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A MANUAL OF 
 
 MEDICAL JURISPRUDENCE 
 
 AND 
 
 TOXICOLOGY 
 
 BY 
 
 HENRY C. CHAPMAN, M. D. 
 
 PROFESSOR OF INSTITUTES OF MEDICINE AND MEDICAL JURISPRUDENCE IN THE 
 JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA ; MEMBER OF THE COL- 
 LEGE OF PHYSICIANS OF PHILADELPHIA, OF THE ACADEMY OF 
 NATURAL SCIENCES OF PHILADELPHIA, OF THE AMERICAN 
 PHILOSOPHICAL SOCIETY, AND OF THE ZOOLOGICAL 
 SOCIETY OF PHILADELPHIA. 
 
 SECOND EDITION, REVISED 
 
 WITH 55 ILLUSTRATIONS AND 3 PLATES IN COLORS 
 
 PHILADELPHIA 
 W. B. SAUNDERS 
 
 925 Walnut Street 
 1898. 
 
Copyright, 1895, 
 By W. B. SAUNDERS, 
 
 7?# l os-f 
 
 J89C 
 
 PRESS OF 
 W. B. SAUNDERS, PHILADA, 
 
PREFACE TO THE SECOND EDITION. 
 
 Since the publication of the first edition of this 
 work, in the autumn of 1892, the further experience 
 gained as a teacher of medical jurisprudence has sug- 
 gested to the author the propriety of giving a brief 
 bibliography bearing upon the statements originally 
 made in the text of the work as based upon his own 
 experience as Coroner's physician to the city of Phila- 
 delphia for a number of years. With that exception, 
 and the addition of several new figures and tables, the 
 text and scope of the work remain essentially un- 
 changed. 
 
 HENEY C. CHAPMAN. 
 
 2047 Walnut Street, 
 December, 1895. 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/manualofmedicalj1898chap 
 
 i 
 
CONTENTS. 
 
 PART I.— MEDICAL JURISPRUDENCE. 
 
 CHAPTER I. 
 
 PAGE 
 
 Importance of the Subject of Medical Jurisprudence — Ordinary 
 and Expert Witness — The Coroner's Physician — Relations of 
 the Medical Profession to the Coroner in Cases of Sudden 
 Death, etc 17 
 
 CHAPTER II. 
 
 Signs of Death — Cessation of Circulation and Respiration — Loss 
 of Sensibility of the fCyes to Light — Ashy Pallor — Loss of Heat 
 — Rigor Mortis — Cadaveric Spasm — Suggillation — Putrefaction 
 — Conversion of Bodies into Adipocere — Length of Time elaps- 
 ing since Death — Remote and Proximate Cause of Death — 
 Symptoms and Post-mortem Appearance of Death from Disease 
 of Brain, Heart, and Lungs 24 
 
 CHAPTER III. 
 
 Manner of Making Post-mortem Examinations in Medico-legal 
 Cases — Identification of the Dead — Coroner's Inquest — Conduct 
 of the Medical Witness in Court 38 
 
 CHAPTER IV. 
 
 Medico-legal Definition of Wounds — Comparison of Wounds with 
 Weapon inflicting them and Clothes of Deceased — Incised, Con- 
 tused, Penetrating Wounds — Suicidal, Homicidal, Accidental 
 Wounds — Gunshot Wounds — Causes of Death from Wounds . 51 
 
XIV N CONTENTS. 
 
 CHAPTEK V. 
 
 PAGE 
 
 Blood-stains — Chemical, Microscopical, Spectroscopical Methods 
 of Investigation — Coagulation of Blood — Conditions influ- 
 encing Coagulation 62 
 
 CHAPTER VI. 
 
 Burns and Scalds — Death from Suffocation by Strangulation — 
 Hanging — Drowning 81 
 
 CHAPTER VII. 
 
 Death from Starvation — Death from Heat and Cold — Death by 
 Lightning 92 
 
 CHAPTER VIII. 
 
 Bape upon Children — Bape upon Adults — Bape upon the Dead — 
 Unnatural Crimes 97 
 
 CHAPTER IX. 
 
 Signs of Pregnancy — Uncertainty of Duration of Pregnancy — 
 Precocious Pregnancy — Unconscious Pregnancy — Pregnancy in 
 the Dead 107 
 
 CHAPTER X. 
 
 Foeticide — Development of Embryo — Formation of Placenta, of 
 Moles — Changes undergone by the Uterus during Pregnancy — 
 Of the Means of Producing Foeticide — Abortion from Natural 
 Causes 116 
 
 CHAPTER XI. 
 
 Infanticide — Live Birth — Appearance of Infant Born at Full 
 Term — Means of Determining whether Child has Breathed — 
 Docimasia Pulmonum — Objections to Hydrostatic Test — Doci- 
 masia Circulationis— Size of Liver and Contents of Stomach in 
 New-born Child— Examination of Mother — Signs of Becent 
 Delivery — Means by which Infanticide is Committed .... 130 
 
CONTENTS. XV 
 
 CHAPTER XII. 
 
 PAGE 
 
 Legitimacy — Inheritance — Protracted Gestation — Premature De- 
 livery — Viability — Procreative Power in the Male and Female 
 — Impotence — Sterility — Tenancy by Courtesy — Paternity — 
 Affiliation — Superfoetation — Doubtful Sex — Hermaphrodism — 
 Presumption of Death — Presumption of Survivorship — Per- 
 sonal Identity of the Living 139 
 
 CHAPTER XIII. 
 
 Feigned Bodily Diseases — Hypnotism — Life Insurance — Medical 
 Malpractice — Medical Kegistration 153 
 
 CHAPTER XIV. 
 
 Insanity — Varieties of Insanity — Idiocy — Mania — Dementia — 
 Medico-legal Relations of Insanity — Criminal Responsibility — 
 Medico-legal Terms in Insanity — Feigned Mental Diseases . . 162 
 
 PART II.— TOXICOLOGY. 
 CHAPTER I. 
 
 Frequency of Death from Poisoning — Definition of a Poison — 
 Mode of Action of Poisons — Influence exerted on Action of 
 Poisons by Habit, Sleep, Disease, etc. — Evidences of Poisoning 
 derived from Symptoms, Post-mortem Appearances, Chemical 
 Analysis, Experiments upon Animals, Circumstantial Evidence 
 — Character of the Evidence the Chemical Expert may be 
 Expected to Give in Cases of Poisoning 180 
 
 CHAPTER II. 
 
 Classification of Poisons — Irritant Poisons — Poisoning by Mineral 
 Acids, by Alkalies and their Salts, Noxious Gases — Poisoning 
 by Phosphorus, Arsenic, Antimony, Mercury, Lead, Copper, etc. 
 — Poisoning by Oxalic Acid, Carbolic Acid, etc. — Poisoning by 
 Decomposed Food, Ptomaines, Neurotic Poisons — Poisoning by 
 Opium, Alcohol, Ether, Chloroform, Chloral, Nux Vomica, 
 Strychnia, Belladonna, Stramonium, Tobacco, Lobelia, Hydro- 
 cyanic Acid 191 
 
A MANUAL OF 
 MEDICAL JURISPRUDENCE AND TOXICOLOGY, 
 
 PAET I. MEDICAL JURISPRUDENCE. 
 
 CHAPTER I. 
 
 Importance of the subject of Medical Jurisprudence — Ordinary and 
 Expert Witness— The Coroner's Physician — Relations of the Medical 
 Profession to the Coroner in Cases of Sudden Death, etc. 
 
 Medical Jurisprudence, or Forensic Medicine, or 
 Legal Medicine, as the subject is often also called, may be 
 broadly defined as medicine in relation to Law. Although 
 a subject of very wide scope and much practical import- 
 ance, it is, nevertheless, usually neglected by the students 
 of medicine. It is very desirable, however, that every 
 physician should have some knowledge of medical juris- 
 prudence. The physician should know what the Common- 
 wealth expects of him and has a right to demand of him 
 in his professional capacity, and he should know his own 
 rights as a medical expert. Every physician, during the 
 course of his professional career, may be called upon to 
 give testimony in cases of rape, foeticide, infanticide, death 
 from poison and from other causes. 
 
 Witnesses, however, are of two kinds. One is a wit- 
 ness in the ordinary acceptation of the term, who testifies 
 simply to matters of fact of which he has personal kuowl- 
 2 17 
 
18 A MANUAL OF 
 
 edge. The other is a witness, who likewise testifies to 
 matters of fact, but concerning which he has special pro- 
 fessional expert knowledge, such as the ordinary witness 
 cannot, from the nature of the case, be expected to have. 
 A person, for example, happens to be walking in the street. 
 He sees a boy run over by a street car, or a man plunge 
 a dirk into another ; or the shot of a pistol is heard and a 
 man is seen to fall. This person is a witness in the ordi- 
 nary acceptation of the term. That is to say, he is liable by 
 the law of the Commonwealth to be at any time subpoenaed 
 to testify in court to these facts. Such subpoena, when 
 served, the witness must obey. Every citizen may be 
 called upon to testify to matters of fact of which he has 
 personal knowledge. The medical expert witness, how- 
 ever, is of a kind different from the ordinary witness. 
 He is called upon by the prosecution or defence to give an 
 opinion or testimony as to facts concerning which he is 
 especially qualified to express an opinion on account of 
 his professional training. His knowledge of the particular 
 facts of a case, however, will depend entirely as to whether 
 he sees proper to make himself acquainted with them or 
 not. No law can compel, for example, a physician to 
 examine the contents of a stomach, with the view of deter- 
 mining whether they contain a poison, if he refuses to do 
 so. The physician can excuse himself on the ground that 
 he does not feel competent to make the chemical analysis, 
 or that the necessities of his practice do not give him suffi- 
 cient time to make such analysis, or that giving testimony 
 in court at the time of the trial may interfere with other 
 professional engagements, etc. The physician may give 
 any such reasons he pleases for refusing to undertake a 
 medico-legal investigation, and no law can compel him to 
 do so. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 19 
 
 Ordinarily it would be unwise for a young physician 
 not to avail himself of an opportunity of giving testi- 
 mony in court, since it undoubtedly leads indirectly to a 
 great deal of practice and professional preferment gen- 
 erally. If the physician docs accept this responsibility, 
 it is important that he should know exactly what his 
 duties will be to the Commonwealth under these cir- 
 cumstances, and also what he may expect from the Com- 
 monwealth. 
 
 Coroner's Physicians. — Usually in every large city there 
 are appointed by the coroner one or more " coroner's " phy- 
 sicians, whose duty it is to make all medico-legal examina- 
 tions, or a police magistrate or some such official has the 
 power to appoint a physician to conduct the same. It is 
 obvious that the more attention any one physician gives to 
 this kind of professional work, the better qualified will he 
 be for performing it ; in Philadelphia the coroner usually 
 appoints one physician as coroner's physician, though fre- 
 quently he is allowed one or more assistants. 
 
 The compensation of the coroner's physician and assist- 
 ants might either be by the fee system or by salary. The 
 latter is much preferable, for, if the emolument of the 
 office depends upon the number of post-mortem examina- 
 tions made, these examinations might be increased need- 
 lessly. At the present time in this city the coroner's physi- 
 cian and assistant are salaried. Apart, however, from the 
 case of the regularly-appointed and salaried coroner's 
 physician, any physician may be called upon by the 
 Commonwealth or the defendant, in murder cases, for 
 example, to give testimony. It is not only desirable, but 
 most important under such circumstances, that if the 
 physician agrees to give his time to the Commonwealth 
 or the defence, the matter of compensation should be 
 
20 A MANUAL OF 
 
 first definitely fixed. If a physician be subpoenaed as an 
 ordinary witness, which summons he must obey, and, having 
 given his evidence in court, the Commonwealth or the de- 
 fence endeavors to obtain an expert expression of opinion 
 upon the facts testified to in addition to the testimony as 
 to the mere facts themselves, the physician is justified in 
 refusing to answer. If, for example, a physician happened 
 to see a man stabbed, and is subpoenaed as an ordinary 
 witness to testify as to the facts, he must answer questions 
 bearing directly upon such facts as he observed. But 
 should the judge, prosecuting attorney, or defence ask a 
 physician who has been so subpoenaed strictly professional 
 questions which an ordinary witness, such as a laboring man, 
 could not possibly answer, and which he alone can answer 
 on account of his being specially qualified, the physician 
 in justice to himself should refuse to answer them. The 
 court has no more right to take advantage of the physi- 
 cian's professional knowledge and skill in extorting evidence 
 without proper compensation than it would have to take 
 his property ; his knowledge is his property, his capital. 1 
 
 Relations of the Medical Profession to the Coroner. — 
 While in a general way it is always proper that every 
 law-abiding citizen should contribute to the Common- 
 wealth anything that lies in his power, whatever his 
 profession may be, by which the ends of justice will be 
 attained, it is only right that he should be sufficiently 
 compensated by the Commonwealth for so doing. 
 
 In cases of persons dying suddenly, from violence, or 
 within twenty-four hours of the time a physician has been 
 in attendance, the coroner is notified by the attending phy- 
 sician, members of the family, or some one interested in 
 
 1 Vide Webb vs. Page : 1st Carrington and Kerwin's Nisi Prius He- 
 ports, p. 23. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 21 
 
 the case. As there is some difference of opinion among 
 physicians and lawyers as to the interpretation of the law 
 bearing upon such cases, it is well that the law should be 
 stated. By the Act of Assembly, March 22, 1867, it is 
 provided : " That it shall be the duty of the coroner of the 
 city and county of Philadelphia to hold an inquest on the 
 body of any deceased person who shall have died a violent 
 death, or whose death shall be sudden ; provided, that such 
 sudden death be after an illness of less than twenty-four 
 hours, and that no regular practising physician shall have 
 been in attendance within said time, or that suspicious 
 circumstances shall render the same necessary ; which said 
 suspicions shall first be sworn to by one or more citizens 
 of said city." Such being the law, the attending physician 
 may say that, while in cases of death from violence or occur- 
 ring under suspicious circumstances, it is undoubtedly his 
 duty to notify the coroner, this law cannot be so inter- 
 preted as to compel him to notify the coroner in cases of 
 death from chronic disease, even though he may not have 
 been in attendance within twenty-four hours of death. 
 
 Let us suppose that a physician, in accordance with that 
 interpretation of the law, signs a death-certificate, assign- 
 ing some chronic disease as the cause of death, not having 
 seen the patient within twenty-four hours, or, perhaps, not 
 within a week of death. It is not impossible that in such 
 a case suspicions might be aroused after burial, the body 
 might be exhumed, and a post-mortem examination might 
 reveal poison as the true cause of death. An attending 
 physician, under these circumstances, would certainly be 
 subpoenaed to appear before the coroner to explain his 
 action, even though he were not held for criminal prose- 
 cution. 
 
 It may be urged, however, if the attending physician 
 
22 A MANUAL OF 
 
 notifies the coroner in cases of death from chronic disease, 
 in which he has not been in attendance within a period 
 of twenty-four hours of death, that the family of the de- 
 ceased will be needlessly annoyed. It will be said that, 
 on notification of death, the coroner will hold an inquest 
 involving the bringing of his jury to the house of the 
 deceased, making a post-mortem examination, outraging 
 the feelings of the family, etc. As a matter of fact, how- 
 ever, there is no necessity that the family should be 
 annoyed in the slightest degree. The coroner, being- 
 notified, will either authorize the attending physician to 
 sign the certificate, or send his physician to the house to 
 simply inspect the body, and possibly to ascertain if the 
 family and friends of the deceased are entirely satisfied as 
 to the cause of death. 
 
 On the other hand, let us suppose that the attending phy- 
 sician does not notify the coroner in a case of death from 
 chronic disease where he has not been in attendance within 
 a period of twenty-four hours, and that the attention 
 of the coroner is called to the fact that the life of the de- 
 ceased was heavily insured, or that the insurance company 
 objects to the payment of the premiums on that ground. 
 Under such circumstances the coroner is obliged to have 
 the body exhumed, a post-mortem examination made, the 
 attending physician and members of the family of deceased 
 perhaps subpoenaed to appear at his office, the inquest only 
 proving that the true cause of death was such as was first 
 assigned in the death-certificate. All such trouble and 
 annoyance can be avoided in such cases by simply notify- 
 ing the coroner. However, therefore, the law bearing on 
 such cases may be interpreted, why should the attending 
 physician assume any responsibility, and risk future 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 23 
 
 trouble when there is an official regularly appointed for the 
 
 investigation of such cases? 
 
 It is sometimes also held by physicians that the law 
 cannot compel the attending physician to notify the coroner 
 in a case of death from violence, if death be delayed 
 several months or years. Such an opinion, however, is a 
 misinterpretation of the law, and would not be sustained, 
 since it is distinctly stated in the act, without qualification, 
 that the coroner shall hold an inquest " on the body of 
 any deceased person who shall have died a violent death." 
 Indeed, even if the attending physician were fully satisfied 
 that the cause of death could not be even remotely traced 
 to some act of violence or injury suffered by the deceased 
 years before death, it would be advisable for him to notify 
 the coroner to relieve himself of any responsibility, in the 
 view of a suit for damages possibly being instituted. 
 
