasted for two years. Both these cases were shown to be impostures. The notorious Dr. Tanner, of our own countiy, undertook, for a consider- ation, to perform the feat of a forty days' absolute fast, in New York, in August, 1880, and, to all appearance, he accomplished it. It is stated that during all this time he partook of nothing save some ounces of pure water each day, and that his loss of weight at the end of forty days was thirty-six pounds. The fluctuations in his pulse, tem- perature, and respiration were unimportant. This case was not under very strict medical supervision, and the doubt as to its genuineness seems to be confirmed by the fact of his voracious feeding on the completion of the fast, unattended by any bad effects, which is contrary to the general expe- rience of others who have been deprived of food for a length of time. Since the above case, several instances are recorded of voluntary fasting for periods varying from several weeks to some months ; but there is nearly always some uncertainty as to absolute fasting. Chronic starvation, as the result of disease, is a frequent cause of death, as is witnessed in stricture of the esophagus, DEATH BY STARVATION. 1 95 cancer, and other disorders of the stomach and bowels, dis- ease of the pancreas, marasmus, etc. It is Hkewise the cause of disease and death in young children fed upon un- suitable milk, as when this fluid is deficient in some of its proper constituents. Such cases are abundantly illustrated in the miserable victims of baby-farming. Chronic starva- tion is also witnessed on a large scale in districts where famine has prevailed, as in certain parts of India, and in the Irish famine of 1847. The symptoms of chronic starvation are generally well- marked. The sense of hunger is not very urgent ; emacia- tion, especially in the last stage, is extreme ; the eyes are hollowed, the pupils dilated ; the skin is harsh and dry, and hangs loosely over prominent bones, and, in chronic cases, becomes covered with a brownish, dirty-looking coating, and exhales an offensive odor, like that of putrefaction. The bowels are either very constipated or the feces are scanty, dry, and dark-colored. There is great muscular debility, palpitation, with tinnitus auriiim ; pains in the stomach, with a dry, parched mouth ; the intellect sometimes clouded, but again clear to the end, with despondency of mind. The pulse is at first somewhat quickened, afterward it is slower ; the temperature is usually below that of health. Post-mortem Appearances. — Great emaciation of the body, with an almost entire loss of fat ; sunken cheeks and eyes. The skin shriveled, and emitting a disagreeable odor. The muscles soft, pale, and wasted. The brain sometimes con- gested, and at others pale and soft, with effusion of serum on the surface and in the ventricles ; the lungs healthy or anemic ; the heart more or less contracted and void of blood ; stomach and intestines contracted, thin, and transparent ; the latter usually empty ; the bladder contracted and empty. 196 MEDICAL JURISPRUDENCE. As regards the medico-legal relations of starvation, although it is rarely the cause of homicidal death, it should be remembered that the law does not require the absolute deprivation of food to be proved, but only the necessary quantity and quality to be withheld, provided this has been done with an evil intention. Cases of this character are sometimes witnessed in baby-farming. Death from poisoning will be treated at length in a special section under the title Toxicology. CHAPTER VII. FEIGNED DISEASES. I. Feigned Bodily Diseases. — These become the sub- ject of inquiry very frequently, especially among soldiers, sailors, and prisoners, who are ever ready to resort to all sorts of pretexts to escape duty, to avoid certain kinds of punishment, or to secure comfortable quarters in a hospital. Among civilians the same fraud is sometimes attempted, as in an alleged incapacity to perform military service, to undergo imprisonment, or to discharge the duties of a juror or witness. Casper remarks : This simulation of disease is sometimes carried out by a purely mental effort, as by cunning, lying, or mimicry ; at others, by the aid of mate- rials of various kinds, such as crutches, bandages, trusses, cutting in.struments, spectacles, etc. All such cases of pretended disease are termed fictitious by Dr. Ogston. There is another class of cases which are produced by the patient at his. convenience, or at least are exaggerations of some trivial complaint ; these are named factitious by the above author. The ingenuity of malingerers is almost incredible. Not only may they resort, when occasion requires, to all manner of disgusting performances, such as swallowing excrement or blood, or other offensive substances, but they may actu- ally maim or injure various organs for the purpose of gaining their object. "The greatest difficulty in detecting impos- ture arises when we examine the subjective symptoms ; and extreme caution is then needed, besides the adoption of 197 198 MEDICAL JURISPRUDENCE. the most delicate tests, which should repeatedly be made use of until we are satisfied as to what is the real condition of the patient." (Hamilton.) If we may trust chroniclers, simulated diseases were much more common in former times than at present. We rarely now note such extraordinary cases of deception as are described in old books, of persons vomiting frogs and lizards or snakes, passing inky urine, or discharging im- mense stones from the bladder, etc. Such instances of fraud would soon be detected by the modern means of diagnosis. It is proper that the physician should understand the reasons or motives of the malingerer for feigning disease, since these may often aid him in unmasking the decep- tion. These motives may be classed under the following heads : 1, Fear. — As, for example, to avoid military service; or, in the case of the soldier, to be excused from going into battle. According to Beck, the observations of Mr. Lane on the modern Egyptians show that the practice of break- ing out one or more teeth, or cutting off a finger, or putting out an eye, was exceedingly common among the young men throughout that country. The same motive influences culprits to escape certain species of punishment which they have deserved, such as flogging or the treadmill. 2. Gain. — This is a very prevalent and powerful motive to simulate disease, as, e. g., to obtain damages for some alleged injury, either public or private ; it is often the source of groundless charges in railway accidents ; to pro- cure better quarters, either in a hospital or almshouse ; to obtain a divorce ; to excite commiseration and aid from the benevolent ; and in numerous other methods. FEIGNED DISEASES. 199 3. Laziness. — As in beggars and others, to escape work and live in idleness. 4. Notoriety. — This is chiefly witnessed in hysterical women, who will simulate almost every variety of disease, and submit to painful treatment ; who will frequently muti- late themselves, and pretend to take poison, or destroy themselves in some other manner, and with no other con- ceivable motive except to gain notoriety. As regards the mode of diagnosis, the following general rules may be observed : Cunning and shrewdness must be met by the exercise of these same qualities on the part of the examiner. In nothing are experience and tact of greater assistance to their possessor than in the management of this sort of cases. The examiner should always bear in mind that simulation may be possible, and that this is likely to be practiced in a given case if a sufficient motive exists ; he should try to discover this motive, using great caution in the attempt. One should not be content with a single examination of the patient, but should surprise him with an unexpected visit, made soon after the first one, and observe him closely when he is not aware of notice ; by this means the decep- tion may often be discovered when he is off his guard. The patient's account of the rise and progress of his dis- ease should be compared with known medical facts con- nected with the history of the real disorder. It is often useful to mention in the patient's hearing certain false symptoms of the alleged disease, and afterward ask him after these symptoms ; when, if simulating, he will be very apt to enact them just as he heard them. One who complains of a multitude of ailments should always be sus- pected, especially ailments which have no natural connec- 200 MEDICAL JURISPRUDENCE, tion with one another. All local ailments should be exam- ined with the parts uncovered ; all dressings and bandages must be removed. The physician should not be misled by cicatrices, cupping scars, leech bites, or blisters. No im- portance whatever is to be attached to the statements of relatives or friends, since they would naturally sympathize with the patient. Anesthetics (ether and chloroform) may sometimes be employed successfully in suspected cases of contracture of the spine or muscles, A very successful method is to threaten, and even use, some veiy repulsive medicine or remedy, as powerful revulsives, and especially the actual cautery ; but there are some cases that prove obstinate and unconquerable, even under this severe ordeal. Special Diagnosis. — Feigned Pain. — There is probably no symptom so commonly complained of by the malingerer, and none more difficult to determine by the examiner, than pain, because it is purely a subjective symptom. Hence, it will try the skill and tact of the physician to the utmost. A close and patient investigation will, however, usually detect the fraud. The simulator will either be too exactly correct in his description or else entirely incorrect in his localization. He will exhibit great distress under the slightest pressure, when his attention is directed to the part ; but when this is directed elsewhere, no evidence of pain is manifested. Questions or hints, skillfully thrown out, may put him off his guard and reveal the deception. A favorite seat of pain is the back, and it is usual among soldiers to attribute it to rheumatism, contracted by exposure from sleeping on the damp ground. Of course, there are some real sufferers from this cause, but they are outnumbered by FEIGNED DISEASES. 20I the simulators. The latter may often be detected by close watching when they think they are unobserved. Their agility of motion contrasts wonderfully with their lameness and difficulty of movement when they come into court or before the medical officer for examination. If the pain complained of is very severe and persistent, and there is an absence of all other concomitant symptoms, there is strong room for suspicion. So, too, if the person complains of intolerable pain in executing certain muscular movements, but evinces no suffering when exercising the same parts in a way more in accordance with his wishes. " A young lady, desirous of escaping her piano practice, complains of pain in one arm and shoulder, and gains the sympathy of her unthinking mother, while the same day she may devote one or two hours to lawn tennis, or use her hands in other ways, and give no report of pain." (Hamilton.) Beck refers to the case of a girl of fifteen years who, in order to be taken away from school, com- plained of severe neuralgia of the face. On a subsequent occasion, when a recurrence of the pain was complained of for some similar motive, Thompson very successfully em- ployed a strong mental remedy, based upon the known antipathy she had to a dog. He informed her that the only remedy remaining was to rub the affected part over the back of that animal. The result was a complete and imme- diate cure, without the application of the remedy. But, admitting the frequency of malingering in the case of pain, the examiner should, on the other hand, avoid the risk of making a too hasty diagnosis, since there may be cases of real occult disease accompanied by pain, and where the latter symptom may be wrongfully attributed to imposture. 17 202 MEDICAL JURISPRUDENCE. Fever, especially of the intermittent and ephemeral types, may sometimes be cleverly imitated. The heat of skin and excitement of pulse have been produced by the use of stim- ulants, as spirits, cantharides, etc., and by friction on the skin ; the coating of the tongue, by the use of chalk, pipe clay, liquorice, etc. Dr. Cheyne was sent for to a soldier who was said to be in the chill of an intermittent. He found him shaking violently, but, on throwing off the bed-clothes, he was seen, not in the cold, but in the sweating stage, pro- duced by his exertions. Pretended Heart-disease. — Extreme feebleness of the pulse has been produced by ligatures around the arm, by pres- sure upon the axillary artery, and, in certain individuals, by taking a deep inspiration and suspending the breathing. The case of Col. Townshend, reported by Cheyne, was of a similar character, where there was a voluntary suspension of the heart's action for a limited period. Palpitation may be excited by the internal use of various drugs, as tobacco, digitalis, and American hellebore ; also by introducing these substances into the rectum. The stethoscope should be used in all suspected cases. Feigned Pulmonary Ttiberadosis. — This disease has been simulated by coughing and by producing emaciation by abstinence and the use of vinegar ; by pricking the gums or fauces and spitting up blood ; by mixing the sputa of ordinary catarrh with pus and blood, etc. A careful stetho- scopic examination will usually detect the imposture ; but the examination of the sputa for the specific bacillus will be the most satisfactory text. Foreign blood may also be dis- covered by the microscope. Hematemesis has been imitated by the patient swallowing blood and then throwing it up in the presence of spectators. Casper mentions a case of a FEIGNED DISEASES. 203 woman who exhibited a bloody handkerchief as an evidence of her having vomited blood, but which, on microscopic examination, proved to be the blood of a bird. Hematuria has been feigned by mixing blood with the urine or by using substances that have the power of reddening this secretion. The suspected patient should always be made to urinate in the presence of the examiner, and the urine be properly examined for blood. Feigned Incontinence of Urine. — This is frequently prac- tised by soldiers in order to get into a hospital. A good plan to detect the imposture is to give an opiate at night, and introduce the catheter during his sleep ; or by taking him by surprise during the day, and introducing the instru- ment, when it will be found that the urine has not drained off drop by drop as it was secreted, but that the bladder pos- sesses the power of retention. If the disease is real, the pre- puce and glans penis are found to be pale, from its continu- ance, and always moist ; and the clothes exhale a urinous odor. Feigned Epilepsy. — This disease is very frequently simu- lated, probably for the reason of the pity and affright that it is apt to inspire ; and also on account of the short dura- tion of the paroxysm and the length of the interval during which the patient may enjoy his Hberty. Impostors affect the most violent forms of the disorder, suddenly falling down in convenient places, and writhing in great contor- tions ; they thus are apt to overdo it. Many cases may be unmasked by threats, or by applying a strong faradic cur- rent, or the actual cautery. But instances are related where the impostor has suffered all manner of injury rather than confess, and the noted Clegg, " the dummy clincher," threw himself, in one of his pretended paroxysms, from a corridor to the floor, a distance of nearly twenty feet. 204 MEDICAL JURISPRUDENCE. Sometimes the impostor will produce frothing at the mouth by inserting a piece of soap behind the cheek. In suspected cases it is, therefore, well to examine the mouth. If closely watched, the malingerer may be observed to look about him, or to show some interest in the result of his actions. In real epilepsy, there is an entire loss of con- sciousness, and also of sensation to the severest applica- tions. DeHaen relates the case of a beggar in Paris, who often fell in the streets. A bed of straw was prepared, through compassion, on which he might be laid, to pre- vent injury to himself When next attacked, he was laid on it, and the four corners set on fire. He sprang up and fled. The best plan is for the examiner to be fully acquainted with the phenomena and signs of the genuine disease, so as to be able to compare them with the feigned. In true epilepsy the patient falls forward, and as he falls he is very pale ; during the convulsion, the features are turgid and livid ; the veins of the neck swollen ; the pupils dilated and insensible to light ; the hands clenched, with the thumbs closed within the hands. If the hands be forced open, they remain relaxed, whereas in the feigned, they imme- diately close again. The muscular rigidity is simultaneous over the whole body ; nor is there any regular period for the return of the fits. Thus, a simulated case was detected by the surgeon stating in his hearing that the real disease always came on in the morning ; he swallowed the bait, and the subsequent attacks always occurred before noon. In the real disease, the sense of smell is entirely abolished. Occasionally there may be hemiplegia. The urine, feces, and semen may often be discharged during the paroxysm. Ecchymoses are sometimes found on the shoulders after a FEIGNED DISEASES. 205 fit ; and bruises and other injuries may sometimes be met with, as results of the fall. Beck mentions another fact that should be remembered, namely, that the real epileptic is desirous of concealing his situation, through a sort of false shame, whilst the pre- tender talks about the disease, and apparently delights in publicity. In the feigned, the glottis is not closed, and respiration, though impeded, is not interrupted ; nor does the face become so swollen or livid as in the real. Feigned Paralysis. — This disease is frequently simulated, usually in a single limb, but sometimes in both the upper or the lower extremities. In such cases it will be found that there is usually more or less rigidity ; that there is no atrophy, as in the real, and that the electric currents will produce their usual reactions. The sensation and reflex movements, moreover, are not lost. One of the most efficient means of detecting the impostor is to administer a severe electric shock. Suddenly and unexpectedly seizing the paralyzed limb will sometimes discover the fraud, by the patient exerting his strength to prevent the raising of the limb. Hutchinson administered to one who pretended to have paralysis of his right arm a large dose of laudanum secretly, in his tea, and when he was sound asleep he tickled his right ear with a feather, when instantly the lame hand was raised. In some cases the pretense may be unmasked by the use of anesthetics ; and in one of paralysis of the legs reported by Marshall, after every