 Whatever views physicians may hold as to the propriety 
 of the law regulating the conduct of the coroner, it is well 
 for them to realize the authority enjoyed by that official, at 
 least in this Commonwealth, before entering into any con- 
 flict with him. The office is an exceedingly old one, having 
 been in existence hundreds of years, antedating that of 
 any of the judges of our courts. He can subpeena any 
 one to his office at any hour of any day, and commit for 
 contempt. The coroner has an enormous amount of 
 authority, if he chooses to exercise it, and if he abuses it 
 can give those with whom he comes in official contact 
 endless trouble and annoyance. Indeed, so true is this 
 that the office has been abolished in many places. Such 
 being the case, so long as the office exists, the author would 
 recommend to physicians to notify the coroner in all doubt- 
 ful cases involving his jurisdiction, thereby saving them- 
 selves much annoyance, trouble, and loss of time. 
 
24 ' A MANUAL OP 
 
 CHAPTER II. 
 
 Signs of Death — Cessation of Circulation and Respiration — Loss of 
 Sensibility of the Eyes to Light — Ashy Pallor — Loss of Heat — Rigor 
 Mortis — Cadaveric Spasm — Suggillation— Putrefaction — Conversion 
 of Bodies into Adipocere — Length of Time Elapsing since Death — 
 Remote and Proximate Cause of Death — Symptoms and Post-mortem 
 Appearance of Death from Disease of Brain, Heart, and Lungs. 
 
 It is frequently stated that persons have been buried 
 alive, or we hear of individuals having been aroused with 
 great difficulty from a state of trance or catalepsy, prema- 
 ture burial being thereby fortunately prevented. If the 
 slightest doubt prevails as to whether a person is dead, a 
 physician should certainly not give a death-certificate, still 
 less contemplate opening the body. While there is no 
 doubt that all accounts of persons being buried alive are 
 very much exaggerated, nevertheless, as these statements 
 may not be entirely without foundation, it is most import- 
 ant that the physician should be familiar with the signs of 
 death. There are a number of signs by which a living 
 body can be distinguished from a dead body. The con- 
 tinuous cessation of the circulation and respiration may be 
 regarded unequivocally as indicating death. 1 It is im- 
 possible to conceive of a human being living for any length 
 of time — an hour, for example — unless the heart beats or 
 the lungs expand and contract. Not unfrequently, however, 
 it is very difficult to determine positively whether the 
 heart is beating or not, or to state positively that respira- 
 tion has entirely ceased. 
 
 Cessation of Circulation and Respiration. — It is well 
 
 1 Tidy, Charles Meymott : Legal Medicine, London, 1882, part i. pp. 
 32, 36. " 
 
MEDICAL JUKISPRUDENOE AND TOXICOLOGY. 25 
 
 known that certain animals, like the marmot, are in the 
 habit, during the winter months, of hibernating. This 
 condition is one of deep and prolonged sleep. The beats 
 of the heart are reduced to three or four to the minute; 
 the respirations are so infrequent, and follow each other 
 at such long intervals, that the most experienced and care- 
 ful observer will often find it difficult to convince himself 
 that the blood is really circulating, and that the animal is 
 breathing. Nevertheless, such is the case, for, toward 
 the spring, the creature begins to show evidence of return- 
 ing vitality. The heart increases in the strength and 
 number of its beats, the respiration increases in its 
 frequency and force, and with the spring once well set in 
 the normal activity of the animal is re-established. 
 
 A similar condition is presented, to a certain extent, in 
 the case of human beings in a 'state of trance or catalepsy, 
 and in the case of those who have been suffering from pro- 
 longed disease of a low typhoid state. Under such 
 circumstances, the heart often beats so slowly and in- 
 frequently, the respiratory movements of the chest are 
 so slight, that the most careful and closest inspection is 
 required to determine whether the patient is alive. In 
 such cases, however, if a ligature be bound around one of 
 the fingers, the part between the ligature and the end of 
 the finger, if the blood is still circulating, will become a 
 deep red or purple in color, through the congestion due to 
 the arrest of the circulation at that point. But no such 
 change will be observed if life is extinct. Further, if 
 respiration has not entirely ceased, by placing a mirror in 
 front of the mouth the watery vapor exhaled can usually 
 be detected through its condensing as a slight cloud upon 
 the glass. The presence of such a cloud, however faint, 
 is a proof that the person is still living. 
 
26 A MANUAL OF 
 
 Loss of sensibility of the eyes to light is a characteristic 
 sign of death. When a lighted candle is brought near to 
 the eye, the pupil contracts, and as it is removed from the 
 eye the pupil dilates. This change in the size of the 
 pupil may be regarded as a characteristic of vitality ; for, 
 though the phenomena may occur within a few hours 
 after death, the muscular fibres of the iris, sooner or 
 later, like all muscular fibres, lose their power of con- 
 tractility. Atropia, also, on account of its effect in 
 dilating the pupil, may be used as determining whether 
 life is extinct. 
 
 The ashy pallor of the body may be regarded as a sign 
 of death, though not a characteristic one, since it is not 
 present in death from all diseases, as in a person dying, 
 for instance, from jaundice or from yellow fever. 
 
 Loss of Heat. — One of the most remarkable of vital 
 phenomena is the power man possesses of maintaining the 
 temperature of his body at about 98.6° F. whatever be the 
 character of the surroundings, whether the region be tropi- 
 cal or arctic, whether the season be winter or summer. 
 After death, however, the body begins to lose heat, and at 
 first very quickly. During the first three hours after 
 death the body may lose perhaps as much as four degrees 
 per hour. The temperature then progressively falls at the 
 rate of a degree and a half an hour until, within between 
 fifteen and twenty-four hours after death, it is that of the 
 surrounding atmosphere. 1 
 
 Loss of heat is a characteristic sign of death, but there 
 
 are certain conditions which influence the rate at which 
 
 1 Taylor and Wilks : Guy's Hospital Reports, third series, vol. ix., 
 October, 1863, p. 180; Niderkorn: Rigidite cadaverique chez I' Homme, 
 Paris, 1872; Burman : Edinburgh Medical Journal, vol. xxv., 1880, p. 
 993 ; Goodhart : British Medical Journal, 1874, p. 303 ; Guy's Hospital 
 Reports, 1870, p. 365. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 27 
 
 the body cools. Bodies that arc thin and emaciated cool 
 more quickly than fat ones, fat being a non-conductor. 
 
 The bodies of young children lose heat more rapidly than 
 those of adults, and the bodies of old people more rapidly 
 than those of individuals in the prime of life. A body 
 that is exposed to the air will lose its heat more quickly 
 than when it is inclosed, and a body unclothed will lose 
 heat more quickly than if it were clothed. If the room 
 in which a dead body is lying be large and airy, the 
 heat will be given off more rapidly than if the room be 
 a small, close, and confined one. A body immersed in 
 water loses its heat more rapidly than when it is exposed 
 to the air. 
 
 It should be mentioned in this connection that in per- 
 sons dying from yellow fever, smallpox, tetanus, cholera, 
 and from some other acute diseases, there often occurs a 
 rise instead of a fall of temperature. The cause of this 
 increase of temperature, amounting in certain instances to 
 as much as 9° F., is not yet understood. 
 
 Rigor Ilortis (cadaveric rigidity), or the stiffening of 
 the muscles throughout the body, is a characteristic sigu of 
 death. Rigor mortis may set in within three to six hours, 
 or may be delayed until fifteen to twenty hours, after death. 
 It may last only a few moments, or from twenty-four to 
 forty-eight hours, or even weeks. The variations in time 
 of its appearance and duration appear to depend upon the 
 previous condition of the body. The order in which the 
 muscles pass into the condition of rigor mortis is a very 
 definite one. The muscles of the eye first become rigid ; 
 then successively the muscles of the neck, chest, upper ex- 
 tremities, and finally the muscles of the lower extremities. 
 It should be mentioned in this connection, however, that 
 considerable difference of opinion has prevailed among 
 
28 A MANUAL OF 
 
 those 1 who have especially studied the phenomena of 
 rigor mortis as to the exact order in which the dif- 
 ferent parts of the body pass into that condition, as 
 well as the time of its appearance and duration. Rigor 
 mortis disappears in the same order ; that is, the mus- 
 cles of the neck relax first. The muscles of the ex- 
 tremities may still be rigid, even though the remaining 
 muscles are relaxed. After the rigor mortis has entirely 
 passed off the general pliancy of the body is restored, and 
 decomposition at once begins. Rigor mortis is due to the 
 coagulation of myosin, differing in this respect from ordi- 
 nary muscular contraction. 
 
 It is often asserted that in certain instances, as in death 
 from electricity, and in the case of animals hunted to 
 death, rigor mortis does not occur. This statement is 
 erroneous, inasmuch as rigor mortis is the sequence of 
 death from any cause. But, in the instances just men- 
 tioned, it is so slight as to escape observation. 
 
 Cadaveric, spasm (spasmodic rigidity), or the spasm 
 often occurring at the moment of death, 2 in the case of 
 persons who have died from sudden or violent deaths, 
 though resembling rigor mortis, and sooner or later pass- 
 ing into that condition, is not necessarily identical with it. 
 Cadaveric spasm, occurring in cases of suicide, appears to 
 be due to all the vital energy having been concentrated in 
 the one final muscular effort, and not at all to coagulation 
 
 1 Nysten : Recherches de Physiologie et de Chimie pathologiques, etc., p. 
 384 ; Sommer : De Signis Mortem Humanis Absolutem ante Putredinis Ac- 
 cessum Indicantibus, Havnise, 1833 ; Particula Posterior Caput Octavium, 
 p. 185; Larcher: Archives des Generates Medecine, vol. i., 1862, p. 685; 
 Maschka : Handbueh der Gerichtlichen Medeein, Dritter Band, Tubingen, 
 1882. 
 
 2 Brinton : American Journal of Medical Science, January, 1870; Og- 
 ston : British and Foreign Medical Review, April, 1857, p. 303. 
 
MEDICAL JUKISPRUDENCE AND TOXICOLOGY. 29 
 
 of the myosin of the muscle. The weapon in sudi cases 
 is often grasped with such firmness that after death it 
 requires considerable force to remove it. 
 
 Suggillation. — In connection with the signs of death, 
 the condition known as cadaveric lividity or suggillation 
 may appropriately be mentioned. It is the result of the 
 settling of blood in the capillaries, and gives rise to vio- 
 let-colored or livid patches, which, while at first iso- 
 lated, afterward coalesce. Such discolorations are ob- 
 served in the most dependent parts of the body, such as 
 the back, under surface of the neck, calves of the legs, etc. 
 When occurring in the lungs and other internal organs, 
 cadaveric lividity is known as hypostatic congestion. 
 Cadaveric lividity is sometimes mistaken for a bruise. 
 The latter condition can, however, readily be distinguished 
 from cadaveric lividity, since, if a bruise be divided by a 
 scalpel, either effused blood or a clot will be found. 
 
 Putrefaction, or the decomposition of nitrogenous sub- 
 stances by certain bacteria, with the development of gaseous 
 foul-smelling products, is usually regarded as the most posi- 
 tive sign of death. 1 The length of time intervening between 
 death and the beginning of putrefaction varies very con- 
 siderably according to the conditions of the body as well 
 as those of the surroundings. Thus, fat and flabby bodies, 
 those of new-born children, and of women dying in 
 childbirth, putrefy rapidly, probably on account of the 
 amount of fluid present in the body under such circum- 
 stances. The bodies of persons dying from exhaustive 
 diseases, such as typhus fever, or from injuries involving 
 the bruising and mangling of the bodies, or from poison- 
 ous gases like carbonic oxide, etc., undergo putrefaction 
 
 1 Fliigge, Dr. C. : Micro-organhms, translated by W. W. Cheyne, 
 London, 1890, p. 608. 
 
30 A MANUAL OF 
 
 quickly. Putrefaction is retarded, however, in cases of 
 death from alcohol, phosphorus, arsenic, aud certain 
 narcotic poisons. While the phenomena of putrefac- 
 tion are undoubtedly due, as already mentioned, to the 
 presence of certain bacteria, the products of the decom- 
 position of the albuminous substances being subsequently 
 modified by the oxidizing action of the atmosphere, present 
 under ordinary circumstances, nevertheless, the rapidity 
 of the process will be greatly influenced, not only by the 
 amount of moisture present in the atmosphere, but by the 
 temperature of the latter. 
 
 Indeed, putrefaction is arrested in the presence of per- 
 fectly dry air. Thus, in the sandy deserts of Arabia and 
 Africa, a dead body, losing rapidly its fluids, dries up and 
 mummifies, while bodies buried naked or but very little 
 clothed in wooden coffins, in shallow graves to which 
 the air has ordinarily access, putrefy rapidly. The in- 
 fluence of temperature in promoting or retarding putre- 
 faction is well shown by the fact that bodies putrefy more 
 rapidly in summer than in winter. Indeed, putrefaction 
 is entirely arrested at a temperature of 32° F., as well 
 known ; bodies of men and animals buried in ice for nearly 
 a hundred years have been found in a state of perfect 
 preservation after exhumation. The temperature most 
 favorable to putrefaction appears to be between 70° and 
 100° F., a temperature of 212° arresting it. Putrefac- 
 tion is undoubtedly due to the presence of bacteria, its 
 progress being modified by the condition of the body at the 
 time of death, the age and sex, the amount of moisture in 
 and the temperature of the atmosphere. Nevertheless, as it 
 has been observed that the decomposition of bodies of the 
 same general character buried in the same kind of coffins 
 and graves varies very considerably, there must be other 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 31 
 
 conditions than those just referred to, and not so well 
 understood in their effects, that influence the rapidity of 
 putrefaction. 
 
 It may be mentioned that bodies putrefy more rapidly 
 in air than in water, and more rapidly in air or water than 
 in earth. Inasmuch as putrefaction is influenced by so 
 many conditions, it is impossible to state exactly when it 
 will first appear or the length of time before a body will 
 entirely be decomposed. As a general rule, 1 it may be 
 said, in the case of bodies exposed to the open air, that 
 within a period after death of from one to three days in 
 summer, and three to six days in winter, there appears a 
 greenish or greenish-yellow spot upon the abdomen about 
 three inches in diameter, accompanied by the peculiar 
 odor of putrefaction. The eyeball at the same time be- 
 comes soft and yielding. During the next succeeding few 
 days — three to five — this greenish discoloration spreads 
 over the body in coalescing spots. Within ten days the 
 epidermis begins to loosen, and at the same time blisters 
 with fluid begin to form. • The chest and abdomen be- 
 come at the same time distended and swollen with the 
 gases which in the mean time develop. The sphincter aui 
 becomes relaxed, and reddish streaks appear along the 
 course of the blood-vessels. By the end of two or three 
 weeks the blisters have broken, maggots have made their 
 appearance, and the nails have loosened. The develop- 
 ment of gases continuing, the abdomen becomes very 
 much distended. The penis is now enormously swollen 
 and shapeless, and the scrotum is enlarged, in some cases, 
 to the size of a child's head. The hairs of the head are 
 loose and can readily be pulled out. Within a period of 
 from four to six months the walls of the body-cavities 
 
 1 Casper : Handbook of the Practice of Forensic Medicine, -1 vols., Lon- 
 don, 1861, vol. i. pp. 33, 37, 40, 52. 
 
32 > A MANUAL, OF 
 
 burst open, discharging their contents. The brain runs 
 out ; the soft parts have either become pulpy or have dis- 
 appeared. The softened flesh falls away from the bones, 
 the skeleton thereby becoming exposed. The sexes finally 
 become undistinguishable, except in the case of the uterus 
 being recognized, the last of the internal organs to putrefy. 
 As a general rule, the order in which the internal organs 
 putrefy is quite a regular one. Inferences from their con- 
 dition as to the time elapsing since death are far more 
 trustworthy, therefore, than those based upon an examina- 
 tion of the body externally. The first part of the body to 
 putrefy internally is the mucous membrane of the larynx 
 and trachea, which becomes in color a dirty red, at the 
 same time that the abdomen becomes greenish externally, 
 as just described. The next organ to decompose is the brain 
 of young infants. Then follow the stomach and intes- 
 tines. In this connection it should be mentioned that the 
 ordinary post-mortem redness of the mucous membrane of 
 the stomach often resembles so closely that due to poison- 
 ing, that the superficial examiner might be readily de- 
 ceived, and attribute such a condition to poison having 
 been taken. The spleen, omentum, and mesentery, and 
 liver, if healthy at time of death, may resist putrefaction 
 for several weeks. The brain in the adult, though a soft 
 structure, does not usually putrefy before the fourth or 
 fifth week. The next organs to putrefy are usually the 
 heart and lungs. Then follow the kidneys, oesophagus, 
 pancreas, diaphragm, and arteries. The last organ to de- 
 compose is the uterus. In certain cases the uterus has 
 been recognized even seven months after death. This fact 
 is an important one, as we shall see hereafter in considering 
 such questions as the possibility of a pregnancy having 
 existed, of a foeticide having been committed, etc. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. ?>?> 
 
 Conversion into Adipocere. — Under certain circumstances, 
 a dead body, instead of undergoing putrefaction in the ordi- 
 nary manner, is converted into the substance known as 
 "adipocere," so called on account of its general resem- 
 blance to a combination of fat and wax. 1 Adipocere, being 
 chemically either ammonium or calcium stearate or oleate, 
 is probably produced through the combination of a fatty 
 acid of the fat with the ammonium resulting from the de- 
 composition of the nitrogeneous tissues, the ammonium 
 being often replaced afterwards by calcium. The forma- 
 tion of adipocere being therefore a saponification, the 
 presence of water, as might be expected, is e.ssential to its 
 production. Dead bodies are, therefore, converted into 
 adipocere only in graves containing water, or in wet or at 
 least very moist soil. Inasmuch as dead bodies lying in 
 water for any length of time may be converted into adipo- 
 cere, it becomes a matter of importance to determine the 
 length of time required for such conversion, since it will 
 enable the medicaf examiner to state, in a general way at 
 least, how long the body has been lying in the water when 
 it was found. As the result of observations and experi- 
 ments it may be said that, on the average, the body of a 
 new-born child will be changed into adipocere after re- 
 maining in water between five and six weeks. An adult 
 body requires, for complete conversion into adipocere, one 
 year if immersed in water, and three years or more if 
 buried in wet earth. 2 
 
 Length of Time Elapsing since Death. — Having de- 
 scribed in a general way the signs of death, there still 
 
 1 Fourcroy : Annates de Chimie, tome v., 1790, p. 154 ; tome vii. p. 17 ; 
 Ohevreul : ibid., tome xcv. p. 5; Orfila et L&sueur: Tiuiie des Ex- 
 humations juridiques, tome i., Paris, 18ol, p. 351; Schaueustein in 
 Maschka, vol. iii. S. 445. 
 
 2 Devergie : Medecim legale, tome i., Paris, p. 97. 
 
 3 
 
34 A MANUAL OF 
 
 remains for consideration the question as to the medical 
 examiner being enabled from such signs alone to deter- 
 mine positively the length of time which has elapsed 
 since death. That it is highly important that the medical 
 examiner should be able to give such testimony has been 
 well shown in cases of murder, such as those in which the 
 defendant proved an alibi, but in which it was also proved 
 by the medical testimony that the wounds causing the 
 death were not inflicted during the period that the defend- 
 ant claimed he was absent. It must be remembered, how- 
 ever, notwithstanding the verdict of guilty in the cases 
 just referred to, that any estimate as to the length of time 
 elapsing since death based upon post-mortem examination 
 alone can only be approximative. In a general way, 
 therefore, it can only be stated in the case of the body 
 being unburied and exposed to the atmosphere, that if the 
 body is only slightly cold and the jaws beginning to 
 stiffen, the eyes glazed and the eyeballs sunken, death has 
 occurred within a period of from fifteen minutes to four 
 hours. If, however, the entire body be cold and rigid, 
 the abdomen has turned green and the odor of putrefaction 
 is perceptible, the body is cold and pliant, and there is cadav- 
 eric lividity, the rigor mortis having passed away, death 
 has taken place within from one to three days in summer 
 and from three to six days in winter. If greenish-brown 
 stains and dark red lines are found extending more or less 
 over a greenish-yellow body, together with relaxation of 
 the sphincter ani muscle, then death has occurred within 
 a period of from eight to ten days in summer, ten to 
 twenty days in winter. If the entire body is green, the 
 chest and abdomen enormously distended, if open blisters 
 are found over the skin, and maggots in the muscles, the 
 nails falling out, the color of the eyes unrecognizable, then 
 
MEDICAL JUEI8PRUDENCE AND TOXICOLOGY. 35 
 
 death has occurred within a period of from two to three 
 weeks in summer, of from four to six weeks in winter. If 
 the contents of the chest and abdomen have been dis- 
 charged, some of the bones bare, the eyes enormously 
 swollen, death has taken place within a period of from 
 four to six months. Whatever be the remote cause of death 
 in any particular instance, whether it be due to disease, 
 injury, wounds, or fractures, it may be referred approxi- 
 mately, at least, to an arrest of the action of the brain, 
 heart, or lungs. In order to be able to determine the 
 cause of death, the medical examiner should be familiar 
 with the symptoms of death as due to the three causes 
 just mentioned, together with the post-mortem appearance 
 accompanying them. 
 
 Symptoms and Post-mortem Appearances of Death from 
 Diseases of the Brain, Heart, and Lungs. — The symptoms 
 of death beginning at the brain, or coma, are stupor, 
 insensibility to external impressions, loss of conscious- 
 ness, slow, stertorous, irregular breathing; the respira- 
 tion and circulation ceasing as the medulla becomes 
 affected. The post-mortem appearances presented in the 
 case of death beginning at the brain are effusion of blood 
 into the cavities, due to apoplexy, rupture of the blood- 
 vessels from fracture of the skull, embolism, abscess, con- 
 gestion, and compression. Death beginning at the heart 
 or syncope may be due to a deficiency in the quantity of 
 the blood or anaemia ; or in the quality or asthenia. Death 
 from anremia may be caused by rupture of an aneurism, or 
 from a uterine hemorrhage, or from a division of a large 
 vessel like the carotid artery. The symptoms of such con- 
 ditions are paleness, lividity of lips, dimness of vision, 
 vertigo, slow, fluttering, weak pulse, ringing in the ears, 
 hallucination, with more or less delirium and nausea and 
 
36 A MANUAL OF 
 
 loss of brain power. On post-mortem examination the 
 heart is usually found contracted and empty, especially if 
 the latter is examined shortly after death. 
 
 Death due to the asthenic condition occurs in fatty de- 
 generation of the heart, in exhaustive diseases of any kind, 
 starvation, and in poisuning from prussic acid. The symp- 
 toms in such cases are cold hands and feet, lividity of lips, 
 nose, and extremities, great muscular weakness, feeble 
 pulse, senses and intelligence retained usually till the last. 
 After death the heart is found contracted, or its cavities are 
 dilated and flabby, and contain blood. 
 
 Death beginning at the lungs, or asphyxia, is caused by 
 mechanical obstacles, such as foreign bodies in the air- 
 passages. Respiration may be arrested by spasm of the 
 glottis, due to nervous excitement, or by paralysis of the 
 respiratory muscles. The symptoms of a person dying 
 from asphyxia are lividity of the face, great dyspnoea, 
 vertigo, loss of consciousness, and convulsions. In death 
 from asphyxia the venous system and the right side of 
 the heart and lungs are found filled with dark blood. 
 The left side of the heart and the arterial system, if rigor 
 mortis has set in, are, however, usually found empty. 
 
 Whatever may be the remote cause of death, the imme- 
 diate cause is then to be looked for in the brain, heart, or 
 lungs. A characteristic set of symptoms precedes death 
 accompanied by characteristic post-mortem appearances in 
 most cases. The medical examiner should be able, there- 
 fore, to usually determine at the least the approximate cause 
 of death. It sometimes happens, however, that notwith- 
 standing that the symptoms are known, and that a most 
 careful post-mortem examination has been made, the cause 
 of death cannot be positively determined. Under such 
 circumstances it may be supposed that there has been a 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. o*7 
 
 sudden stoppage of the heart through reflex nervous in- 
 hibition, as oecurs in persons who have drunk cold water 
 when in an overheated condition, or as the result of sonic 
 violent emotion. In such eases no post-mortem lesion of 
 any kind may be found. It can only be said then that 
 death may be supposed to have been due to some nervous 
 influence. It is not worth while, however, for the medi- 
 cal examiner to guess or speculate about the cause of death. 
 The most prudent course to pursue, in reply to any ques- 
 tions, is to admit that the cause of death cannot be stated. 
 
38 " A MANUAL OF 
 
 CHAPTER III. 
 
 Manner of making Post-mortem Examinations in Medico-legal Cases — 
 Identification of the Dead— Coroner's Inquest — Conduct of the Med- 
 - ical Witness in Court. 
 
 Autopsies. — In cases of sudden death, or death from 
 violence, or death under suspicious circumstances, the 
 coroner views the body, and if not satisfied as to the cause 
 of death, directs his physician to make a post-mortem 
 examination, the extent and thoroughness of which will 
 depend entirely upon his discretion. It is essential that 
 the results of the examination should be recorded at once 
 in a book kept for that purpose, the examiner not waiting 
 until he reaches his home, trusting to his memory for the 
 facts. Neither should the record of the post-mortem ex- 
 amination made in one book at the time be transferred 
 later to another book, since the objection may be made 
 that the two records are not the same. It is needless to 
 add that the coroner's physician should have his name 
 and address distinctly written in his note-book, so that in 
 case it is lost, it may be advertised for, or the opportunity 
 afforded for its return to its owner without delay. 
 
 Before recording the results of the post-mortem ex- 
 amination, the place, the year, the day of the month, and 
 the hour of the day should be noted by the examiner. 
 The deceased must then be identified from their own per- 
 sonal knowledge, and not from hearsay, by two witnesses 
 who knew the individual upon whom the post-mortem is 
 to be made. 1 The height of the deceased should then be 
 
 1 The medico-legal questions as to the importance of the corpus 
 delicti of proving that a death took place are well considered in 
 Wharton and Stille: Medical Jurisprudence, 3 vols., fourth edition, 
 Philadelphia, 1884, vol. iii. p. 613. 
 
MEDICAL JURISPKUDKNCE AND TOXK'ODifiV. 39 
 
 determined, the examiner being always provided for this 
 purpose with a tape-measure. This may become an im- 
 portant part of the testimony in certain cases, like that 
 of murder, since it may be claimed that the deceased 
 being a taller man, and presumably heavier and stronger 
 than the defendant, the murder was committed in self- 
 defence. The body of the deceased should, therefore, be 
 weighed. In a properly-equipped morgue means are 
 provided for this purpose. In their absence the weight 
 of the body can at least be approximately estimated, and 
 an idea can be obtained as to whether the deceased was 
 strong, well-built, muscular, or weak, sickly, emaciated. 
 The temperature of the body and surrounding atmosphere 
 should be noted ; that of the morgue would usually be 
 constant ; but if the post-mortem examination be made 
 elsewhere — in a bar-room, in a yard, or in a field — the 
 temperature would be variable, according to circumstances, 
 season of the year, etc. If the medical examiner be called 
 upon to make an examination of a dead body in the place 
 where it was first found, it is very important that all the 
 surroundings should be most carefully and critically ob- 
 served. If the dead body be found in a room, for ex- 
 ample, its condition should be noted as to the position of 
 the tables, chairs, china — whether the room was in order 
 or confusion, the latter being probably the state in the case 
 of there having been a struggle. The floor, walls, doors, 
 windows, and furniture should be carefully examined for 
 blood-stains or stains of any kind, foot-marks. The con- 
 dition of the clothing of the deceased should be noted as 
 to whether it was cut or torn, etc. Indeed, no fact of any 
 kind that could directly or indirectly aid in determining 
 the cause of death, or lead to the arrest and conviction of 
 
40 ' A MANUAL OF 
 
 the murderer, if murder has been committed, should fail 
 to be recognized and recorded by the medical examiner. 
 
 A thorough examination having been made of the body 
 externally, and the situation, extent, and nature of the 
 external injuries having been noted, if any such be present, 
 the body should next be examined internally. 1 Iu making 
 the internal examination it is best to begin with the head, 
 except in cases of asphyxia, as in such cases if the head is 
 opened first the blood is apt to run out of the right side 
 of the heart. The scalp haviug been divided, and the 
 two parts everted, the skull, after it has carefully been ex- 
 amined, should then be sawed through in such a manner 
 that the calvaria 2 can securely be replaced. The dura 
 mater, having been inspected, should then be divided and 
 the condition of the arachnoid and pia mater be observed. 
 The brain before removal should be examined as to con- 
 gestion of its vessels, laceration of its substance, extravasa- 
 tion of blood, etc. After removal of the braiu the base ot 
 
 1 Orth, Dr. Johannes : Compend of Diagnosis in Pathological Anatomy, 
 with directions for making Post-mortem Examinations, translated by F. E. 
 Shattuck, M. D., and G. K. Sabine, M. D., New York, 1878 ; Virchow, 
 Professor Rudolph : Post-mortem Examinations ivith especial reference to 
 Medico-legal Practice, translated by J. P. Smith, M. D., Philadelphia, 
 1880; Casper: op. cit., vol. i. p. 87. 
 
 2 The word calvarium, often used synonymously with calvaria, does 
 not appear, so far as known to the writer, to have been made use of by 
 Latin authors. The neuter plural calvaria was used, however — for ex- 
 ample, by Ennius in his description of certain marine animals: "Poly- 
 pus Corcyrse, Calvaria purgina acarnse, Purpura, Muriculi, Murex. 
 dulces quoque echini'' (Enniarixe Poesis Beliquim, Lipseae, 1854, p. 167). 
 The acarnse mentioned by Ennius are probably the fish referred to 
 under that name by Aristotle and Pliny — the Pagellus acharne of 
 Cuvier. Apuleius also uses the word calvaria, not, apparently, in the 
 same sense in which that word is used by Ennius as parts of the 
 Acarne, but as if the calvaria were distinct animals, the latter being 
 referred to as "Marina calvaria" (L. Apuleii, Opera Omnia, Lipsea?, 
 1842, pp. 520, 531). 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 41 
 
 the skull should be carefully examined for fractures. The 
 
 condition of the brain should be noted as to its consistence, 
 color, the existence of tumors, abscesses. The spinal column 
 should next be opened through its whole extent, and the 
 cord removed, and its condition noted. The thorax and 
 abdomen should then be opened by making an incision 
 extending from the root of the neck to the pubes, dividing 
 the cartilages of the ribs, and the sterno-clavicular liga- 
 ments, and reflecting the sternum. The heart and lungs, 
 larynx and trachea should be at once examined in situ, 
 and after removal, parts of the organ being preserved. The 
 stomach having been ligated at both the cardiac and pyloric 
 orifices, each orifice being secured by two ligatures, should 
 then be removed by cutting between the two ligatures at 
 each orifice, and placed in a clean glass jar. The intestines 
 should be removed and preserved in a similar manner, 
 though separately from the stomach. The condition of the 
 liver, spleen, pancreas, kidneys, and uro-genital apparatus 
 should be noted and portions of the organs preserved for 
 microscopic examination if necessary. 
 
 WEIGHTS OF ORGANS OF ADULTS. 1 
 
 Heart, male 11 oz. 
 
 " female 9 " 
 
 Brain, male 49J " 
 
 " female ' . . . 44 " 
 
 Spinal cord 1-lf " 
 
 Liver 50-60 " 
 
 Pancreas 2J-3J " 
 
 Spleen 5-7 " 
 
 Lungs (together), male 45 " 
 
 Lungs (together), female 32 " 
 
 Thyroid body 1-2 " 
 
 Thymus at birth £ " 
 
 Kidneys (together) 9 " 
 
 1 Woodman and Tidy : A Handy-Book of Forensic Medicine, etc., p. 11. 
 
42 A MANUAL OF 
 
 Weights of Organs of Adults— Continued. 
 
 Suprarenal capsules 2 dr. 
 
 Prostate gland 6 
 
 Testicles (together) f-1 oz. 
 
 Unimpregnated uterus • 7-12 dr. 
 
 The post-mortem examination having been concluded, the 
 calvaria should be replaced in position, the parts of the 
 scalp inverted, and the latter as well as the abdominal 
 walls brought together and securely sewed. 1 
 
 Identification. — Ordinarily the dead body submitted for 
 medical examination is either entire or almost so. Not 
 infrequently, however, the body has been purposely muti- 
 lated after death, by a murderer, for example, with the 
 view of escaping detection, or as in cases of death from 
 fire, explosions, railroad accidents. Under such circum- 
 stances, when often only parts of the body or bodies can 
 be recovered for examination, the highest anatomical skill 
 may be requisite for the identification of the remains or 
 the determination of the cause of death. But little diffi- 
 culty, however, should be experienced in determining, for 
 example, whether the bones recovered be human or not, if 
 the greater part of the skeleton, especially if parts of the 
 skull, be submitted for examination. It is only when a 
 bone or a fragment of a bone has been obtained, as from 
 the ruins of a fire, that mistakes as to their true nature 
 are likely to be made by the medical examiner. Inas- 
 much as the bones of the domestic animals have been 
 
 1 In this connection it should be mentioned that in cases involving 
 life or death the post-mortem examination should be thorough, lest the 
 defence urge that the true cause of death be other than that alleged. 
 In more than one case through such neglect has the prosecution failed 
 to convict, owing to some organ not having been examined (Taylor, 
 Alfred Swayne : Manual of Medical Jurisprudence, eleventh American 
 edition, by Clark Bell, Esq., Philadelphia, 1892, p. 23). 
 
MEDICAL .TURISPKITDENCB AND TOXICOLOGY. 
 
 43 
 
 frequently mistaken for those of man, even by physicians, 
 if the examiner be in doubt as to the nature of a hone, it 
 would be better for him to submit it to a comparative 
 osteologist for determination, rather than to trust to his 
 own judgment, unless specially qualified by previous osteo- 
 logical studies to give an opinion on the subject. 
 