attempt to discover the fraud had failed, it was finally brought out by rubbing cowhage {Dolichos pruriens) on the soles of the feet, at bed- time. He walked and groaned all night, and the next morning reported himself fit for duty. 206 MEDICAL JURISPRUDENCE. Feigned Unconsciousness , Trance, Catalepsy and Soinnam- bulisju. — These different nervous conditions may all be simulated, where there is sufficient motive ; but careful watching and study of the cases will usually succeed in detecting the imposture. One of the most remarkable cases of feigned uncon- sciousness is that of Phineas Adams. This man was a soldier and was .imprisoned for desertion. He remained apparently unconscious for over two months, in spite of the most powerful applications in the form of revulsives, even to the cutting down through the scalp upon the skull. As his case was considered hopeless he was discharged, and in a couple of days he was seen perfectly restored, and assist- ing his father in thatching a rick. Feigned Diseases of the Eye. — Ophthalmia is artificially produced by the introduction of irritants into the eye. It is, however, detected by the rapidity of its progress, arriving at its height within a few hours after the application of the irritant. In soldiers, sometimes only one eye is affected, and almost uniformly the right one — the one with which he takes aim. A left-handed man would probably inflict the injury on the left eye. It is sometimes difficult to detect cases of blindness arising from amaurosis. In this disease the pupil is usually dilated and fixed, but there are instances in which it retains some contractile power. The patient should be carefully watched to see whether he avoids obstacles placed in his way. If the pupil contracts perfectly, there is no doubt about the case being feigned. The dilated, immovable pupil may be imitated by the use of belladonna or other mydriatics. Feigned Deafness may often be detected by making a FEIGNED btSEASES. 20/ noise at an unexpected moment, such as dropping a piece of metal ; he will be very apt to turn his head in the direction from whence the noise proceeded. The suspected person should be taken unawares, the tone of the examiner's voice should be changed ; his countenance should be watched while something in which he is personally interested is being related to him, A deaf person usually converses in a low tone of voice. Dunlap mentions the case of a soldier who pretended deafness so well that firing a pistol at his ear produced no effect ; but on trying the experiment after he had been put to sleep by opium, he started up out of bed. Pretended Deaf-mutism is more difficult to maintain than pretended deafness. The best plan, in order to detect the imposture, is to say something that deeply interests the patient, and watch the physiognomy. Notice also if a body let fall near the person will, by its vibrations, cause him to look around. The application of a strong faradic current over the larynx will sometimes succeed in detecting the fraud. The case of Victor Travanait illustrates the ingenuity and perseverance of some of these cases. This young man succeeded for four years in eluding the closest scrutiny exercised upon him throughout Europe ; he was, however, at last discovered by the celebrated Sicard, of Paris. Fictitious Tumors and Enlargements. — These are generally feigned by impostors for the purpose of exciting sympathy and material aid. Hydrocephalus in children, and local dropsy in both children and adults, and simulated by blow- ing up the cellular tissues under the skin, and by ligatures on various parts of the body. Mahon relates the case of a young woman of Strasburg, whose abdomen commenced 208 MEDICAL JURISPRUDENCE. to swell, and continued to do so for thirty-nine years, by which means she excited the commiseration and charity of all who saw her, and by which she procured a comfortable support. At her death, in place of the supposed tumor, there was found merely an enormous sack or cushion, which she had habitually worn over her abdomen. She never would consent to a medical examination for obvious reasons. Pretended or Factitious IVoimds, or voluntary mutilations, are inflicted for various purposes, as for attracting sym- pathy, or cloaking some criminal act that may have been committed. Mutilation of the thumb was common among the conscripts of ancient Rome, and it is stated to be quite a common practice among soldiers, during modern wars, to inflict similar injuries upon themselves, either by fire-arms or by cutting instruments. The case of Whittaker, the colored West Point cadet, affords an illustration of self-inflicted wounds, along with an affected unconsciousness, for the purpose of carrying out a certain scheme. This youth had repeatedly failed in his studies ; and upon the eve of his examination, which would most probably have resulted in his suspension, he made a desperate attempt to excite the sympathy of the community, as well as to gain time for study. One morning he was found in his sleeping room, apparently unconscious, and tied to his bed with strips of muslin. There were several slight cuts, one on the ear and another across the toe. He continued apparently unconscious of all surroundings for some time, when he opened his eyes in a stupid condition. His story was that he had been surprised several hours before by a band of masked men, who felled him to the floor, and who, after wounding and threatening him left the FEIGNED WOUNDS. 2O9 room. Numerous circumstances showed that the whole thing was an imposture, and on trial he was found guilty, but his sentence was modified. Another case was that of a bank cashier, who was found gagged and tied, and wounded in a superficial manner, while at the same time the funds of the bank were missing. It was afterward discovered that the wounds were self- inflicted, and that other preparations were made for the purpose of diverting suspicion from himself. In cases of this character, one very suspicious circum- stance is that the wounds are always superficial, and not of a dangerous character ; they are usually mere cuts or scratches, not involving any vital parts. Moreover, the cuts or stabs made in the garments will often be found not to correspond with those made on the body. It sometimes happens that slight and trivial injuries received in a railway or other collision are magnified purposely, in order to obtain larger damages in a suit at law. Again, persons who have unsuccessfully attempted to commit suicide are apt, from motives of shame or disappointment, to attribute their wounds to another. In such cases, the injuries are super- ficial, made usually by the right hand and in front, while the hands themselves are seldom wounded ; in a real assault the hands are very apt to be cut and maimed. Feigned Pregnancy and Delivery will be hereafter con- sidered. II. Feigned Mental Disorders will be discussed under the head of Insanity. CHAPTER VIII. PREGNANCY. The occasions in which Pregnancy becomes the subject of medico-legal inqury are the following: (i) A woman may declare herself pregnant with an heir to an estate, for the purpose of defrauding other heirs-at-law ; (2) for the purpose of extorting money from a seducer or paramour; (3) to stay the infliction of capital punishment until after delivery ; (4) the plea of pregnancy may be set up as an excuse for non-attendance at a trial to awaken sympathy, etc. ; (5) an accusation of pregnancy may be made against a single woman, or one living apart from her husband, which may result in an action for damages for slander ; (6) accusations of malpractice may be made against a medical man for error in diagnosis of pregnancy, or an attempt to bring on an abortion. On the other hand, pregnancy may be concealed (i) in order to procure abortion or infanticide ; (2) in order to avoid disgrace. The Roman law exempted a pregnant female from capital punishment until after delivery. The laws of most modern countries follow the Roman custom in this matter. By the old English law, under the writ of de ventre inspiciendo, " a jury of twelve matrons, or discrete women," was sum- moned to ascertain the fact of pregnancy in the civil case, and the further fact of the woman's being "quick with child," in a criminal accusation. In Scotland, the preg- nancy simply must be proved without reference to quicken- SIGNS OF PREGNANCY. 