 As regards the skull more especially, there is usually no 
 difficulty in determining whether a skull be a human one. 
 The particular race, however, cannot always be indicated, 
 for while there is no difficulty, for example, in distinguish- 
 ing a Caucasian skull (Fig. 1) from that of a typical negro 
 
 Fig. 1. 
 
 Fig. 2. 
 
 The facial angle of Camper; in 
 European crania usually it does not 
 exceed 80° (a, b, c, d, lines forming 
 the facial angle). 
 
 Facial angle of Camper; in the Ne- 
 gro about 70° (a, b, c, d, lines forming 
 the facial angle). 
 
 (Fig. 2), it is not only difficult, but often impossible to 
 exactly identify the many forms of skull intermediate in 
 character between the two. In the identification of human 
 remains the sex, age, and stature are usually to be deter- 
 mined. Inasmuch as the skeleton of the male differs from 
 that of the female as regards the size, weight, strength of the 
 bones, in the relative development of the ridges and promi- 
 nences serving for the attachment of the muscles, and more 
 particularly in the size and shape of the pelvis (Figs. 3, 4), 
 all of which peculiarities are fully described in works on 
 anatomy, there is usually no difficulty if the skeleton is 
 
44 
 
 A MANUAL OF 
 
 entire in determining whether it be that of a male or a female. 
 If, however, a single bone or a fragment of a bone be sub- 
 
 Fig. 3. 
 
 Fig. 4. 
 
 Male pelvis. 
 
 Female pelvis. 
 
 mitted for an examination it is often so difficult to deter- 
 mine the sex that no positive opinion should be expressed. 
 The age of a body can be approximately at least in- 
 ferred from the development of the teeth and the extent 
 of the ossification of the bones. It is important, there- 
 fore, that the medical examiner should be familiar with 
 the period and order in which the teeth appear and the 
 bones ossify. In the jaw r s of a child at full term there 
 are usually found the rudiments of twenty primary and 
 four secondary or permanent teeth, twenty-four teeth in 
 all. The average date of the eruption or cutting of the 
 primary or milk teeth is as follows : The four central in- 
 cisors appear from five to eight months after birth, the 
 four lateral incisors from seven to ten months, the four 
 anterior molars from twelve to sixteen months, the four 
 canines from fourteen to twenty months, and the four pos- 
 terior molars from eighteen months to three years. 1 At a 
 period of life varying between six and seven years the 
 
 1 Bell, T. : Anatomy, Physiology, and Diseases of the Teeth, 1837, pp. 
 66, 79. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 45 
 
 jaws contain forty-eight teeth — twenty milk teeth and 
 twenty-eight permanent teeth situated behind the milk 
 teeth, which they will replace as the former are shed. 
 The order in which the permanent teeth appear is as fol- 
 lows : The four anterior molars appear at seven years, the 
 four central incisors at eight years, the four lateral incisors 
 at nine years, the four anterior premolars at ten years, 
 the four posterior premolars at eleven years, the four 
 canines at about twelve years, the four second molars at 
 about fourteen years, 1 the four posterior molars at from 
 eighteen to twenty-one years of age. As a general rule, 
 the teeth of the lower jaw appear first, but in this respect 
 there are exceptions, as also in the order of the appearance 
 of the teeth. It should be mentioned in this connection, 
 also, that in cases of rickets the cutting of teeth is often 
 delayed, while in syphilis it is premature. 2 In the latter 
 case the teeth have a notched appearance, and often crumble 
 away. With the loss of the teeth and progressive absorp- 
 tion of the alveolar processes due to age, the lower jaw 
 undergoes a marked change in the widening of the angle 
 of its neck, and in the diminution of the width of its body, 
 imparting to the mouth that expression so characteristic of 
 the aged. 
 
 The degree of ossification of the lower epiphysis of the 
 femur (Fig. 5) is one of the most certain signs of the age 
 of the foetus and of the new-born child. 3 Thus if no os- 
 sific deposit be found in the cartilaginous epiphysis of the 
 
 1 Saunders, Edwin : " The Teeth a Test of Age, considered with Refer- 
 ence to the Factory Children/' addressed to the members of both houses 
 of Parliament, London, 1837, p. 42. 
 
 2 Woodman and Tidy : Handy Book of Forensic Medicine and Toxi- 
 cology, London, 1877, p. 623. 
 
 3 Beclard : Xmtrclle Journal dc Mrderine, Chirvrgie el Pharmaeie, tome 
 iv., 1819, p. 113; Casper: op. cit., vol. iii. p. 23. 
 
46 
 
 A MANUAL OF 
 
 femur it may be stated that the foetus has not yet reached 
 the eighth month of intrauterine life. If the ossific deposit 
 has attained a diameter of about one line the foetus has 
 reached full term. If the ossific deposit measures more 
 
 Fig. 6. 
 
 Fig. 5. 
 
 From a child at birth, 
 showing a nucleus in the 
 lower epiphysis. 
 
 The natural skeleton of a child about two years old. 
 
 than one-quarter of au inch the child has lived after 
 birth for some little time. The length of the skeleton 
 of the child at birth is usually about sixteen inches. 
 Ossification begins at the extremities of most of the long 
 
MEDICAL JUKISPBUDENCE AND TOXICOLOGY. 47 
 
 bones at the end of the first year, and progresses from that 
 time on until ossification is completed. The epiphyses <>l 
 all the long bones are usually found united to their shafts 
 in the male at about twenty-four years, in the female at 
 about twenty-two years. After ossification has once been 
 completed it is extremely difficult, if possible, to deter- 
 mine exactly the age from an examination of the skeleton 
 
 Fig. 7. 
 
 Sternum. 
 
 Sacrum. (Anterior surface.) 
 
 alone. It may be mentioned, however, that the bones 
 of the sternum (Fig. 7) are usually found ununited until 
 after forty, 1 those of the sacrum (Fig. 8) and os coccygis 
 until sixty years of age. The height of a body may be 
 
 1 Guy and Ferrier: Principles of Forensic Medicine, London, 1881, p. 
 36 ; Wharton and Stille : Medical Jurisprudence, 3 vols., fourth edition, 
 Philadelphia, 1884, voh iii. p. 470, 
 
48 A MANUAL OF 
 
 approximately estimated from the skeleton, the latter 
 being entire, by placing the bones in position and adding 
 from one inch and a half to two inches to the length to 
 supply the missing soft parts. In the absence of the skull 
 there should be added about ten inches to the height of 
 the spine of the seventh cervical vertebras from the ground. 
 
 A skeleton may be identified as that of some particular 
 person many years even after death through the presence 
 of deformities, fractures, callus, etc. The production of 
 callus is the result of the reparative process that takes place 
 in the case of fractured bones, and its presence proves that 
 some time must have elapsed between the time of fracture 
 and death. The absence of such callus in cases of death 
 following fractures would clearly indicate that death fol- 
 lowed soon after the injury causing the fracture, and that 
 in the case of fracture of the skull the injury was the cause 
 of death. Under certain circumstances it may become a 
 matter of importance to determine from an examination of 
 the skeleton alone the length of time that the body has 
 been buried. It may be said that ordinarily within ten 
 years after burial the soft parts of a body entirely disap- 
 pear; the bones, however, may resist decomposition for 
 thirty or forty years, particularly if the surrounding soil 
 is dry. It is well known, however, that the skeletons of 
 individuals buried in leaden or in stone coffins have been 
 found in a tolerable state of preservation even after a lapse 
 of more than a thousand years. 
 
 Medical Witnesses at the Inquest. — After the coroner 
 has held his inquest, and the coroner's physician and the 
 witnesses have given their testimony, and the jury sub- 
 mitted their verdict, the defendant, in case of the verdict 
 being guilty, is then remanded to the district attorney's 
 office. The case then comes up before the grand jury, to 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 49 
 
 which the coroner's physician slates substantially what he 
 has already said at the coroner's inquest. If the grand 
 jury finds a true bill the case then goes to court; the trial 
 is set for a certain day, is finally held, and the coroner's 
 physician is subpoenaed for the third time to appear in 
 court. 
 
 If the court is aware that the coroner's physician or any 
 of the medical experts engaged in the case have large 
 practice or are connected as lecturers with any particular 
 medical schools, etc., it is very considerate, as a general 
 rule, arranging its business so as to inconvenience them as 
 little as possible. It is incumbent, however, upon the 
 physician, whether he be the coroner's physician or retained 
 as an expert for the defence, to treat the court with every 
 possible respect, to be always punctual in attendance, and 
 if he be unavoidably delayed by professional exigencies, 
 to send the court word explaining the cause of non-attend- 
 ance. The court, however, will not submit to any of the 
 physicians subpoenaed straggling in at any hour of the day 
 with no excuse to offer for their non-attendance but de- 
 tention by their every-day practice. 
 
 Conduct of Medical Witnesses in Court. — At the trial, 
 the medical witness, if he be the coroner's physician, is 
 examined first by the prosecution, by the district attorney. 
 Having given testimony, he is cross-examined by the 
 counsel for the defence, and is then usually re-examined 
 by the district attorney, and here as a rule, the ex- 
 amination ends. In giving evidence in court, the medi- 
 cal witness should always maintain a dignified, composed 
 demeanor. He should never be arrogant or show any 
 irritability, still less lose his temper, however much he 
 may be annoyed by the examination or cross-examina- 
 tion. He should never forget that the object of the 
 4 
 
50 A MANUAL OF 
 
 prosecution is to elicit all the evidence that will lead to 
 conviction ; the object of the defence to try to rebut, break 
 down all that the prosecution hopes to establish. The 
 medical witness should so answer that he can be heard by 
 the whole court, addressing himself more particularly to 
 the jury. His answers should be brief and given in the 
 simplest language, all technical terms being avoided as 
 much as possible. Finally, the medical witness should 
 never be ashamed of saying in open court that he does not 
 know. The court does not expect the medical witness to 
 know everything. Nothing is more foolish for a witness 
 than to hazard a guess in answer to a question for fear of 
 being thought ignorant. 
 
 Dying declarations, it may be mentioned in this con- 
 nection, are accepted in law as evidence without being 
 sworn to. It is naturally presumed that all statements 
 made at such a solemn crisis must be sincere, believed at 
 least to be true by the dying person even if subsequently 
 shown not to be so. The attending physician under such 
 circumstances having expressed the opinion that the patient 
 is dying and in sound mind, a magistrate should be sum- 
 moned to take down any statements that the dying person 
 may wish to make. Should it not be possible to obtain 
 the services of a magistrate, then the attending physician 
 can take down the dying declarations. The physician 
 should, however, limit himself to writing down the exact 
 words of the dying person without offering any interpre- 
 tation whatever. The statement should be read over to 
 the dying person and if possible his signature to it 
 obtained. 
 
MEDICAL JUKLSritUDENCE ANJ) TOXICOLOGY. 51 
 
 CHAPTER IV. 
 
 Medico-legal Definition of Wounds — Comparison of Wounds with 
 Weapon inflicting them and Clothes of Deceased — Incised, Contused, 
 Penetrating Wounds — Suicidal, Homicidal, Accidental Wounds — 
 Gunshot Wounds — Causes of Death from Wounds. 
 
 Medico-Legal Definition of Wounds. — A wound, from a 
 purely surgical point of view, is regarded as a solution 
 of continuity of the soft parts occasioned by external vio- 
 lence. The medico-legal idea of a wound is, however, 
 far more comprehensive, embracing all injuries of the 
 body, external or internal, with or without a solution of 
 continuity of the skin, produced suddenly by external 
 violence. 1 As the danger of a wound will depend on 
 the age and constitution of the person, its position, the 
 weapon by which it was inflicted, the amount of hemor- 
 rhage, and numerous other circumstances, it is impossible 
 for a physician to state positively whether a wound will 
 prove fatal or not. Wounds at first apparently trivial 
 have subsequently, in many cases, as is well known, been 
 the cause of death. The medical witness should, therefore, 
 express himself most cautiously if he replies at all to the 
 questions so often asked, " Will such a wound prove fatal?" 
 " Was such a wound necessarily mortal ?" 
 
 In making a post-mortem examination in cases where 
 death is due to wounds, it is most important that the 
 medical examiner should satisfy himself, not only that the 
 wound was the cause of death, but also that the remainino; 
 organs were healthy, or at least were not in such a condi- 
 tion that death could be attributed in any way to them, or 
 
 1 Beck, T. B. and J. B. : Elements of Medical Jurisprudence, eleventh 
 edition, Philadelphia, 1860, p. 282. 
 
52 
 
 A MANUAL OF 
 
 to any other cause than the one assigned. On more than 
 one occasion has the defendant been acquitted owing to 
 such neglect, giving rise in the minds of the jury to the 
 doubt as to whether disease or the wound was the real 
 cause of death. On the other hand, as in a celebrated 
 case, the defendant would have been convicted of murder, 
 it being in evidence that the deceased, a young girl, had 
 received from him a severe beating, had not the true cause 
 of death, the poison taken, been well established by the 
 medical examination. 1 
 
 In cases of death from wounds the medical examiner 
 should carefully note their exact situation, direction, and 
 
 Fig. 9. 
 
 'V' 
 
 ". ~yi 
 
 m 
 
 Human hair. 1. The hair of a child. 
 2. Hair of an adult. 3. Pointed ex- 
 tremity of the hair of the eyebrow. 
 a. Transverse section of the hair showing 
 the cortical and medullary portion, and 
 air-cells in the centre of the cylinder. 
 
 Human hair with the tubu- 
 lar sheath as torn out by force. 
 
 extent. If the weapon by which the wounds were known 
 
 or supposed to have been inflicted has been obtained, it 
 
 1 Wharton and Stille: op. cit., vol. iii. p. 216. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY 
 
 53 
 
 should bo compared by the medical examiner with the 
 wounds themselves, so that, on subsequent examination, he 
 can positively state whether such wounds as were found 
 could have been inHicted by the weapon submitted. The 
 clothes of the deceased should be carefully inspected, and 
 any rents, cuts, or tears found compared with the wounds 
 in the body and with the weapon by which they were in- 
 
 Fig. 10. 
 
 Fig. 11. 
 
 Microscopic appearance of hairs of 
 various animals. 1. Hair of the span- 
 iel. 2. Hair or fur of the rabbit. 3. 
 Hair of the hare. 4. Hair of the 
 horse. 5. Hair of the goat. 6. Hair 
 of the fox. 7. Hair of the cow. 8, 
 Hair of the fallow deer. 
 
 1. Cotton.— a. normal condition: b, 
 portion treated with sulphuric acid 
 and iodine; c, fragment of gun-cotton. 
 
 2. Flax— a, normal fibre ; 6, portion 
 boiled with nitric acid ; c, treated with 
 nitric acid, and afterwards with sul- 
 phuric acid and iodine. 
 
 flicted. Hairs and fibres found upon the weapon supposed 
 to have inflicted the fatal wound, or upon the person of 
 
54 A MANUAL OF 
 
 the accused, should be examined with the microscope and 
 compared with those of the clothing worn by the deceased. 
 
 As a general rule, human hairs (Fig. 9) can readily be 
 distinguished from those of animals, or from fibres of 
 cotton, silk, wool, etc. The hairs of the lower animals, 
 some of which are represented in Figure 10, differ in 
 many respects from those of man, being generally coarser, 
 thicker, shorter, and less transparent. Microscopically, the 
 most striking differences in hairs are presented by the cells 
 and linear markings of their cortical portions. The fibres 
 of cotton (Fig. 11, l) are flattened bands disposed in a spiral 
 or twisted manner. Those of linen (Fig. 11, 2) are rectili- 
 near, tapering to a point and presenting pointed markings 
 at unequal distances. Silk fibres are cylindrical in shape, 
 almost entirely free from markings, and refract light power- 
 fully. The fibres of wool are rather irregular in form and 
 unequal in thickness. 
 
 The importance of making a thorough post-mortem ex- 
 amination in cases of death from violence is well shown 
 in cases of persons crushed to death, as by a heavily-loaded 
 wagon. 1 It is well known that, although the external signs 
 of violence in such cases may be limited to a few abrasions, 
 the internal injuries causing death may be of the most ex- 
 tensive and serious character. 
 
 Character of Wounds. — Wounds are usually described 
 as being incised, lacerated, contused, punctured, or pene- 
 trating. Incised wounds may generally be recognized by 
 the regularity and evenness of the cut; and it might natu- 
 rally be supposed that they would be made by cutting 
 weapons, penetrating wounds being supposed to be inflicted 
 by pointed instruments, and contused wounds by blunt ones. 
 It must be admitted, however, that in certain cases, as in 
 1 Casper : op. cit., vol. i. p. 112, case xl. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 55 
 
 wounds inflicted by broken glass or china, which resemble 
 exactly incised wounds, it might be very difficult to Bay 
 how the wounds had been made. Indeed, it is impossible 
 for the medical examiner, though often asked, to state 
 positively whether a wound was inflicted with a particular 
 kind of weapon. 
 
 Suicidal Wounds. — It often becomes important to deter- 
 mine whether a wound was inflicted before or after death. 
 In the case of an incised wound this is not very difficult, 
 since, if made before' death, the edges of the wound are 
 everted and are more or less filled with coagulated blood, 
 principally of an arterial character, or with granulations, 
 pus, or sloughs, if any length of time has elapsed before 
 death. Contused wounds, if made during life, are char- 
 acterized by ecchymoses, suggillation, or the black-and- 
 blue discoloration due to the rupture of small vessels, and 
 the effusion of blood into the cellular tissue under the 
 skin. The progressive changes of color — purple, black, 
 violet, green, yellow — exhibited by ecchymoses serve not 
 only to indicate whether the bruise was made before or' 
 after death, but also as to the length of time elapsing 
 since its production. Thus, for example, within twelve 
 hours after the injury, and in some cases immediately 
 afterward, the color presented by the bruise is that of a 
 purplish-black ; by the third day it has become violet ; 
 by the fifth or sixth day, green ; and by from the 
 eighth to the tenth day, yellow. The latter color grad- 
 ually disappears by from the twelfth to the fourteenth 
 day, the skin reassuming its natural hue and presenting 
 no trace of the discoloration. The situation, extent, and 
 direction of a w T ound and the position in which the 
 weapon was found should most carefully be observed 
 and noted by the medical examiner, as it may become 
 
56 A MANUAL OF 
 
 essential under certain circumstances to determine whether 
 the wound was suicidal, homicidal, or accidental. 1 In 
 cases of persons taking their own lives, the mouth, fore- 
 head, the region over the heart, etc., are usually chosen if 
 fire-arms were used ; the throat or heart if the wounds 
 were inflicted with cutting instruments. While ordinarily 
 accessible parts of the body are selected by suicides, it 
 must not be forgotten that insane persons, in committing 
 suicide, have inflicted wounds upon themselves in most in- 
 accessible parts, such as the back of the head and neck. 
 It is well known that insane persons have killed them- 
 selves by falling backwards, their heads striking upon some 
 hard substances, or by shooting themselves through the 
 back of the head. The fact of a person being found dead 
 shot through the back of the ear might suggest that the 
 wound was homicidal. It would not, however, prove it ; 
 since it is well known that insane persons have taken their 
 lives in that very way. Incised wounds of the throat, es- 
 pecially if the direction of the wound be from left to right, 
 the deceased being right-handed, are usually regarded as 
 presumptive of the death being suicidal. 
 
 Homicidal Wounds. — It should be remembered that a 
 very common way of committing murder is by cutting 
 the throat of the victim, the murderer standing behind ; 
 a wound inflicted in such a manner would resemble that 
 committed by a suicide. On the other hand, the irregu- 
 larity of the wound often observed in such cases, and 
 sometimes submitted as a proof that the wound was homi- 
 cidal, and attributable to the resistance offered by the 
 deceased in his struggle for life, might just as well be ac- 
 counted for on the supposition that it was suicidal and due 
 
 1 Casper : Gerichtliche Leichen CEffnungen, Erstes Hundert, Berlin, 
 1853, S. 17. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 57 
 
 to the nervousness and indecision of the deceased. A 
 homicidal can usually be distinguished from a suicidal 
 wound by its direction. Tims, for example, if a man 
 were found dead with a wound in the neck of such a char- 
 acter that it could be positively stated that the weapon had 
 been partially turned and withdrawn, and again plunged 
 into the neck in a different direction, as is sometimes done 
 by German butchers, 1 the proof would be strong of the 
 wound being homicidal. Or, if the nature of the wound 
 in the neck indicated that it had been made by cutting 
 from within outward, as is often done by English butchers 
 in the killing of sheep, it would be strong presumptive 
 evidence that murder had been committed. 
 
 Accidental wounds are usually found in such parts of 
 the body as are exposed. If wounds, the nature of which 
 might otherwise lead to the supposition that they had 
 been made accidentally, are found upon both sides of the 
 body, the presumption would then be that they were 
 homicidal. 
 
 Gunshot wounds are essentially contusions. Owing, 
 however, to the vitality of the parts struck being destroyed 
 by the projectile, there ensues a process of sloughing. In 
 this respect gunshot wounds differ from ordinary wounds. 
 They differ very much in appearance, according to the 
 nature of the projectile, to the distance from which the 
 piece was discharged, etc. As a general rule the hemor- 
 rhage following a gunshot wound is not very great, unless 
 some of the large vessels are wounded. It should be 
 mentioned, however, that though the external hemorrhage 
 may not be very great, owing to the form and size of the 
 wound, the internal hemorrhage may be so severe as to 
 prove fatal. If the weapon be in close proximity to the 
 1 Kopp's Jakrbucher, Erster Jahrgang, 180S, S. 143. 
 
58 A MANUAL OF 
 
 body at the moment that it was discharged, the wound 
 made is large, the skin is denuded, blackened, and partly 
 burned. The hair or the clothes are also usually scorched. 
 The orifice of entrance of the missile, if it be a ball, is 
 depressed and larger than that of the exit orifice. 1 The 
 character of the entrance orifice of the wound will depend 
 upon the shape of the missile, the velocity with which it 
 was travelling, and the distance from which it was fired. 
 Thus, a wound made by a conoidal ball, like that of a 
 minie rifle, is linear in form. Such a wound produces but 
 little external, though considerable internal, injury. On 
 the other hand, the wound made by a rifle ball is ragged 
 and large. A ball after entering the body may, as is well 
 known, be so deflected from its course by striking a bone 
 or a tendon, etc., as to pass entirely around the body and 
 so reach finally the point of entrance. If a gunshot wound 
 be caused by a load of shot, the appearance presented will 
 depend upon the distance from which the shot was fired. 
 If the weapon discharged be within twelve inches of the 
 body, the wound will usually be a single one. Beyond 
 that distance each shot will make a single individual 
 wound. 2 It should be mentioned that a single shot 
 might cause death, as in the case of the wounding of 
 the aorta. Serious, if not fatal, wounds may be caused by 
 wadding and gunpowder alone if the weapon be within 
 three or four inches of the body. 
 
 Causes of Death from Wounds. — With reference to the 
 committing of suicide by means of fire-arms, it may be 
 mentioned that in fully four- fifths of the cases reported 
 
 1 According to some authorities, the exit is larger than the entrance 
 orifice (compare Casper, vol. i. p. 266; Woodman and Tidy, p. 1115; 
 Wharton and Stille, vol. iii. p. 234). 
 
 2 Lachese : Annates de Hygiene publique, Paris, 1836, p. 359; Casper: 
 op. cit., vol. i. p. 266. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. ■>■> 
 
 the part of the body selected for the infliction <>f tlic 
 wounds was the head, the mouth being the part more par- 
 ticularly chosen. 1 Under certain circumstances it may 
 become important for the medical examiner to be able to 
 state, in the case of death from wounds, the real cause of 
 
 Fig. 12. 
 
 Imaginary lines drawn upon the surface of the abdomen, dividing it into 
 regions. These were, no doubt, devised by reason of the absence of any charac- 
 teristic eminences or depressions upon this extensive surface, principally attrib- 
 utable to the absence of any skeleton, osseous or cartilaginous. 1. Right hypo- 
 chondriac region. 2. Epigastric. 3. Left hypochondriac. 4. Right lumbar. 
 5. Umbilical. G. Left lumbar. 7. Right iliac. S. Hypogastric. 9. Left iliac. 
 
 death, whether immediate or remote. The immediate 
 cause of death from a wound is either hemorrhage or 
 shock, the latter being the result of a powerful impression 
 made upon the nervous ceutres. Of the remote causes 
 of death from wounds the most common are tetanus or 
 1 De Boismont : Du Suicide, deuxieme edition, Paris, 1865, p. 681. 
 
60 A MANUAL OF 
 
 lock-jaw, erysipelas, hospital gangrene, surgical opera- 
 tions, including the use of ether or chloroform. The 
 danger of wounds depends, to a great extent, upon the 
 parts of the body affected. Thus scalp wounds are not 
 usually dangerous unless followed by erysipelas. It should 
 be remembered, however, in cases of wounds of the head, 
 that a fracture or effusion of blood upon the brain, or con- 
 cussion, may be produced by a blow, even though the scalp 
 be uninjured. It is most important that the effects of 
 concussion should not be mistaken for those of intoxica- 
 tion. Unfortunately in too many instances persons arrested 
 upon the charge of intoxication have died in station-houses 
 from concussion of the brain, when their lives might have 
 been saved had medical attendance been summoned. 
 
 Wounds of the face are not usually dangerous unless the 
 orbit be involved, as in penetration of the orbital plate by 
 the point of an umbrella thrust into the face. The danger 
 of wounds of the neck is due to the presence of the great 
 vessels, the division of which, in case of the throat, gives 
 rise to severe hemorrhage. The trachea and larynx may 
 be divided, however, without necessarily proving fatal, 
 unless the blood flows into the trachea in such quantity 
 as to cause death. Death from wounds of the chest is 
 usually due to hemorrhage from the heart, lungs, or great 
 vessels. In cases of wounds of the abdomen, involving the 
 liver, stomach, or intestines (Fig. 12, 1 , 2, 3), the cause of death 
 is frequently peritonitis. With regard to wounds of the blad- 
 der (Fig. 12, 8) it must be borne in mind that, if distended, it 
 may readily be ruptured by a blow upon the abdomen, 
 the cause of death being usually peritonitis. Frequently, 
 however, under such circumstances, there may be no signs 
 of external injury. In wounds of the spine the danger is 
 proportional to the extent to which the spinal cord is in- 
 
MEDICAL JDE18PRUDENCB AND TOXICOLOGY. 61 
 
 volved, death taking place instantaneously if the medulla 
 or upper portion of the spinal cord be wounded. The 
 danger in wounds of the generative organs is due to the 
 severe hemorrhage which usually ensues. In the male 
 sex, in the case of the insane, castration and amputation 
 of the penis arc frequently self-inflicted. 
 
62 A MANUAL OF 
 
 CHAPTER V. 
 
 Blood-stains — Chemical, Microscopical, Spectroscopical Methods of 
 Investigation — Coagulation of Blood — Conditions Influencing Coag- 
 ulation. 
 
 Not unfrequently, in cases of murder, it becomes 
 necessary to determine if certain dark stains, such as are 
 found on a knife, linen, underwear, pieces of wood, etc., 
 were made by blood. The appearance presented by blood- 
 stains will vary according to their size, shape, and color. 
 Usually the stain consists of distinct spots ; it may, how- 
 ever, be a mere streak or film. The color of recent blood- 
 stains is red, that of old ones brown or brownish-red. It 
 will be more or less modified according to the nature of the 
 material upon which the blood has fallen. Thus the color 
 of blood upon soft wood, linen, or cloth is dark ; that upon a 
 polished metallic surface is shining, the spots presenting in 
 the latter case cracks radiating from the centre. There are 
 three methods of examining stains supposed to have been 
 made by blood, the chemical, the microscopical, the spec- 
 troscopical, all of which, on account of the importance of 
 the subject, merit at least a brief description. 
 
 The chemical method of investigation is based upon the 
 fact that the haemoglobin of the blood is soluble in cold 
 water. If the suspected blood-stain is in sufficient quan- 
 tity and not so old that the haemoglobin has been con- 
 verted into hsematiu, by proper manipulation a solution 
 
MEDICAL JUEISPEUDENCE AND TOXICOLOGY. 63 
 
 of the coloring matter of the blood can be obtained and 
 then tested. If the article stained be a linen shirt, for 
 example, a small piece should be cut out and suspended 
 in a test-tube containing cold distilled water. In a few 
 minutes, or longer, if the stain be an old one, the color- 
 ing matter of the blood will pass into the water, color- 
 ing it red. If the stained material to be examined is 
 attached to wood or a knife-blade, it must be scraped 
 or cut off and then soaked in water. Should the solu- 
 tion be not complete, a trace of citric acid or a little 
 ammonia may be added, the latter not affecting the color 
 of the solution. The solution so obtained should then 
 be heated in a test-tube over a spirit-lamp. If the solu- 
 tion be that of the coloring matter of the blood, it will 
 coagulate, the red color will disappear, and a brownish- 
 green material will be precipitated. In this way a solution 
 of the coloring matter of the blood may usually be dis- 
 tinguished from other red solutions, such as those of red 
 prints, logwood, kino, madder, cochineal, which do not 
 coagulate when heated, and which change their color when 
 ammonia is added. 
 
 Stains made by red paint or by lemon-juice on iron, 
 while slightly resembling blood-stains, can be distinguished 
 from the latter through their color becoming a bluish, 
 inky black on addition of tincture of galls, ferro-cyanide 
 of potassium, or by other tests for iron. Another test for 
 blood, that known as the guaiacum test, is based upon the 
 fact that the resin of guaiacum when oxidized assumes a 
 sapphire-blue color, and that this change in the color of 
 the resin can be induced by the addition of blood and per- 
 oxide of hydrogen together, but not by the addition of 
 blood alone. A convenient way of applying the guaiacum 
 
64 A MANUAL OF 
 
 test, frequently made use of by the writer, is to add a few- 
 drops of a freshly-prepared tincture of guaiacum to a 
 small quantity of water, by which the resin is precipitated. 
 The water holding the resin in suspension is then divided 
 into three portions. To the first portion a few drops of 
 peroxide of hydrogen dissolved in ether are added ; to the 
 second portion a few drops of the solution supposed to con- 
 tain the coloring matter of the blood. In neither case 
 will any change in the color of the resin be observed. 
 Now to the third portion add a few drops of the suspected 
 solution and of the etherized peroxide, and at once the resin 
 will assume a sapphire-blue color. Should the solution be 
 turbid through excess of the resin, a few drops of alcohol 
 will instantly clear it. It should be mentioned in this 
 connection that the resin of guaiacum in the presence of 
 peroxide of hydrogen is oxidized, turns blue by the ad- 
 dition of bile, saliva, red wine, as well as by blood. The 
 color of bile and saliva, however, should serve to dis- 
 tinguish these secretions from blood, while in the case of 
 red wine several hours are required to produce the blue 
 color in the resin. It will be observed that the existence 
 of blood is not directly proved by the chemical tests just 
 described, but is inferred from the presence of its coloring 
 matter or haemoglobin, and in most cases is only pre- 
 sumptively established. 
 
 The microscopic method of proving the existence of 
 blood depends on the ability of the examiner to treat 
 the material submitted to him in such a way that if it 
 be blood the corpuscles, and more especially the red ones, 
 may be sufficiently restored to admit of identification 
 under the microscope, or at least to enable him to obtain 
 the crystalline forms developed through changes in their 
 coloring matter. The separation of the corpuscles from a 
 
MEDICAL JUIUSI'KUDKNCK AND TOXICOLOGY. GO 
 
 material consisting of pieces of linen, wood, or iron stained 
 witli blood mixed with dirt, etc., is a far more difficult 
 operation, however, than that of demonstrating simply the 
 presence of blood-crystals. If the material submitted for 
 examination is a piece of linen, for example, stained with 
 what is supposed to be blood, a piece of it should be cut 
 out and. placed upon a clean glass slide and moistened with 
 
 Fig. 13. 
 
 © ^ 
 
 Blood-Corpuscles (X 450). 
 
 a solution consisting of one part of glycerine to seven 
 of water, or with a solution of common salt having a 
 specific gravity of that of the serum of the blood. The 
 specimen should then be covered with a thin cover-glass 
 and examined with the microscope. By this method, if 
 the stain be blood, and not too old, the red blood-corpus- 
 cles and sometimes the white ones as well will be usually 
 brought into view. If the material suspected to be blood 
 is in the form of a clot, on a knife-blade, for example, a small 
 portion of it should be scraped off with a needle on to a 
 perfectly clean glass slide. A thin cover-glass being pressed 
 firmly down on the fragment until it is reduced to powder, 
 the glass slide is then placed upon the stage of the micro- 
 scope. A drop of distilled water being allowed to flow slowly 
 from the margin of the cover-glass toward the powdered 
 material, if the latter be blood the corpuscles will gradually 
 make their appearance, and, although faint and colorless, 
 5 
 
66 A MANUAL OF 
 
 are usually sufficiently definite in outline to admit of 
 identification. 
 
 A red blood-corpuscle of man (Fig. 13), as seen in 
 freshly-drawn blood, may be described as a biconcave 
 disk, a mass or cell of protoplasm without a cell wall 
 or nucleus, and with a diameter in its greatest width on 
 an average of -g-^o^-th °f an inch. 
 
 Micrometer. — Inasmuch as there are obtained from sup- 
 posed blood-stains certain bodies having the size just men- 
 tioned, and as this is usually regarded as one of the strong- 
 est proofs that such bodies are red blood -corpuscles, the 
 method by which they are measured must be described. 
 The instrument used for this purpose by the microsco- 
 pist-is an eye-piece micrometer, that is, an eye-piece 
 upon the glass of which have been ruled a number of 
 parallel and equidistant lines, which, on being projected 
 upon the field of the microscope, will be seen by the ob- 
 server to cover any objects visible there and to define their 
 limits. To use the eye-piece micrometer, the value of the 
 spaces between the lines must be determined for the par- 
 ticular magnification, since these will vary with the ob- 
 jective 'and the length of tube used. To accomplish this, 
 there is placed upon the stage of the microscope a glass 
 slide upon which have been ruled a number of parallel 
 lines separated from one another by distances of y^th, 
 r ^ ¥ th, and y^g-ffth °f an mcn respectively (Fig. 14). Let 
 us suppose, for example, that the magnifying power used 
 is such that ten lines of the eye-piece micrometer corre- 
 spond exactly to the space between two of the lines upon 
 the stage micrometer that are separated by ygVffth of an 
 inch, the value of the spaces between the lines of the eye- 
 piece micrometer will be then equal to jowoth °f an mcn , 
 and an object covered by four such spaces as a white 
 
MEDICAL .lUKLSl'UUDENCK AND TOXICOLOGY. 
 