211 ing, and without the jury of matrons. At the present day, both in England and in our own country, the jury of matrons has been very properly superseded by a jury of instructed physicians. To enable the physician to decide upon the fact of preg- nancy, he must necessarily be acquainted with its signs. These may be described under the heads of (i) the uncer- tain and (2) the certain, or positive, signs. I. Uncertain Signs. — These comprise the following : {a) Stippression of the Catamenia. — This may be regarded as a probable sign of pregnancy if it occurs in a woman who was always regular, and if at the end of three months she recovers her usual health without reestablishment of the function ; since, if the suppression were the result of disease, a general and continued loss of health would be apt to follow. But there are many exceptions, — as when the menses are suppressed, temporarily, by disease ; when men- struation continues throughout pregnancy ; when it has never occurred in the woman at all, and yet she has given birth to several children and continued in good health ; and when the catamenia have appeared only during pregnancy, but were absent at other times. In cases of concealed pregnancy, the woman may stain her linen with blood (and even with borrowed menstrual blood) for the purpose of imitating menstruation. This deception may generally be detected by close watching, and still more accurately by a microscopic examination of the suspected stains. Menstrual blood does not coagulate so readily as ordinary human blood, on account of the vaginal mucus. It also contains epithelium scales, easily recognized by the microscope. Uj) Morning Sickness. — Nausea is very apt to be an early 212 MEDICAL JURISPRUDENCE. accompaniment of pregnancy, sometimes as early as the second or third week after conception. It usually ceases after quickening, but it may continue throughout the whole period as a most distressing symptom. There are many cases, however, where it does not occur ; and it is also an uncertain sign of pregnancy, because nausea accompanies many diseases. [c) Enlargement of the Abdomen. — In pregnancy, the en- largement of the abdomen begins to be obvious after the end of the third month, when the uterus rises out of the cavity of the pelvis. At about the fifth month, it is midway between the pelvis and umbilicus, which latter it reaches at the end of the sixth month. During the seventh month, it reaches half way between the umbilicus and the ensiform cartilage ; at the end of the eighth month, it is on a level with this cartilage. During the ninth month, it does not ascend higher, but the tumor widens somewhat and falls slightly forward. This sign is subject to many fallacies : the enlargement may proceed from ascites, ovarian dropsy, ovarian tumor, retained catamenia, flatus of the intestines, impacted feces, excess of fat, distention of the bladder, and enlargement of spleen and kidney. Great caution is necessary in order to make a diagnosis ; mistakes have been made even by expe- rienced examiners. Intestinal flatus may be distinguished by percussion ; the presence of fluid (ascites and ovarian dropsy), by palpation ; ovarian enlargement, by its history and progress. In true pregnancy, after the seventh month, the tumor will sensibly contract under the cold hand, and the fetal movements may be distinctly felt. The outlines of the fetus also can often be felt. A dark line extending from the umbilicus to the pubis may also generally be dis- SIGNS OF PREGNANCY. 21 3 tinguished ; but this may date from a previous pregnancy, and also may accompany ovarian enlargement. The enlargement of the abdomen may lead to unfounded suspicions reflecting upon the reputation and happiness of the female. In certain puzzling cases, in which the enlarge- ment is accompanied by subjective signs on the part of the woman, simulating the movements of the child, it may be traced to accumulation of flatus in the intestines, accom- panied by contraction of the abdominal muscles, constituting a phantom tumor ; this condition is best cleared up by placing the woman under ether, when the enlargement will be found to subside. (^d) Quickening. — By this term is understood the first perception by the mother of the movements of the fetus. Its usual time of occurrence is from about the sixteenth to the twenty-fourth week — sometimes earlier, sometimes later. It may often be absent altogether, even when a healthy child is born. Its cause is ascribed either to the rising of the uterus out of the cavity of the pelvis, or to the increased activity of the fetus, or to the latter now coming in contact with the uterine walls. However produced, it is a very deceptive sign of pregnancy, as it is purely a subjective symptom, and many nervous women, especially when anxious to have children, will mistake movements of the intestines and the contraction of the abdominal muscles for the motions of a child. {e) Development of the Breasts. — As a general rule, during the progress of pregnancy, the breasts become larger, fuller, more knotty, and tender to the touch ; enlarged veins course along the surface ; the nipples and the surrounding follicles become more prominent ; the areola widens and assumes a darker hue, especially observable in brunettes. In fair 214 MEDICAL JURISPRUDENCE. women, these changes are often not noticeable. Besides, enlargement of the breasts often occurs in suppression of the menses, in uterine fibroids, and in ovarian and uterine disorders. An excessive adipose secretion around the breasts is liable to be confounded with a true enlargement of the mammary gland. The increased development of the breasts, being due to the secretion of milk, is more observable towards the end of the pregnancy, when, frequently, this secretion is mani- fested. The presence of milk in the mammary gland is no proof of pregnancy, since it has frequently been seen in the unimpregnated female, and even in young girls. Dr. E. Warren, of North Carolina, relates an instance of a woman, aged fifty-five years, whose catamenia had ceased, and who was in poor health, when she undertook to bring up the child of a deceased friend. To keep it quiet at night, she was accustomed to put it to the breast. In six months the secretion of milk was perfectly established, and she con- tinued to nurse it for twelve months, the child becoming healthy and strong.- Still more remarkable are the cases of secretion in the breasts of males. DungHson relates the case of a man aged fifty-five years, who performed the office of wet nurse for several years. (y) TJie violet color of the vagina, due to venous conges- tion (Jacquemin's test), commencing about the fourth week. This is considered by Montgomery and others, as a very certain sign of pregnancy, though its absence is not to be accepted as a negative proof Dr. R. Barnes regards the flattening of the upper wall of the vagina as a reliable sign of pregnancy in the early months. It is attributed to the enlargement of the womb with slight anteversion, throwing SIGNS OF PREGNANCY. 215 the OS backward, and rendering the superior wall of the vagina tense. II. Certain, or Positive, Signs : — («) Bal/ottement. — This test will determine the presence of a fetus (or some floating body) in the liquor amnii, as early as the fifth or sixth month of pregnancy. It is prac- tised by causing the woman to stand upright, and introduc- ing a finger into the vagina up to the mouth of the womb, while the other hand is placed over the abdomen, so as to steady the uterine tumor. If the tip of the finger is now suddenly jerked upward against the os, a sensation will be imparted to it as from a body floating upward in a liquid, and falling back again to strike the finger. It is stated that floating tumors of the uterus, attached to its walls by a pellicle, may produce the same sensation to the finger. (^) Change i?i the Body and Cervix of the Uterus. — The shortening of the cervix is perceptible to the touch after the fifth month ; the os uteri is directed more backward, and there is a peculiar velvety feel about it. The neck con- tinues to shorten until the ninth month, when it becomes obliterated, having been absorbed into the body of the womb. The feel of the os in the unimpregnated and in the pregnant state is different ; in the latter, it is more patulous than in the former. (c) The Active Motions of the Child. — These can rarely be distinguished before the fifth month, after which they usually increase in strength, progressively. They are manifested by placing the cold hand upon the surface of the abdomen. These movements should not be confounded with intestinal movements caused by the escape of flatus from one portion of the bowels into another. Cases often occur in which the active motions of the child are scarcely perceptible. 2l6 MEDICAL JURISPRUDENCE. (d) Pulsation of the Fetal Heart. — This is an unequivocal proof of pregnancy, when it can be positively and repeatedly determined. The sound resembles the ticking of a watch ; it is a double sound, not synchronous with the mother's pulse, and counting from 150 to 120 a minute, according as pregnancy advances. It is heard over different parts of the abdomen, but preferably between the ilium and the umbilicus, on either side. At times it may be inaudible, owing to a change in the position of the child. This sound may often be heard as early as the fifth month, but it be- comes more distinct as pregnancy advances. {e) Other Fetal Sounds. — These are the Uterine and Um- bilical Souffle. The first is a peculiar blowing or whistling sound, audible over most of the abdomen, and beheved to be due to the passage of the blood through the uterine arteries, or the placental vessels. It is synchronous with the pulse of the mother. It can be perceived as early as the tenth week, but better at a later period, up to the end of the seventh month. It is not an important sign of preg- nancy, inasmuch as it may be heard in enlargement of the uterus from any cause, as by tumors, etc. The second or Umbilical sound is attributed to the circu- lation through the umbilical vessels. It is more difficult to distinguish than the other sound, and is of little diagnostic importance. It is a single bellows murmur, synchronous with the pulsations of the fetal heart, and is heard over a very limited space, and is best distinguished in cases where the cord is wound round the body of the child. With all the above signs at command, it is safer not to give a posi- tive opinion in a case of suspected pregnancy before the sixth month. The Corpus Luteuni. — The value of the corpus luteum SIGNS OF PREGNANCY. 21/ or the stellated cicatrix, as a diagnostic sign of pregnancy, is materially lessened by the well-ascertained fact that a similar body is formed in the ovary after each menstrual flow, or, more correctly speaking, after each discharge of a ripened ovum. The latter is usually termed a false corpus luteum, and it differs from the true corpus luteum of preg- nancy in certain particulars, such as the shorter duration, the less complete development of the stellate structure and yellow color, and the absence of a central cavity. This is the general rule ; and the reason usually assigned for the increased growth and development of the corpus luteum of pregnancy is the increased nutrition derived by the Graafian follicle, through the stimulus of impregnation. The value of this "sign" is still further lessened by the fact that a corpus luteum has been found when there has been neither pregnancy nor menstruation. Tidy cites two illustrations of this last character ; one, that of a prostitute who was poisoned by hydrogen cyanid, when neither pregnant nor menstruating, and in whom a fully- ripe corpus luteum was found after death. The other, a woman who died, aged forty-one, from gangrene of a uterine fibroid ; the ovary contained a perfectly formed corpus luteum, resembling that of pregnancy. In both these cases the author very properly ascribes the abnormal development to the increased determination of blood to the part ; his conclusion being, that "there may be pregnancy without the presence of a true corpus luteum, and also that bodies undistinguishable from true corpora lutea may be found where there has been no pregnancy, and in aged women long past the period when pregnancy was probable. Instances of precocious pregnancy are mentioned by various writers, occurring as early as in the eleventh and 2l8 MEDICAL JURISPRUDENCE. twelfth years, among the women of India and Abyssinia, and occasionally even in temperate climates. The earliest period of pregnancy that we find recorded is mentioned by Tidy, as given by Mr. Lefevre, of a girl who menstru- ated at four years, and became pregnant at eight years. Another case is recorded in which pregnancy occurred at eight years and ten months, and the child at birth weighed seven pounds. In another instance, quoted by Wharton, and Stille, menstruation commenced in the first year, and pregnancy in the ninth. The child at birth weighed seven and three quarter pounds. Instances of late pregnancy are recorded, often as late as fifty years ; and a case of twins at sixty-four years. The question whether a woman may become pregnant unconsciously must be answered affirmatively. Women are not infrequently raped when in an unconscious state through narcotism, or the anesthesia produced by ether or chloroform ; and pregnancy may result from such ah inter- course, as is well known, but that a woman should be unconscious both of the fact of sexual intercourse, and also continue unconscious of the resulting pregnancy up to the birth of her child, can scarcely be believed, unless she is feeble-minded or idiotic. Cases of this character may occur in unmarried women, who may protest most earnestly their utter ignorance of the whole affair, and pretend to ascribe the pangs of labor to colic or some other disorder ; and who, when the child is shown them, may positively deny all knowledge of its origin. With married women the case is quite different. With them unconscious pregnancy is a very possible occurrence. Many instances might be adduced of married women who, having had no children for several years, on becoming PREGNANCY IN THE DEAD. 2I9 actually pregnant, refused to recognize their true condition, ascribing their increase of size to dropsy, or some other disorder. Cases may occur when it may become necessary to ascer- tain the fact of pregnancy in the dead, as, e.g., to determine the identity of a body, and to rescue the reputation of the deceased from the charge of unchastity. It should be remembered that the unimpregnated uterus resists putre- faction longer than any other organ of the body. Casper mentions the case of a young woman whose body was found, nine months after her disappearance, in a privy, so decomposed that the soft parts separated easily from the bones, but the uterus which was firm when examined, proved to be in the unimpregnated state. This circumstance was of the greatest consequence, as it served to rebut the charge of seduction and murder against a young man, who had been suspected of foul play. On the other hand, the discovery of a fetus (or a mole) in the uterus of the deceased is, of course, decisive proof of pregnancy ; and even years after interment, provided the fetus has reached the period of ossification, traces of its bones may be discovered among the bones of the mother. CHAPTER IX. CRIMINAL ABORTION, OR FETICIDE. Criminal Abortion is the unlawful producing the expul- sion, and consequent destruction, of the fetus (usually im- mature) from the womb of the mother. The term abortion, or miscarriage, is understood in medicine to express the expulsion of the fetus before the sixth month of gestation, or before it is considered viable ; after this period, it is said to be a premature labor. In law, however, no such distinc- tion is made, the expulsion of the contents of the uterus at any period being considered an abortion. It is not necessary here to discuss at what period of utero- gestation does the fetus become endowed with life. The fact that it evinces no palpable signs of life before quicken- ing is no proof whatever of the absence of life ; it merely shows that the life is extremely feeble in that early stage of its being. Formerly, the laws of most countries recognized a dis- tinction between an abortion produced before and after quickening, awarding a much milder punishment to the former than to the latter. The most recent laws of the United States and Great Britain recognize no such distinc- tion in regard to the criminality of the act, in relation to the time of commission. But cases of feticide, although extremely common, veiy rarely become the subject of a criminal trial, unless they have resulted in the death of the woman, in which case it is regarded as murder. Before considering the medico-legal bearings of the sub- ject, it will be proper to advert to the fact that abortion very 220 CRIMINAL ABORTION. 221 frequently occurs from natural causes. With some women a miscarriage results in the early months of every preg- nancy, and this in spite of every effort to prevent it. This tendency to abort is greatest at the menstrual periods. Among the causes of the abortion are certain constitutional diseases, as syphilis, small-pox, fevers, albuminuria, exces- sive passions, poisons, death of the ovum, or disease of the placenta and membranes. The question whether a natural tendency to abort would mitigate the criminality of the act of producing it, when it resulted in the death of the woman, would doubtless receive a negative reply. The two leading medico-legal questions in every case of feticide are : Has the fetus in utero been actually destroyed, and what are the evidences ? Has this been brought about by natural (including accidental) causes, or by artificial (or criminal) rfieans ? I. What are the proofs that a fetus has been destroyed ? - These are derived (i) from an inspection of what has been expelled from the uterus, and (2) from an examination of the reputed mother. I . By an inspection of what has been expelled from the uterus, we can discriminate between a true fetus and other bodies, such as hydatids, moles, polypi, and membranes. The age of the fetus may also be fixed with tolerable accu- racy. As regards the nature of the other substances, which may be expelled from the womb, it may be remarked that the true hydatid is exceedingly rare. The hydatidiform, or vesicular mole, is of quite frequent occurrence ; it arises from a diseased condition of the vilH of the chorion ; these become infiltrated with serum, and hang in masses, like bunches of grapes. These growths are unquestionably the result of impregnation. 222 MEDICAL JURISPRUDENCE. Moles are also the result of a diseased condition of the membranes or placenta. The fleshy mole is composed of layers of fibrous matter enclosing a central cavity, in which sometimes fragments of the embryo may be seen. It would seem to result from hemorrhage into the chorion. In the fatty mole there has also been an early death of the fetus, with fatty degeneration of the placenta. A withered fetus may often be observed, connected with the diseased pla- centa. Both these varieties of moles are positive evidences of pregnancy. Other substances besides the above may be expelled from the uterus, which are not the result of impregnation, such as false membranes, the product of dysmenorrhea, and also polypi. All these, of course, should be subjected to a microscopic examination before an opinion is ventured, and lest an unwarranted imputation be formed against the character of the woman. A fact of some medico-legal importance in connection with this subject is that natural abortion usually occurs about the third or fourth month, and the ovum is nearly always expelled entire — i. e., the membranes not ruptured. But as criminal abortion is usually produced about the same time, by perforating the membranes, of course the fetus would, in that case, be expelled first, and the placenta and membranes afterward. This latter circumstance might aid materially in the diagnosis of the case. 2. The signs of an abortion deduced from an examina- tion of the reputed mother. These signs are by no means satisfactory, especially if the abortion has occurred in the early months of gestation. The discharges of blood and the relaxed condition of the vagina might easily be ascribed to menstruation, and the somewhat open state of the os uteri CRIMINAL ABORTION. 