 67 
 
 corpuscle (Fig. 14, W) would have a diameter therefore of 
 rTr$"o~o* n ~ tsW^ °^ an ' n<; ^- ft is obvious, however, 
 that with such magnification a red blood-corpuscle, if its 
 diameter be s^V^ 1 °f au inch, will be covered by less than 
 four such spaces, and by more than three, since -^Vo^ 1 °^ 
 an inch is less than ^ q ft q ^ th and more than xTTolTTr^ 1 °^' an 
 inch. As the red corpuscles, in order to be measured, 
 must lie within the space between two lines the value of 
 which is known, and further, as the edges of the corpuscle 
 must be exactly in contact with the two lines circum- 
 scribing it, an object-glass and length of tube must be 
 
 Fig. 14. 
 
 R 
 
 HI 
 
 W 
 
 P.l 
 
 HI! Mill 
 
 Lines of Eye-Piece Micrometer, projected upon Stage Micrometer, as seen with 
 different magnification. 
 
 used so that exactly 32 lines of the eye-piece micrometer 
 can be counted within a space of y^-th of an inch, as each 
 space will then be equal to sY^th °f an i ucn > and will 
 exactly cover the red corpuscles (Fig. 14, R). 
 
 Such a simple micrometric arrangement as that just 
 described (Fig. 14) will suffice for determining whether 
 bodies supposed to be red corpuscles have an average 
 diameter of g^-Q-th of an inch, and, approximately at 
 least, the diameter of larger or smaller bodies. It is 
 obvious, however, that if the body to be measured was 
 
 300 
 
 Q-th of an inch in diameter, in order to measure it 
 
 the 
 
 accurately the magnification (Fig. 14) would have to be 
 so altered that the space of the yFotn of an inch would 
 contain exactly thirty lines instead of thirty-two. To 
 
68 
 
 A MANUAL OF 
 
 avoid the inconvenience of altering the magnification in 
 each case — which alteration would necessitate altering the 
 length of the tube or changing the objective, or both— 
 
 Fig. 15, l. 
 
 B 
 
 a a 
 
 Fig. 15, 2. 
 B C 
 
 a 
 
 
 B, C, lines upon stage micrometer; A, fixed line in ocular; a, b, movable lines 
 in ocular. 
 
 microscopists make use of a form of micrometer essentially 
 the same as that used b) r astronomers in measuring the 
 apparent diameter of the heavenly bodies. This con- 
 sists of an ocular (Fig. 15, l) through which may be seen 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 69 
 
 projected upon the stage micrometer a fixed line A, and 
 two movable lines a, b. The latter < a 1 1 be moved across 
 the field of the microscope by means of a wheel (not rep- 
 resented in the figure), the distance traversed by cither of 
 the threads from the fixed line being determined by the 
 number of divisions through which the wheel is rotated 
 (Fig. 15, 3). As an illustration of the manner in which 
 this is accomplished, let us suppose that the thread b is 
 made to coincide with the fixed line A of the ocular, and 
 the latter is made to coincide at the same time with the 
 line B of the stage micrometer (Fig. 15, 2), and that the 
 wheel is turned through one hundred divisions ; that is, 
 makes one complete rotation. It will be observed that the 
 line b will traverse the space between the lines B and C 
 of the stage micrometer, stopping at and coinciding with 
 the line O. By the turning of the wheel through one 
 hundred divisions the line b has, therefore, been made to 
 traverse the space of the -nnjth of an inch, the space be- 
 tween B and C of the stage micrometer having been so 
 graduated ; consequently, if the wheel be turned through 
 ten divisions, the line 6 will be made to traverse the 
 yoW^ 1 °f au mcn ; an d so on proportionally. The rela- 
 tion between the space traversed by the line 6 of the ocu- 
 lar and the number of divisions through which the wheel 
 is turned having been experimentally determined by 
 means of the stage micrometer, the latter is removed, and 
 the object-glass holding the object to be measured is 
 substituted in the field of the microscope. To determine 
 the size of the latter, it is only necessary then to turn the 
 wheel until the body to be measured (Fig. 15, 3) is exactlv 
 circumscribed by the fixed line A and the movable line 6 
 of the ocular, and to read oif the number of divisions 
 through which the wheel has been turned to accomplish 
 
70 A MANUAL OF 
 
 this ; for example, y^-th of an inch : 100 divisions of 
 wheel : : x : 20 divisions : 
 
 x = 5-g-Q"th °f an mcn = diameter of body. 
 
 It is evident, however, that if the wheel must be rotated 
 through twenty divisions and a fraction of a division in 
 order to bring the body to be measured between the lines 
 A and b, that fraction might be such that even with a 
 vernier attached to the wheel it would be impossible to 
 get an exact reading, and consequently the measurement 
 would only be approximate. 
 
 It is a matter, however, of the greatest difficulty with 
 high powers to adjust accurately the divisions of the 
 eye-piece micrometer, whatever form of instrument may 
 be used, to either those of the stage micrometer or to 
 the margins of the objects to be measured, even with 
 all the ingenious accessory contrivances that have been 
 devised to facilitate the operation. Indeed, it must be 
 admitted that the measurement of so small a body as the 
 red corpuscle, even when made by a most skilful micro- 
 scopist and with the best of modern instruments, from the 
 very nature of the case can never be anything but an ap- 
 proximate one. If the measurement of the red blood- 
 corpuscle from freshly-drawn blood and under the most 
 favorable circumstances is at best only approximative, 
 how much more so must such measurement be in the case 
 of a blood-stain where the size of the blood-corpuscle will 
 depend upon the relative amount of the fluid absorbed 
 that was used in its preparation for microscopical examina- 
 tion ? Indeed, one of the greatest difficulties experienced 
 in restoring the form of the blood-corpuscles obtained from 
 a blood-stain is to prevent them becoming distorted, 
 swollen, or even bursting from excessive absorption of the 
 fluid used in their preparation. The size of a corpuscle, 
 
MEDICAL JUKI8PKUDENCE AM) TOXICOLOGY. 71 
 
 as obtained from a blood-stain, can only bo regarded then 
 as representing approximately the size of the corpuscles of 
 such blood. Further, it must be borne in mind, in this 
 connection, that while about ninety out of every hundred 
 red corpuscles, whether the blood be that of man or other 
 mammals, have the same diameter, the latter depending 
 upon the species; of the remaining ten corpuscles, some 
 are larger, some smaller than the average corpuscle. That 
 being the case, if it just so happened that only the ex- 
 ceptionally small corpuscles were present, the blood, though 
 human, might be erroneously regarded, on account of the 
 small size of the corpuscles, as that of a dog, for example, 
 in which the corpuscles are smaller than those of man. 
 On the other hand, if the blood examined was that of a 
 dog, but only the exceptionally large corpuscles were 
 obtained, such blood, on account of the large size of its 
 corpuscles, might improperly be considered as human. 
 
 It must be admitted, therefore, that while the red blood- 
 corpuscles of the mammalia can be shown by measurement 
 to differ in size (see table), the blood examined being 
 freshly drawn in each instance, red blood-corpuscles as 
 obtained from blood-stains cannot be positively identified 
 by such a method as human red blood-corpuscles. Any 
 evidence offered as positive proof based upon micrometric 
 methods that blood is human, as distinguished from other 
 mammalian blood, must be regarded as only circumstantial 
 at best, for the following three reasons mentioned above : 
 1. The micrometric method is approximative. 2. The 
 size of the corpuscle restored is variable, depending upon 
 the amount of fluid absorbed. 3. The size of the cor- 
 puscles varies, even in the blood of the same mammal. 
 
72 
 
 A MANUAL, OF 
 
 Table of Blood-Corpuscles (Diameters in fractions 
 of an inch). 
 
 Birds. 
 
 Mammals. 
 
 Diameter. 
 
 Manatee 2T0 o 
 
 Elephant 27V5 
 
 Ant-eater ^759 
 
 Sloth 
 
 Whale 
 
 Camel 
 
 Man 
 
 Orang s^sa 
 
 Chimpanzee 3T12 
 
 2865 
 
 1 
 
 3099 
 1 
 
 312 3 
 
 1 
 
 3 200 
 
 Opossum .... 
 
 Rabbit 
 
 Black Rat ... . 
 
 Mouse 
 
 Brown Rat . . . 
 Gray Squirrel . . 
 
 Ox 
 
 Cat 
 
 Sheep 
 
 Goat 
 
 Pigmy Musk Deer 
 
 3TT2 
 _ 1 
 3557 
 i_ 
 
 3 607 
 
 "375? 
 
 1 
 
 3 8 l¥ 
 
 J 
 
 3911 
 
 _1 
 
 ¥000 
 
 1 
 ¥2 6 7 
 
 ¥¥o¥ 
 _ 1 _ 
 5300 
 1 
 
 63 66 
 
 1 
 
 12325 
 
 Ostrich 
 Owl . 
 Swan 
 Pigeon 
 
 Diameter. 
 1 
 
 ■ • T6¥9 
 _ 1 
 
 • • 1763 
 
 1 
 
 • ■ 1806 
 
 1 _ 
 
 • ' 1TJ73 
 
 Reptiles. 
 
 Turtle xaVi 
 
 Viper 
 
 Lizard 
 
 127? 
 
 1 
 
 1555 
 
 Amphibia,. 
 
 Amphiuma 3^3 
 
 Proteus £00 
 
 Siren ? |o 
 
 Menopoma -$\z 
 
 Fishes. 
 
 Pike 2^0 
 
 Perch 21W 
 
 Lamprey 2Ts¥ 
 
 The red blood-corpuscles of man and the mammalia 
 generally can be readily distinguished, however, from 
 those of birds, reptiles, and fishes, the latter being not 
 only relatively of large size, but oval in form and nu- 
 cleated (Fig. 16). It should be mentioned, in this con- 
 nection, that the red corpuscles of the camel and llama are 
 oval, and that those of the lamprey are somewhat circular. 
 No difficulty should arise on account of this circumstance, 
 for, as in the case of the camelidse, the corpuscles are 
 without a nucleus, though ovoid in form ; while in the 
 lamprey the corpuscles are nucleated, even if circular. 
 The fact that the red corpuscle of a bird differs in form 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 73 
 
 and in size from that of a mammal is important from a 
 medico-legal point of view. As an illustration, let us 
 suppose that in the ease of blood-stains found in a wagon 
 
 Fig. 16. 
 
 M AM M A L S, 
 
 nrrnn 
 
 £ MUSK DEER CAMEL 
 
 •3200 I 1-30.99 1 1-2/45 I I-42G8 I 1-4600 I 1-12325 I 1-3123 
 
 BIRDS. 
 
 
 Blood-corpuscles of vertebrates. 
 
 in which a person was suspected to have been murdered, 
 the explanation offered by the person accused of the crime 
 was that the blood spilled was that of a chicken which 
 had been killed by him for market. If, after examination, 
 
74 A MANUAL OF 
 
 the expert testified that the red blood-corpuscles obtained 
 from the blood were round and without nucleus, that 
 testimony alone would prove that the statement of the 
 defendant was false, and would be presumptive evidence 
 of guilt, and might lead to the confession of the crime and 
 to conviction. 
 
 Fig. 17. 
 
 Prismatic crystals from human blood. 
 
 Blood-crystals (Fig. 17), due to the crystallization of 
 the haemoglobin or coloring matter of the blood, consti- 
 tute an important proof of the existence of blood. 1 The 
 blood-crystals can be readily obtained from freshly-drawn 
 human blood by evaporating a drop of the blood to dry- 
 ness on a glass slide, adding a drop of distilled water, and 
 allowing the water to evaporate under a thin glass cover. 
 The glass slide having been transferred to the stage of the 
 microscope, the crystals will soon appear in certain forms 
 
 x Preyer: Die Blut-Ory stalk. Jena, 1871; Dragendorf in Maschka, 
 vol. i. S. 483. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 75 
 
 and sizes, but usually as small prisms. 1 If the blood sub- 
 mitted for examination has, however, undergone changes 
 
 such as would have occurred in the case of a blood-clot, 
 the following will be found a convenient methoa of ob- 
 taining the crystals : Triturate the substances suspected to 
 be blood in a mortar with a little common salt, add glacial 
 acetic acid, and warm the mixture till bubbles appear ; 
 then set aside to cool. If the substance so treated con- 
 tains hsematin, that is, modified haemoglobin, crystals of 
 hsematin hydrochlorate will appear as rhombic tablets, 
 stars, or crosses. The presence of such blood-crystals may 
 be regarded as proving that the material from which they 
 were obtained was blood, but not necessarily human blood, 
 since the crystals of the blood of certain animals are un- 
 distinguishable from those of man. Therefore, the presence 
 of blood-crystals as evidence that a suspected material from 
 which they have been obtained is blood is even of less 
 value from a medico-legal point of view than the presence 
 of blood-corpuscles, since the microscopist is unable, from 
 the form of the latter at least, to distinguish the blood of 
 the mammalia from that of other vertebrata. 
 
 The spectroscopic method of investigating blood-stains 
 is based upon the fact that blood interferes with the trans- 
 mission of certain rays of light, and that it gives rise to 
 what are known as the dark absorption bands of the blood 
 spectrum. It is well known that wheu sunlight is trans- 
 mitted through a prism it is decomposed into the seven 
 colors : Violet, indigo, blue, green, yellow, orange, red. 
 If, however, a weak solution of arterial blood be placed 
 
 1 Another method is to mix together in a watch-glass a drop of blood 
 with glacial acetic acid in excess, and evaporate to dryness slowlv over 
 a spirit lamp. The mass so obtained, when viewed under the micro- 
 scope, will usually exhibit the crystals in great numbers. 
 
76 
 
 A MANUAL, OP 
 Fig. 18. 
 
 Red, Orange. Yellow. Green. 
 
 ^4 olB o J> 
 
 Blue. 
 
 Indigo. Violet. 
 
 Oxyhemoglobin, 
 and N0 2 -Haj- 
 moglobin: 
 
 CO-Haemoglobiiu 
 
 Beduced Haemo- 
 globin. 
 
 Haematin in acid 
 solution. 
 
 Haematin in al- 
 kaline solution. 
 
 Beduced Hsema- 
 tin. 
 
 Solar spectrum 
 with Fraun- 
 hofer's lines. 
 
 I I""'"" l "T 
 
 / 3 9 10 11 12 IS 14 
 
 Spectra of blood. 
 
 Fig. 19. 
 
 Layer of blood in a glass vessel through which the light is transmitted. 
 
 Scheme of a spectroscope for observing the spectrum of blood. A, Tube. S, Slit. 
 m m, Layer of blood with flame in front of it. P, Prism. M, Scale. B, Eye of 
 observer looking through a telescope, r v, Spectrum. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 77 
 
 between the souree of light and the prism, two dark 
 bands will appear (Fig. 18) in that part of the spec- 
 trum previously occupied by the yellow ray, and more 
 particularly in that portion of the yellow ray adjoining the 
 orange and green rays, the two dark bands being sepa- 
 rated by that part of the yellow ray still transmitted 
 through the blood. If the arterial blood be now replaced 
 by venous blood, or simply deoxidized, as can be done by 
 appropriate means, the two dark bands will disappear, and 
 in that part of the spectrum where the yellow ray was 
 transmitted there will appear one dark band, while that 
 part of the spectrum lying on either side of the dark band 
 will be occupied to a small extent by the yellow ray. By 
 means of the spectroscope not only can a suspected mate- 
 rial be proved to be blood and arterial distinguished from 
 venous blood, but blood in general can be distinguished 
 from that which has absorbed carbonic oxide gas, as also 
 from solutions of acid alkali and reduced hsematin, the 
 dark bands presented by their spectrum being different in 
 each instance (Fig. 18). The spectroscopic method is the 
 most convenient, reliable, and delicate of the different 
 
 methods which have been described for investigating- blood- 
 ed o 
 
 stains. 
 
 The spectroscope employed in medico-legal examinations 
 is the same as that used in chemical and physical re- 
 searches, the essential parts being shown in Figure 19, 
 or it may consist simply of a spectroscopic attachment to 
 a microscope. The delicacy of the spectroscopic method 
 of investigating blood-stains is such that a solution con- 
 sisting of one grain of haemoglobin, upon which the absorp- 
 tion of the light depends, to a pint of water will interfere 
 with the transmission of strong sunlight sufficiently to 
 render the two dark bands visible. It thus becomes pos- 
 
78 A MANUAL OF 
 
 sible, by means of a spectroscope, to state positively that 
 stains years old on wood, linen, or iron, even when found 
 in a putrid condition, were made by blood. It is true 
 that the spectra of solutions of the coloring matter of the 
 petals of cineraria, 1 of cochineal, madder, and other red 
 dyes, present dark bands in their spectrum, but their situ- 
 
 Fig. 20. Fig. 21. 
 
 Blood before coagulation. Blood-clot floating in the fluid serum 
 
 after coagulation. 
 
 ation is either not exactly the same as those of the blood 
 spectrum, or they can be distinguished from those of the 
 latter by the action of ammonia and potassium sulphate. 
 
 The spectroscopic method of investigating blood-stains, 
 reliable and delicate though it may be, does not enable the 
 examiner to state that a suspected material is human blood, 
 but only blood. By none of the methods, therefore, of 
 examining blood-stains, whether chemical, microscopic, or 
 spectroscopic, can human blood be distinguished positively 
 from that of other animals. 
 
 Coagulation of Blood. — One of the most remarkable 
 properties of the blood is its power of separating into clot 
 and serum, due to the coagulation and subsequent shrink- 
 age of its fibrin (Figs. 20, 21), the process being com- 
 
 1 Of the different menstrua used by the writer to obtain the color- 
 ing matter from the petals of cineraria, glacial acetic acid was found to 
 be the best. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 70 
 
 pleted outside the body within a period of from 10 to \'Z 
 hours. 
 
 BLOOD. 
 
 Before Coagulation. After Coagulation. 
 
 f Water, f 
 
 T . „ . . Albumen, > i Serum. 
 
 Liquor Sanguinis, -i SaUg) ^ [ 
 
 [ Fibrinogen^. . 
 
 "> I Clot. 
 Corpuscles, ^ 
 
 Conditions Influencing Coagulation of Blood. — While 
 the blood does not usually coagulate in the living body, it 
 almost invariably does so in the dead body, and within 
 a period varying between 12 and 24 hours. There are 
 various conditions which influence the coagulation of the 
 blood within and without the body, some of which are 
 better understood than others. Only those conditions in- 
 fluencing coagulation which may have an importance from 
 a medico-legal point of view need be here considered. 
 Blood flowing from a small orifice coagulates more quickly 
 than when flowing from a large one ; more quickly when 
 it is received into a shallow rough vessel than when in a 
 deep smooth one. The coagulation of the blood is retarded 
 or even prevented when mixed with solutions of sodium 
 sulphate and carbonate. Rapid freezing will prevent the 
 coagulation of the blood ; blood so frozen will, however, 
 coagulate if carefully thawed. A temperature of from 32° 
 to 140° F. favors coagulation. The menstrual blood is kept 
 in a more or less fluid condition by the vaginal secretions. 
 
 The medical expert is often asked to express an opinion 
 as to how much blood the body of the deceased contained. 
 While it is impossible to state exactly how much blood 
 there is iu any human body, it may be said that on an 
 average there is one pound of blood for every eight 
 pounds of body- weight ; that is, there would be about six- 
 
80 A MANUAL OP 
 
 teen pounds of blood in the body of a man weighing one 
 hundred and twenty-eight pounds. This estimate is based 
 upon the fact that twelve pounds of blood were collected 
 during the execution by beheading of a criminal weighing 
 one hundred and twenty-eight pounds, and that four 
 pounds of blood were obtained after the execution by 
 washing out the blood-vessels. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. <S 1 
 
 CHAPTER VI. 
 
 Burns and Scalds — Death from Suffocation by Strangulation — Hanging 
 — Drowning. 
 
 A burn may be defined, medico-legally, as an injury 
 produced by the application of a heated substance to the 
 surface of the body, while a scald results from the appli- 
 cation of a liquid at about its boiling-point. The effects 
 of burns and scalds upon the body are essentially the same. 
 Burns vary in their intensity from a mere redness of the 
 skin to a complete carbonization of the body. 
 
 The danger from burns depends more on their extent 
 than upon their depth. This is due to the .fact that the 
 excretory and heat-regulating functions of the skin are 
 interfered with in proportion to the extent of the skin 
 involved. 
 
 It may be stated, as a general rule, that if one-third of 
 the body, or even one-third of the skin, be severely burned, 
 the burn will probably prove fatal. Death in the case of 
 burns is usually due to shock, though often caused by suf- 
 focation, exhaustion, or gangrene. It must be remem- 
 bered, however, that the result of burns will be very much 
 influenced by the age and constitution of the individual 
 and the part of the body affected. Thus, for example, 
 burns are more dangerous in the young than in the old ; 
 more so on the trunk of the body than on the limbs ; more 
 so if in separate patches than when continuous, supposing 
 the parts burned are of equal extent. 
 
 The post-mortem appearances observed in cases of death 
 
82 A MANUAL OF 
 
 from burns are not very constant. Among those frequently 
 noticed, however, are capillary injection of the mucous 
 membrane of the alimentary canal and bronchi, perfora- 
 ting ulcers of stomach and duodenum, and serous effu- 
 sion of the ventricles of the brain. It has frequently 
 occurred that the body of a person murdered has been 
 burned after death, in the hope that the death might be 
 attributed to accident, and so enable the murderer to 
 escape the consequences of his crime. It may become, 
 therefore, very important in medico-legal cases for the ex- 
 aminer to be able to state whether a body was burned 
 during life or after death. Among the facts that may be 
 mentioned as proving that burns had been inflicted during 
 life an important one is the presence of blisters and par- 
 ticularly of blisters containing serum. It is true that 
 blisters may be produced a few minutes after death by 
 heat ; but when so produced they contain air, not serum. 1 
 It should be mentioned, however, that in the case of drop- 
 sical persons blisters containing serum might be produced 
 by the application of heat after death. On the other hand, 
 the absence of blisters does not prove that a body was not 
 burned during life, since blisters do not necessarily result 
 from burns. Further, blisters, even when present, are 
 sometimes so modified by the effects of the heat when 
 intense as to be unrecognizable. Another proof that a 
 body has been burned during life is the presence of a red 
 line around the burn, the color of which gradually fades 
 away into that of the surrounding skin. This red line 
 remains after death, and cannot be produced by the appli- 
 cation of heat to the dead body. It must be admitted, 
 however, that it is often extremely difficult to state posi- 
 tively whether a body has been burned during life or after 
 1 Christison : Edinburgh Medical Journal, 1831, p. 3^0. 
 
MEDICAL JU'UINIMIUDKNCK AND TOXICOLOGY. 8)5 
 
 death. Indeed, if a dead body he found completely chaired, 
 it would be impossible to decide whether the individual 
 had been burned alive or not. 
 
 Death from Suffocation. — Death from suffocation, whether 
 by strangulation, hanging, or drowning, or however pro- 
 duced, is due in each instance to the same cause — the 
 deprivation of the system of air, or asphyxia. Apart from 
 the three principal modes of death from suffocation, which 
 have just been referred to, and which will be considered 
 separately, there are other modes of death from suffocation 
 less common than those mentioned, but occurring so fre- 
 quently as to demand some attention. Thus, for example, 
 infants are frequently suffocated accidentally from being 
 too closely wrapped up, or from being rolled upon by their 
 mothers, often so intoxicated as to be unaware of what they 
 are doing. Children, feeble persons, and drunkards have 
 been suffocated by falling into ash-heaps, dirt-piles, etc. 
 The passage into the larynx of marbles and whistles acci- 
 dentally swallowed by children, of half-chewed meat bolted 
 through over-haste in eating — a habit unfortunately too 
 common even in adults — is a not uncommon cause of suf- 
 focation. 1 Occasionally, suffocation is intentionally pro- 
 duced, as in cases where individuals, having determined to 
 commit suicide, force foreign bodies, like balls of hay, for 
 example, down their own throats. Death from suffocation 
 may be, however, homicidal as well as accidental or 
 suicidal. Indeed, one of the commonest ways of killing 
 new-born children is by suffocation, the crime being easily 
 committed and leaving but few traces to tell the tale. 
 Frequently, persons have been suffocated by having foreign 
 bodies like corks and pieces of meat forced down their 
 
 1 Tidy : op. cit., part ii. pp. 448, 449 ; Taylor : op. cit., p. 426 ; "Whar- 
 ton and Stille : vol. iii. p. 348. 
 
84 A MANUAL OP 
 
 throats, the murderers hoping that death would be at- 
 tributed to accidental suffocation, and thus have suspi- 
 cion diverted from themselves. Therefore, the medical 
 examiner, in cases of death from suffocation, even after 
 most careful examination, should be extremely cautious in 
 expressing an opinion as to whether death was accidental, 
 suicidal, or homicidal. The post-mortem appearances 
 usually observed in cases of death from suffocation and 
 from causes such as those mentioned are lividity of the face 
 and lips, congestion of the eyes, bloody mucous froth about 
 the mouth and nose, congestion of the lungs and of the 
 right side of the heart and kidneys. 
 
 Death from Suffocation by Strangulation. — Strangulation 
 may be produced either by simple pressure of the hand 
 on the windpipe, as in throttliug, or by means of a rope, 
 strap, handkerchief, piece of a sheet, bowstring, etc. It 
 differs from hanging principally in the position of the cord, 
 which is horizontal in the former case and oblique in the 
 latter. From a medico-legal point of view this is an im- 
 portant distinction, since death from strangulation would 
 be usually regarded as homicidal, that from hanging as 
 suicidal. Among the signs of death from strangulation 
 may be mentioned the staring eyes with dilated pupils, the 
 livid and swollen face, the protruding and often-bitten 
 tongue, blood about the nose, mouth, and ears, turgidity of 
 the genitalia, with escape of urine and feces. The larynx 
 is flattened, congested internally, and coated over with a 
 bloody frothy mucus. The right side of the heart and the 
 venous system are gorged with blood. The marks made 
 by the fingers and thumb upon the front of the neck, as in 
 throttling, or the horizontal mark or marks made by the 
 cord according to the number of times it was wound around 
 the neck, with the infiltrated blood beneath, are striking 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 85 
 
 evidences of death from strangulation. It is true that such 
 marks can be made by winding a cord around the neck of 
 a dead body, and that therefore too much importance must 
 not be attached to their presence ; but it must be borne 
 in mind that the livid, swollen countenance, the protruded 
 tongue, the staring eyeballs, which are always present in 
 death from strangulation, and which cannot be produced 
 after death, must be always taken into consideration, as 
 well as the marks observed on the front of the neck. 
 According to Tidy, 1 an ecchymosed mark can be pro- 
 duced experimentally within three hours, a non-ecchy- 
 mosed one within six hours, after death. Casper, how- 
 ever, states, 2 as the results of his experiments, " that any 
 ligature with which any body may be suspended or 
 strangled, not only within a few hours, but even days 
 after death, especially if the body be forcibly pulled 
 downward, may produce a mark precisely similar to that 
 which is observed in most of those hanged while alive." 
 It is remarkable that the marks of strangulation some- 
 times persist weeks and even years after burial. 
 
 Strangulation is sometimes produced accidentally. Cases 
 have occurred, for example, where death was due to com- 
 pression of the windpipe by straps or strings habitually 
 worn around the necks of persons engaged in carrying 
 heavy baskets of fish or vegetables for sale. Suicidal stran- 
 gulation is rare. Among the insane, however, it is not of 
 unfrequent occurrence, being so easily accomplished. In- 
 deed, in certain cases it requires the greatest vigilance on 
 the part of the attendants to prevent it. 
 
 Death from Suffocation by Hanging. — In this mode of 
 death the body is suspended by the neck, the weight of the 
 
 1 Tidy : op. cit., part ii. p. 431. 
 
 2 Casper: op. cit, vol. ii. p. 173. 
 
8b A MANUAL OF 
 
 body acting as the compressing force. If the neck is com- 
 pressed beneath the thyroid cartilage, death is usually due 
 to asphyxia, and is rapid ; but if just beneath the chin, as 
 is usually the case in executions, to congestion of the brain 
 (apoplexy), and is slow. In most cases, however, death is 
 due rather to the effects of both causes combined. Occa- 
 sionally, death is caused immediately by pressure upon the 
 spinal cord through fracture or displacement of the odon- 
 toid process of the second cervical vertebra. The hyoid 
 bone and thyroid cartilage have also in some instances been 
 fractured. Death from fracture of the vertebra? in hang- 
 ing, however, is not so frequent as is usually supposed. The 
 post-mortem appearances observed in cases of death from 
 hanging do not differ essentially from those already de- 
 scribed in death from strangulation. Indeed, the mere 
 inspection of the body will not enable the examiner to state 
 positively that death was due to hanging. The flow of 
 saliva out of the mouth, down the chin, and straight down 
 the chest, is possibly one of the most positive signs of this 
 kind of death ; but the absence of such a flow would 
 hardly justify the examiner in stating that death was not 
 due to hanging. It is also extremely difficult to determine, 
 when a body is found dead from hanging, whether the 
 death should be regarded as accidental, suicidal, or homi- 
 cidal. It is true that in cases of suicide by far the greatest 
 number are committed by hanging ; but that would only 
 lead to a presumption as to the cause of death. From the 
 fact that very young children rarely commit suicide, it 
 might be supposed that the age of the deceased might 
 assist the examiner to some extent in determining the cause 
 of death. It must be remembered, however, that suicide 
 has been committed by hanging by a boy of nine and by 
 a man of ninety-seven years of age, and that death from 
 
MIMICAL JURISPRUDENCE AND TOX U'<)\.<><: V. <S7 
 
 the same cause, though accidentally occasioned, is not of 
 mi frequent occurrence among children. 
 
 Death from Suffocation by Drowning. — In death from 
 drowning, suffocation is caused by the presence of some 
 liquid, usually water, which, interfering with the passage 
 of air into the respiratory passages, acts even more effec- 
 tually than when the throat is compressed externally, as 
 in strangulation or hanging — the water entering even the 
 bronchial tubes and air-vesicles. A human being, as a 
 general rule, dies if submerged for a period of from four 
 to five minutes. In order that a person should be suf- 
 foeated by drowning, it is not necessary, however, that 
 the whole body should be submerged. It is of no un- 
 common occurrence to find the dead bodies of persons, 
 such as drunkards and epileptics, lying face downward 
 in shallow pools into which they had fallen and by which 
 they had been suffocated. The external signs presented 
 by a drowned person will vary with the length of time the 
 body has been in the water. Supposing the body not to 
 have been in the water longer than two or three hours, 
 and not to have been inspected immediately after removal, 
 the face will be found pale, the eyes half open, the eye- 
 lids livid, the pupils dilated, the mouth usually open, the 
 tongue swollen, often indented by the teeth, the lips and 
 nostrils covered with a mucous froth. The skin usually 
 presents the condition known as goose-flesh, and the penis 
 is retracted. In addition abrasions are often found upon 
 the body, especially upon the hands, which frequently con- 
 tain particles of sand, gravel, mud, and pieces of wood 
 grasped by the drowning person in his struggle for life. 
 Internally, the lungs are found disteuded, overlapping the 
 heart, sodden and doughy, owing to the water drawn in, 
 and full of bloody mucous froth. In cases in which the 
 
88 A MANUAL OF 
 
 lungs contain little or no water, the water will be found in 
 the pleural cavities, into which it has transuded. Fre- 
 quently, water is found in the stomach, together with parts 
 of weeds, sand, and mud, such as are present in the ponds 
 or river in which the person was drowned. As a general 
 rule, the right side of the heart is gorged with dark blood. 
 Both sides of the heart may, however, be distended with 
 blood. 
 
 The remaining organs do not present any characteristic 
 changes. As the human body is somewhat heavier than 
 water, the body of a drowned person will remain sub- 
 merged until, through the development of putrefying gases, 
 it becomes sufficiently light to float. The time elapsing 
 between the moment when a person is drowned and that 
 at which the body will come to the surface, varies with the 
 temperature of the air and water, the buoyancy of the lat- 
 ter, the age, sex, and constitution of the individual. In 
 summer a body may float within twenty-four hours after 
 drowning. A drowned body will rise to the surface 
 sooner in salt than in fresh water. Fat bodies float sooner 
 than thin bodies, and the bodies of women float sooner 
 than those of men. Though a matter of importance, it is 
 often impossible to state positively, in the case of a body 
 floating in the water supposed to have been drowned, the 
 length of time that has elapsed since life became extinct. 
 In this connection it can only be stated that the mucous 
 froth and water usually found in the lungs of drowned 
 persons disappear after putrefaction sets in ; or when the 
 body has been exposed for any great length of time to the 
 air. 
 
 Death from drowning is usually accidental or suicidal — 
 rarely homicidal, however, except in the case of infants, 
 which are frequently gotten rid of in this way. But it 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 
 
 89 
 
 must be borne in mind that a person might be murdered 
 and then thrown into a river or pond with the idea that 
 death would be attributed to drowning. Therefore, the 
 body of* a drowned person should be always most care- 
 fully examined for marks of violence. On the other hand, 
 the presence of wounds upon a body found dead floating in 
 the water would not prove that the case was one of homi- 
 cide, since suicides have frequently inflicted wounds upon 
 themselves before drowning. The fact that the limbs are 
 found tied together, that a stone or a heavy weight is sus- 
 pended from the neck of a body taken out of the water, 
 would not necessarily indicate homicide, as suicide has 
 often been committed in that manner. 
 
 Fig. 22. 
 
 Resuscitation after drowning: first movement. 
 
 Fig. 23. 
 