223 might merely indicate some disease of that organ. Hence a woman may more readily conceal her condition in the early, than in the later months of pregnancy ; but in pro- portion as it approaches the full term, the signs of the abortion become more definite, resembling those of delivery, and which will be discussed hereafter. When, however, death has followed within three or four days after the attempt to procure the abortion, the case may usually be made out satisfactorily ; but if the woman sur- vives three or four weeks, it will be almost impossible to determine it by the autopsy, since all the usual signs will have disappeared ; and this is especially true where the abortion has occurred in the early stage of pregnancy. In a fatal case of criminal abortion, the first duty of a physician is to ascertain how far this is to be ascribed to the means employed. For this purpose the vagina and uterus should be examined for marks of injury by the use of instruments. Wounds on the walls of the vagina would indicate the use of instruments, most probably by an inex- perienced hand ; whilst perforations of the neck of the womb, and sometimes of its fundus, indicate the use of pointed instruments, very possibly in the hands of a professed abortionist. In some instances a blunt instrument, such as a cathe- ter, is employed ; and in a case that some time since came under Dr. Reese's observation, the attempt to perforate the membranes seemed to have failed, while the instrument employed passed up between the membranes and the uterine walls, and tore the placenta, producing internal hemor- rhage, and ending fatally. In cases of instrumental violence there will frequently be discovered marks of metritis and peritonitis. The stomach and bowels should likewise be 224 MEDICAL JURISPRUDENCE. carefully inspected for signs of irritant poisons (abortives), such as redness and the remains of the various reputed abortives, as powdered cantharides, savin, ergot, etc.; also for the oils of savin, tansy, pennyroyal, etc.; the latter may sometimes.be recognized by the odor, or they may be sepa- rated by distillation or by ether. In all fatal cases of feticide the condition of the uterus and its appendages should be examined, so as to form, at least, an approximate estimate of the period of the preg- nancy. The uterus in the unimpregnated (normal) state measures (according to Montgomery) about two and a half inches long, one and three quarter inches broad, and one inch thick. Its size, of course, gradually increases as preg- nancy advances, according to the following average : very little change occurs during the first month. During the second month it enlarges considerably. At the end of the third month its length is five inches, of which one inch is for the cervix. At the end of the fourth month it is five inches long from the fundus to the beginning of the cervix. At the end of five months, its length is six inches. At six months, the length is seven inches. At seven months, it is eight inches. At eight months, it is nine to nine and a half inches. At nine months, it is ten and a half to twelve inches in total length. If death should occur from hemorrhage, at full term, no contraction of the womb will have taken place ; but if the woman survive for a few days, there will always be more or less contraction of that organ. In two days after delivery (at full term), the womb will have contracted down to seven inches in length and four in width ; after one week it will be about five or six inches long and two wide ; after two weeks, the length is four or five inches, and the width one CRIMINAL ABORTION. 22$ and a half inches. At the end of the second month, it will have attained its normal size. Its shape also changes as well as its size. In the unim- pregnated state it is flat, pyriform, and somewhat triangular. After impregnation it assumes somewhat of a globular shape ; but no change of consequence occurs in the cervix until about the fifth month, after which it progressively shortens, losing one fourth its length in the sixth month, another fourth in the seventh month, still another fourth in the eighth month, and at the close of the ninth month, or full .term, becoming entirely obliterated, so that at this period the shape of the uterus is ovoid. The thickness of its walls at full term is about that of the unimpregnated condition — one third to two thirds of an inch ; but in a few hours after delivery, under contraction, its thickness increases, often to two inches. The uterine vessels undergo considerable enlargement in pregnancy — especially the veins, which attain such dimen- sions as to be denominated sinuses, at the position where the placenta is attached. The ligaments of the uterus like- wise share in the general change. The broad ligaments become gradually effaced, in consequence of being absorbed (so to speak) in the increased development of the uterus. The round ligaments increase in thickness. Both become extremely vascular. The Fallopian tubes increase in size, become less convo- luted, and are much more vascular. Usually that one through which the ovum has passed is somewhat the larger. The ovaries also share in the general increased vascularity. That one from which the ovum escaped dis- plays a peculiar fullness or prominence at one portion of the organ. If this be cut open, a yellowish-looking body 19 226 MEDICAL JURISPRUDENCE. will be observed, named corpus luteum, which has already been described. It should not be forgotten that all the above signs of abortion may occur after the expulsion of hydatids and moles ; also, that a corpus luteum may be found in the virgin state. It will be proper here to describe the gradual development of the fetus, together with its appearance at the different stages of its growth, so as to furnish the data for establish- ing its probable uterine age. At the earliest period when the human embryo can be discerned (from fourteen to eighteen days), it presents the appearance of a flocculent mass, of a semi-transparent, gelatinous consistence, about two and a half lines in length. In the third or fourth week, the length of the embryo is from four to six lines ; the weight twenty grains. Its form is curved, and already the rudiments of the several organs are visible in the shape of dots and protuberances. At the end of the eighth week, the length is fifteen to eighteen lines ; the weight, two to five drachms. The head forms more than two thirds of the body ; the features are more distinguishable, and the sex may sometimes be made out. At the end of the twelfth week (three months), the length is two and a half to three inches ; weight, one to two ounces. The whole ovum is now about the size of a goose egg. The fingers are separated, but the toes not ; the genital organs very prominent. At the end of four months, the length is five to seven inches ; weight, six to seven ounces. The skin rosy, very delicate, and covered with a fine down ; hair on the head short and silvery. The disproportionate quantity of the amniotic liquor disappears, and the fetus nearly fills CRIMINAL ABORTION. 22/ up the cavity of the uterus. At the end of five months, the length is from eight to ten inches ; weight, eight to ten ounces ; nails distinct ; the head, liver, heart, and kidneys disproportionately large. If abortion occurs now, the mem- branes are usually first ruptured and the fetus escapes. At the end of the sixth month the length is about twelve inches ; weight, about one pound or over. The color of the body is of a cinnabar-red ; down and sebaceous matter cover the skin ; umbilicus a little above the pubis ; fat in small quantities under the skin ; head very soft ; fontanelles widely separated ; palms of hands and soles of feet purpHsh ; scrotum empty ; labia project, but do not conceal the clito- ris ; the membrana pupillaris still distinct ; nails distinct ; meconium in small quantity in the large intestines ; bladder hard and pyriform, with a very small cavity. At the end of the seventh month, the length is fourteen to fifteen inches ; weight, two to four pounds. The skin is of a dirty-red color ; hair on the head about half an inch long ; membrana pupillaris disappearing ; eyelids no longer adherent ; nails more firm ; convolutions begin to form on the brain ; meco- nium is more abundant ; the ears lie close to the side of the head. If the child should now be born, the arms and legs will be bent in the position they maintained in the womb. At the end of the eighth month, the length is fifteen to sixteen inches ; weight, three to four pounds. The skin is thicker and more natural, and is covered with a fine, soft hair ; hair on head is darker ; nails firmer ; breasts often projecting ; the testes still at the rings, but often one (the left) is found in the scrotum ; lungs are reddish ; liver still very large ; membrana pupillaris absent. At the end of the ninth month, the length is eighteen to twenty inches ; weight (average) seven pounds ; ossification more complete ; 228 MEDICAL JURISPRUDENCE. bones of cranium touch each other ; fontanelles smaller ; hair on head longer and darker ; nails more solid, and pro- longed to the ends of the fingers ; convolutions of brain more numerous ; lungs redder and more voluminous ; me- conium nearly fills the whole intestine ; bladder contains urine ; both testes descended, and vulva closed. In the development of the fetal brain, its form and dis- position, as also that of the spinal cord, can be recognized as early as the eighth week. In the third month, the tuber- cula quadrigemina, optic thalami, and corpora striata are seen ; the medulla oblongata can be distinguished about the sixth or seventh month. The gray portion is not formed until nearly the end of the ninth month. The weight of the fetal brain, as stated by Wenzels, is — at five months, 720 grains ; at eight months, 4,960 grains ; at nine months, 6, 1 50 grains. The point of insertion of the umbilical cord will aid in determining the age of a fetus, when about its full term. From numerous observations, the conclusion arrived at is, that at full term the cord is inserted a few lines below the middle of the body ; earlier than this, the point of insertion is at the center. Moreau's observations, at the Mater- nite of Paris, show, that out of five hundred cases at full term, in only four was the umbilicus exactly in the center of the body ; in all the rest, it was from eight to ten lines below it. Beclard and others have pointed out a very certain test of the age of the fetus about the full term, viz., the osseous deposit in the inferior epiphysis of the femur. If there is no visible trace of this, the fetus cannot be over eight months ; if it has the size of a hemp seed (half a line), it is in the ninth month ; and if from two to three lines in diameter, it CRIMINAL ABORTION; 229 has arrived at full term ; if more than thfee liri6S, the child has probably lived after its birth. The weight of children born at the full term varies very considerably. As already stated, the average weight may be taken at about seven pounds, — rather less in females ; but, in many instances, the weight far exceeds this. Dr. Owens mentions one that weighed seventeen and three quarter pounds, and that measured twenty-four inches in length. Dr. Meadows gives one that weighed eighteen pounds and two ounces, and measured thirty-two inches. Dr. Donellan, of Louisiana, mentions a case of triplets, of which one weighed nine and a half pounds, one seven and a half pounds, and one seven pounds, the united weight being twenty-four pounds. On the other hand, children at full term often fall below the average, weighing only from four to six pounds. II. The second medico-legal question is, Was the abortion produced by natural, or by artificial (criminal) means ? The examination of the reputed mother, especially if death has resulted, would generally settle this question satisfactorily by the presence or absence of the results of instrumental or other interference. It will be proper here to point out the various means that are generally J resorted to in order to effect the purpose. These criminal means may be consid- ered under the heads of general and special. And here it may be premised that, as an almost universal rule, where there is no constitutional predisposition on the part of the woman to abort, this process can very rarely be effected except by instrumental interference. Hence, the violent measures which are sometimes resorted to to accomplish it. Many cases are reported where severe bodily injuries have 230 MEDICAL JURISPRUDENCE, been inflicted with a view to bring on an abortion, but with- out the desired result. The most violent exercise, and the most brutal violence have been submitted to without success. 1. The general means include repeated blood-letting, emetics, and drastic purgatives. Blood-letting often acts as the most effectual means of preventing abortion in plethoric women ; nevertheless, if it could be shown in a case of abortion that the female had previously resorted to frequent bleedings, this fact might be received as presump- tive evidence against her. The same is true of the employ- ment of leeches. The above remarks are also applicable to the use of emetics. Although violent vomiting might bring on prema- ture labor in the last stages of pregnancy in feeble women, it can have no effect in the earlier months. The well-known nausea and vomiting (the latter sometimes quite violent) of pregnancy do not produce miscarriage. The drastic cathartics are often resorted to for the same purpose ; they may possibly effect it in weak women; especially if predisposed to miscarriage, but as a general rule they are powerless. 2. The special means employed comprise the use of certain drugs which are supposed to possess the power to excite uterine contraction, and are therefore named emmenagogues and abortives ; and also the use of instrumental measures for the purpose of puncturing the membranes, and so inducing uterine contraction. The number of the popular abortives is very considerable ; only a few need be noticed here. Ergot, or Spurred Rye, undoubtedly possesses ecbolic properties ; that is, it is capable of causing contractions of the uterus during labor, but it is not certain that it can affect this organ in the earlier stages of pregnancy. It is. CRIMINAL ABORTION. 23 I however, certain that it very often fails to bring on miscar- riage, although large and repeated doses have been taken. Cotton root {Gossypiiun lierbaccuui) has a wide reputation as an abortive. It is even said to be more certain and powerful than ergot. Savin (tops oi Juniperiis sabind) is highly esteemed as an ecbolic. Its virtues depend on a volatile oil (oil of savin), which is also much employed as a popular abortive. Savin is a powerful irritant to the stomach and bowels. The oil has frequently caused death through peritonitis and gastritisl without discharging the fetus. It is an exceedingly dan- gerous remedy. Tansy, pennyroyal and rue all act in a similar manner ; they each contain a powerful volatile oil, which is considerably used as an abortive, but in the majority of cases without the result intended. They fre- quently produce the death of the woman through their violent irritant action. Various other substances are em- ployed as abortives, such as cantharides, copper sulphate, cimicifuga, and potassium iodid, etc. Of one and all of the above reputed abortives it may be affirmed, without contra- diction, that they are uncertain in their operation on the uterus, that they always endanger the mother's life, and that they not infrequently destroy the mother, without effecting the discharge of the fetus. The special means also comprise blows and violent pres- sure made upon the abdomen, loins, and back of the woman. Occasionally, but by no means always, such procedures may result in the expulsion of the fetus, but they necessarily entail great risk of Hfe to both mother and child. The use of pointed instruments introduced into the uterus so as to rupture the membranes is the only certain method of pro- ducing uterine contraction and insuring the expulsion of 232 MEDICAL JURISPRUDENCE. its contents. This operation in the hands of empirics, or of the female herself, is often followed by very serious and fatal consequences, from wounding and even perforating the womb. Other methods are sometimes successfully em- ployed, as the injection of warm water between the uterus and ovum, and the dilatation of the os uteri by means of sponge and other tents, or by the use of Barnes' dilator. A case is mentioned by Dr. Channing, in which a bent wire was introduced into the uterus, where it became entangled in the tissue and had to be cut off; the piece remained within for six years, and, singular to remark, the case was one of merely suspected pregnancy. In another case, strong sulphuric acid was injected into the vagina for the purpose of bringing on an abortion. The result was violent inflammation, causing adhesion of the walls of the vagina, and also of the bladder. The Caesarean section was finally performed, which terminated fatally. Druggists are often asked for substances to produce abortion, and in order not to offend by refusing to sell, yet not involve themselves in a criminal act, dispense harmless powder, such as milk-sugar or starch mixed with a small amount of quinin to give a marked taste, and thus lead the person to believe that an active drug is being used. Before leaving this subject, it is proper to state that the operation for abortion may sometimes become necessary in regular medical practice. The cases demanding it are deformity of the pelvis to such an extent as to preclude the possibility of delivery of a living child at full term ; and possibly when the vomiting during pregnancy is of such a violent and continued character as actually to endanger the mother's life. In every such case, however, the practitioner CRIMINAL ABORTION. 233 should secure a consultation before venturing to perform the operation. Abortion may sometimes be feigned for sinister purposes, such as to secure compensation for an alleged seduction and consequent pregnancy, or to excite sympathy and aid. In such cases, a thorough examination of the woman and the alleged fetus will serve to clear the matter up. Legally considered, the criminality of abortion is not affected by the fact that the woman was not really pregnant, nor by the birth of monstrosities or of moles, nor by the fact of an extra-uterine pregnancy. CHAPTER X. INFANTICIDE. By Infanticide is understood the criminal destruction of the new-born child. In a legal sense, it is immaterial whether the child is killed immediately after its birth, or a few days subsequently. The crime of Infanticide has been prevalent throughout the world, from the remotest period of history. Before the establishment of Christianity it was allowed among the most enlightened and cultivated nations of the earth, and even at the present day its practice is frequent in the most civilized countries, although placed under the ban of the law, and involving mostly the destruction of illegitimate children. Child-murder is treated by the law like any other form of homicide, and tried by the usual rules of evidence in such cases. There is this important point in the nature of the medical evidence required, namely, that it must prove satisfactorily that the child was born alive ; in other words the burden of proof that a living child was destroyed is thrown upon the prosecution. The law hu- manely assumes that every child is born into the world dead, until the contrary is shown, because so many children do thus actually come into the world, and many others die very soon after, from various causes ; and in these latter, the signs of their having lived are frequently indistinct. As the charge of infanticide can never be sustained unless there is distinct proof that the child was legally alive at its birth, great difficulty is usually experienced in obtaining sufficient evidence to convict a woman accused of this 234 INFANTICIDE. 235 crime. As a general rule, she has been delivered in secret, with no witness of the birth ; and the body of the child is frequently concealed or destroyed. There is, besides, a general reluctance on the part of a jury to convict a woman of willful murder for this crime, horrible as it is, on account of a feeling of sympathy for the prisoner arising from the probability of her seduction and desertion. The term "born alive," in the legal sense, implies the complete expulsion of a living child from the mother. A child is not " born " legally, if any portion of its body — a leg, for instance — is retained within the vulva. Hence, through a fiction of the law, the destruction of a living child, if only partially born, is not regarded as murder ! It is not, however, necessary that the umbiHcal cord should be cut, in order to come within the meaning of the statute. In the majority of cases of infanticide, the child has ar- rived at the full term of gestation ; but, as children are often born at an earlier period, — either naturally, or by artificial means, — the examiner should be prepared, from the inspec- tion of the body, to give an opinion as to the probable age that the child had attained in the uterus. For this purpose, he should be acquainted with the general appearance, size, and development of the fetus at the different periods of its uterine life. In a case of infanticide, the medico-legal questions in- volved pertain, first, to the infant, and, secondly, to the reputed mother. I. Questions relating to the infant : (i) Was it born alive ? (2) What was the cause of its death ? (3) Its age ? (4) The interval since its deatli ? I. Was it born alive? In the absence of all positive evidence from witnesses, the inference must be derived from 236 MEDICAL JURISPRUDENCE. the external appearance, and from the internal examination of the child's body. The general appearance of the body of an infant that was born alive, at full term, and had breathed, may be described as follows : The remains of the sebaceous matter (ve^^nix caseosa) will usually be found under the arm- pits and behind the ears ; the hair will be dry and clean ; the ears do not lie so close to the side of the head as in dead-born children ; the eyes remain half open, in spite of all efforts to close them ; the capiit succedaneum, or swell- ing on the back of the head, is much more distinct than in the still-born child ; the former contains a glutinous, bloody serum, while in the latter there is only a small quantity of colorless liquid. The thorax is more arched, and the dia- phragm more depressed, than in the case of the still-born. According to Casper, the highest level of the diaphragm in the still-born child is between the fourth and fifth ribs, while it descends to between the sixth and seventh in the living. The lungs will also present unmistakable evidences, which will be described later. The remnant of the umbilical cord attached to the body will exhibit evidence of com- mencing desiccation, if the child has lived for a few hours. A dead-born child, having perished immediately before its birth, will usually be found more or less covered with the vernix caseosa ; its hair closely agglutinuted ; ears lie close to the side of the head ; eyes closed, and eyeHds, when raised, do not remain open ; mouth closed, and a drop of watery blood is often seen trickhng from the nostril. The thorax appears flat and unexpanded ; the trachea is flattened, and often contains a viscid, mucous secretion. The lungs lie in the posterior part of the thorax ; they are of a brownish-red color, have a granular structure, and do not crepitate upon pressure ; their length is greater than INFANTICIDE. 237 their breadth, and their edges are rounded. The remnant of the umbilical cord has a fresher look than when the child has lived a few hours. If the death of the fetus has occurred some time before its birth, there will be the following signs of intra-uterine putrefaction : The body is extremely flaccid and flattened, as if it had been macerated in water ; the skin is spotted, and the cuticle detached in many places, especially on the abdomen ; the head lies perfectly flat in any position ; the bones of the cranium move easily on one another ; the face is flattened and the features distorted. The cellular tissue and cavities are infiltrated with a bloody serum ; the viscera are easily loosened from one another ; gas is developed in the lungs and liver. The color of the lungs is dark brown. There is an absence of the usual odor, and also of the green color of ordinary putrefaction. It is important to have clear and definite ideas concern- ing the proofs of a live birth, in cases of infanticide. It is well known that many children come into the world still- born — that is, without giving any sign of life by respiration or otherwise — and yet, by proper attention, they subse- quently revive and continue to live. From this it is to be inferred that respiration is not the only evidence of a live birth. Nevertheless, in the cases of infanticide that come under judicial investigation, in which the proofs of a living birth are to be discovered solely by an inspection of the dead body of the child, the fact of respiration is the main point to be determined by the examiner. If this fact can be satisfactorily proved, there can be no doubt that the child had lived ; but it does not necessarily prove that it was born alive, since it might have perished (naturally or otherwise) before it was actually born, in the legal sense. 238 MEDICAL JURISPRUDENCE. Again, a child may live for several hours after its birth, breathing very feebly ; and after its death the air cells of the lungs may present no evidence of distention ; so that, judged by this single sign presented after death, the child would be said to have been born dead. As to the question whether any evidence of life before respiration can be discovered in the dead body in a case of infanticide, the answer must be that, at present, there are no satisfactory medical data to enable one to express a positive opinion in such cases — certainly not from a mere inspection of the lungs. Should there, however, be other evidence, such as marks of great violence upon the body, or proofs, through witnesses, that respiration had been designedly pre- vented, either by the woman herself or by an accomplice, such circumstances would certainly afford very strong pre- sumption of murder. Dr. Causse, quoted by Taylor, con- tends that a true ecchymosis found on the body of a new- born child is proof that the blood was circulating at the time, and that it had been extravasated, which could only occur in a living body ; and that this proof would be strengthened if the blood was found coagulated, and the surrounding tissues deeply infiltrated. Devergie held a similar opinion in relation to the significance of ecchymoses and infiltration of blood. Still, while fully admitting the force of these proofs of vitality as good medical evidence, they are scarcely to be received as sufficient of themselves to establish the charge, since they are open to the objection that the injuries might have been inflicted during birth, or accidentally after birth. Proofs that the Child lias Breathed. — These proofs are derived (i) from the organs of respiration; (2) from the organs of circulation ; (3) from the abdominal organs. INFANTICIDE. 239 I . Proofs afforded by the respiratory organs. {a) The thorax is higher or more vaulted in appearance than when the child has not breathed ; its capacity is increased ; but the attempt to indicate these changes by actual measurements and comparisons cannot be depended upon, on account of the natural difference in the size of the thorax in different children at birth. {b) The diaphragm is considerably more depressed after respiration has been established than before ; according to Casper (as already mentioned), in children born dead its highest point reaches between the fourth and fifth ribs, whereas in those born alive and fully respiring it descends to between the sixth and seventh ribs ; the position of the diaphragm may also be affected by the gases produced during putrefaction. (