 Resuscitation after drowning: second movement 
 
 Resuscitation. — While the best method of resuscitation of 
 a drowned person is not strictly a medico-legal question, as 
 the propriety of the treatment of drowned persons has been 
 
90 A MANUAL OP 
 
 severely criticised at coroner's inquests, a few words in 
 connection with this subject may not seem inappropriate. 
 In attempting to resuscitate a drowned person, the first 
 thing to do is to remove all clothing from the neck and 
 chest. The body should then be wiped dry, and covered 
 with dry clothes. The mucous froth that has collected 
 within the nostrils, mouth, and throat must be cleaned out, 
 the tongue pulled forward, and kept from falling back, in 
 this way covering the larynx. The body should then be 
 placed at full length, face downwards, with the forehead 
 resting on one arm, so as to allow all fluids to run out of 
 the mouth. Ammonia, snuff, aromatic vinegar, may be 
 now cautiously applied to the nostrils. If by these means 
 respiration has not been restored, the body must be placed 
 upon its back, and the head slightly raised. The arms 
 should be gently carried outwards and upwards, raised above 
 the head, and kept momentarily in that position (Fig. 22). 
 By these movements, which should take about two seconds, 
 inspiration is effected, and air passes into the chest. The 
 arms should then be lowered and brought closely to the 
 sides of the chest, the lower part of the breast -bone being at 
 the same time compressed (Fig. 23). These movements, by 
 which expiration is effected and air driven out of the chest, 
 should also be made in about two seconds. These alternate 
 movements of the arms should be repeated about fourteen 
 times a minute. As soon as spontaneous breathing com- 
 mences, heat may be applied either in the form of a warm 
 bath or friction. When the power of swallowing returns, 
 a little warm brandy and water may be given, and then 
 the patient should be put to bed and allowed to sleep. 
 This treatment should be persisted in for several hours, 
 except in those cases where the body has been long under 
 water and is taken out cold and rigid — where there is com- 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 91 
 
 plete insensibility, no .spontaneous breathing, entire absence 
 of the heart-beat, the eyelids half closed, the lower jaw 
 stiff, and mucous froth continually escaping from the 
 nostrils and mouth. On the other hand, slight flushing of 
 the face, convulsive twitches of the face, returning warmth 
 of the skin, gasping and sobbing, breathing movements of 
 the body and limbs, are signs indicating speedy recovery. 
 
92 A MANUAL OF 
 
 CHAPTER VII. 
 
 Death from Starvation — Death from Heat and Cold— Death by Light- 
 ning. 
 
 Death from Starvation. — The symptoms of and post-mor- 
 tem appearances in death from starvation, whether the sys- 
 tem be deprived suddenly or gradually of food, are essentially 
 the same. Advantage is often taken of this fact by those in 
 charge of so-called " baby- farms/' where, to save expense, in- 
 fants are slowly starved by food insufficient in quantity and 
 quality, and where their death is attributed to the diseases 
 common to infancy. Usually, in such cases, the true cause 
 of death is overlooked, suspicion even being averted, as 
 the length of time is so great that months often elapse 
 before death is accomplished by the starving process. For 
 this reason death from chronic starvation is so much more 
 common than from acute starvation. Indeed, death from 
 acute starvation occurs almost always accidentally, as in 
 the case of those who are buried in a mine, or of those w T ho 
 are shipwrecked or lost on desert wastes. Starvation is 
 very rarely suicidal. Lunatics and prisoners sometimes 
 attempt to take their own lives by abstaining wholly from 
 food ; but, as a general rule, such attempts are unsuccessful. 
 
 Among the symptoms of starvation may be mentioned 
 severe pain in the epigastrium, which usually passes away 
 in a day or so, being replaced by an indescribable feeling 
 of weakness, a sort of sinking. The face becomes pale 
 and cadaverous, and there is a wild look in the eye. 
 General emaciation follows, and an offensive odor is noticed 
 about the body, which is covered with a brownish secretion. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 93 
 
 The voice becomes weak, and muscular effort impossible 
 The intelligence can, with difficulty, be aroused. Im- 
 mediately before death there is a decided fall in the tem- 
 perature. Death takes place usually in from ten to twelve 
 days, often accompanied with mania and convulsions. 
 In death from starvation the most important changes 
 noticed on post-mortem examination are the loss in body- 
 weight, the almost entire absence of fat and blood, and 
 the loss in bulk of the most important viscera. The coats 
 of the intestines are sothinned as to be almost transparent, 
 the gall-bladder is distended with bile, and decomposition 
 sets in very readily. As already mentioned, death from 
 inanition or chronic starvation is characterized by the 
 symptoms and post-mortem changes just described as re- 
 sulting in death from acute starvation. 1 
 
 Death from Heat and Cold. — Death from heat does not, 
 as a general rule, become a subject of medico-legal investi- 
 gation. As, however, in cases of death from sun-stroke, 
 from exposure to the heat of engine-rooms, etc., doubts 
 may be raised at the coroner's inquest, especially in the 
 absence of witnesses, as to whether death was really due to 
 such causes, and was not suicidal or homicidal, it is im- 
 portant that the medical examiner should be familiar with 
 the symptoms and post-mortem changes presented in such 
 cases. The symptoms of exposure to excessive heat, 
 whether to that of the direct rays of the sun, or to that of 
 
 1 It is often stated that the quantity of food required by a healthy 
 man doing work during twenty-four hours is as follows: 
 
 Meat, 16 oz. 
 
 Bread, 19 " 
 
 Butter or fat, 3J " 
 
 Water, 52 fl. oz. 
 
 If health, however, is to be maintained, fresh vegetables, fruits, tea, 
 coffee, and sugar should be added from time to time to the above diet. 
 
94 A MANUAL OF 
 
 the peculiar atmosphere of engine-rooms and factories, 
 saturated with moisture, and therefore interfering with the 
 heat- regulating functions of the skin, vary from headache 
 with drowsiness to complete insensibility, coma, and par- 
 alysis. In most such cases death appears to be due to 
 paralysis of the heart. Among the post-mortem appear- 
 ances which are not constant may be mentioned congestion 
 of the brain and its membrane, serum in the ventricles, 
 congestion of the heart, lungs, and viscera. In some cases, 
 however, there is anaemia of the brain. 
 
 Death from cold is usually accidental, occurring, for ex- 
 ample, in drunkards who have fallen asleep in the snow, 
 or in persons who have lost their way in woods or in snow- 
 drifts. Death from cold is, however, not unfrequently 
 homicidal. Thus, newly-born infants are often intention- 
 ally frozen to death by exposure to the air of a very cold 
 winter night. Death takes place very quickly under such 
 circumstances, infants having but little power to resist 
 cold. Young children have been frozen by being im- 
 mersed in vessels of ice-water. Lunatics have died of 
 exhaustion after too long exposure to the cold shower- 
 bath, administered as a punishment for misbehavior. In 
 all such cases the temperature of the air, the season of the 
 year, the time of day, the place of exposure must be all 
 taken into consideration by the examiner. 
 
 The post-mortem changes in death from cold are not 
 characteristic. Among the most noticeable are the general 
 pallor and stiffness of the body, the irregular and dif- 
 fused red patches on different parts of the body, even in 
 such as are not dependent, the unusual accumulation of 
 blood on both sides of the heart, and the congestion of the 
 viscera. In all cases of death supposed to be due to cold, 
 it is important to determine whether the body, when found, 
 
MEDICAL JUBISPEUDEN'CE AND TOXICOLOGY. 95 
 
 was putrefying, since, as putrefaction is prevented by 
 
 freezing, it would be a strong proof, if a body were found 
 putrefied in ice or snow, that death was not due to freezing, 
 but that the freezing had occurred after death. 
 
 Death by Lightning. — Death by lightning is of medico- 
 legal interest from the fact that in the case of bodies found 
 dead in remote places and hearing marks of violence death 
 has been attributed to murder rather than to litrhtninu;. 
 The effects of death from lightning vary considerably in 
 their intensity. Frequently the hair is singed, the skin 
 deeply burned or punctured, the clothes burned, the boots 
 torn open. If such articles as watch-chains or coins or 
 knives happen to constitute part of the circuit, they will be 
 usually found melted or half melted. In some cases the 
 body may be uninjured, and yet the clothes burned or en- 
 tirely torn off. In other cases the clothes may entirely es- 
 cape, and yet the body may be much burned. In death from 
 lightning the brain and its membranes are usually found 
 congested, the brain being frequently disorganized. The 
 stomach, intestines, liver are usually congested. The heart 
 does not present auy marked alteration. The lungs are, 
 however, usually congested and full of mucus. Rigor mor- 
 tis frequently sets in immediately after death. In such 
 cases the body is found in exactly the same attitude as 
 when it was struck. The coagulation of the blood is re- 
 tarded. On the other hand, putrefaction is accelerated. 1 
 
 1 For post-mortem appearances presented in cases of death by elec- 
 trocution or from the accidental application of electricity, see Taylor, 
 op. cit., p. 470 ; Richardson : Medical Times and Gazette, May 15, 1869, 
 p. 511 ; Allan McLane Hamilton : System of Legal Medicine, New York, 
 1894, vol. i. p. 134; vol. ii. p. 367. Bullard: "The Medico-Legal Re- 
 lations of Electricity," Medical Jurisprudence, Forensic Medicine, and 
 Toxicology, by R. A. Witthaus and Tracy C. Becker, vol. ii., New York, 
 1S94. 
 
96 A MANUAL OF 
 
 Death by lightning is usually instantaneous, being due 
 to shock. But in some cases death is delayed, being then 
 due to some affection of the brain or spinal cord, such as 
 epilepsy, paralysis, effusion of blood, tetanus, etc. The 
 effect of a stroke of lightning, as well known, is very 
 capricious. Of three or four persons sitting under a tree 
 one or two only may be killed, the others escaping. Per- 
 sons are reported as having been killed while sitting under 
 a low tree, notwithstanding the presence of tall trees, a 
 lightning rod, and an iron bridge near by. Should the 
 question ever arise as to whether death was due to a stroke 
 of lightning, such facts as there having been a thunder- 
 storm at about the supposed period of death, the peculiar 
 appearance of the deceased, the co-existence of burns and 
 wounds, the finding of half-melted buttons and coins, 
 would strongly point to that conclusion. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY, 07 
 
 CHAPTER VIII. 
 
 Rape upon Children— Rape upon Adults— Rape upon the Dead — Un- 
 natural Crimes. 
 
 Kape, medico-legal ly, is the carnal knowledge of a 
 woman forcibly and against her will. 1 At one time the 
 punishment for rape was death, castration, fine, or im- 
 prisonment. At the present day rape is regarded as a 
 felony (in America ' at least), and is punished by fine 
 and imprisonment for a term of years. From the fact 
 that, as a general rule, the crime of rape is committed 
 in the absence of witnesses, the law usually admits the 
 testimony of the victim to substantiate the charge. It is 
 very essential, however, that medical testimony should be 
 obtained as corroborative evidence, as probably nine-tenths 
 of the accusations of rape are false. At one time the law 
 demanded proofs of penetration as well as emission on the 
 part of the male. At present proof is only required of 
 vulval penetration, without the hymen being necessarily 
 ruptured. 
 
 Rape of young children, as might be expected, is far 
 commoner than that of adult women, children being in- 
 capable of offering much resistance, even when old enough 
 to realize the nature and consequences of the act. Owing 
 to the superstition prevailing in Europe, among the lower 
 classes, that an old gonorrhoea is cured by intercourse with 
 a virgin, rape of young children is far more common 
 abroad than in America. If the victim be under six- 
 teen years of age, her consent does not excuse the act. 
 
 In cases of the insane, idiotic, or only feeble-minded, 
 the consent of the female will not be accepted as an excuse 
 1 Guy and Ferrier : op. cit., p. 59. 
 7 
 
98 A MANUAL OF 
 
 for the act. Difficulty, however, is sometimes experienced 
 in determining to what extent the reason of the female 
 alleged to have been overcome is affected. It may be 
 mentioned, in this connection, that the fact that a woman in 
 a state of stupor has been subjected to rape would not be 
 an excuse for the act ; neither would submission from fear 
 nor from ignorance of the nature of the crime. Further, 
 even if the character of the woman was notoriously bad, 
 yet, if it was in evidence that such a woman, a prostitute, 
 for example, had been forced against her will, the act would 
 be a rape. But, under such circumstances, it must be ad- 
 mitted that on account of the bad character of the woman 
 the evidence would have to be very strong to convict. 
 
 In every alleged case of rape it is most important that 
 the medical examiner should note exactly the time of 
 making his examination, and also determine, so far as 
 possible, the time elapsing since the act was committed, as 
 this may subsequently become important evidence in prov- 
 ing whether or not the woman entered complaint at once, 
 and submitted without delay to an examination, as also 
 in enabling the defendant to prove an alibi. The female 
 should be visited by the medical examiner as soon as 
 possible after the perpetration of the crime, as all traces 
 of rape, if such has been committed, may disappear in 
 three or four days ; or, in the event of the accusation being 
 a false one, the woman should not be allowed time to pro- 
 duce artificially evidences simulating those of rape. In 
 alleged cases of rape, a medical examination is not com- 
 pulsory ; but if a woman under such circumstances refuses 
 to have an examination made, that in itself would be strong 
 presumptive evidence against the truth of the charge. 
 
 In cases of rape the medical examiner may expect to 
 find marks of violence about the genitalia, wounds, bruises, 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 99 
 
 etc., on both the person of the woman and of the accused, 
 spermatic and blood-stains on the person and clothing of 
 both, gonorrhoea or syphilis in one or both. Rape per- 
 petrated upon young children by men is attended, as 
 might be expected, on account of the great disproportion in 
 size of the sexual organs, with far more severe local in- 
 juries than when committed upon adult women. Indeed, the 
 absence of any such marks of violence would be strong 
 proof of the charge of rape made being a false one. 
 
 If a child be examined within two or three days after 
 the commission of the crime, the vulva will be usually 
 found inflamed and swollen, and more or less covered with 
 clotted blood, which has oozed from the abraded mucous 
 membrane. From the vagina there flows a muco-purulent, 
 ropy discharge of a yellowish-green color, which stains 
 and stiffens the linen. Urination is frequently painful, 
 from the inflammation extending to the urethra. The 
 hymen may be destroyed, or only lacerated, or escape 
 injury entirely. Too much importance, however, must 
 not be attached by the medical examiner to the presence 
 or absence of the hymen as disproving or proving a rape. 
 Indeed, as a matter of faGt, in most cases of rape upon 
 children, the hymen escapes injury entirely, probably be- 
 cause it is situated in such cases far back. On the other 
 hand, the hymen may have been destroyed, not necessarily 
 by rape, but by disease, accident, or even intentionally, 
 the object being in the latter case to extort money by a 
 false accusation of rape. 
 
 The vagina is frequently found very much dilated in 
 the case of young children who have been assaulted. The 
 medical examiner should bear in mind, however, that such 
 a dilated condition of the vagina has often been artificially 
 produced by the introduction of hard bodies with the view 
 
100 A MANUAL OF 
 
 of fitting the children for sexual intercourse. It is very 
 important that the muco-purulent discharge from the 
 vagina just referred to as following rape should not be 
 confounded with either infantile leucorrhoea, gangrenous 
 inflammation of the vulva, or gonorrhoea. Infantile 
 leucorrhoea occurs in unhealthy, particularly strumous 
 children, whose hygienic surroundings are of the worst 
 character. It should be borne in mind by the medical 
 examiner that the presence of such a discharge in a young 
 child is often taken advantage of by an unscrupulous 
 mother to bring a charge of assault against an innocent 
 man. Gangrenous inflammation of the vulva, less com- 
 mon than infantile leucorrhoea, is found among neglected 
 children suffering from inanition, exhaustion, etc. As a 
 general rule, the absence of blood and of bruises in a 
 young child alleged to have been assaulted would be strong 
 proof that the vaginal discharge was due rather to leucor- 
 rhoea or gangrenous inflammation than to the effects of 
 violence. 
 
 In endeavoring to determine whether a vaginal discharge 
 be due to gonorrhoea rather than to violence, the medical 
 examiner should bear in mind that a gonorrheal discharge 
 does not make its appearance until between the fourth and 
 the eighth day, and is usually much more profuse and lasts 
 longer than the muco-purulent discharge incidental to rape. 
 In all alleged cases of rape it is important to determine 
 whether the accused be affected with gonorrhoea or syphilis, 
 since if the child be so diseased there would be strong 
 proof of the guilt of the accused. It is possible, however, 
 that either gonorrhoea or syphilis might be communicated 
 to young children either accidentally or intentionally by 
 means of sponges and towels that had been previously used 
 by persons affected with these diseases, and that advantage 
 
MEDICAL JUUISI'UIJDKNCK AND TOXICOLOGY. 
 
 L01 
 
 may be taken of this to accuse an innocent man of felonious 
 assault. In all cases of alleged rape, the clothing and 
 person of the female and of the accused should be carefully 
 examined for seminal stains, which stiffen the linen or 
 other wearing apparel very much as gum or albumen will 
 do. There are several methods by which seminal stains 
 can be identified, such as the yellow color assumed when 
 gently heated or when dissolved in weak nitric acid or by 
 the odor when moistened with warm water. 
 
 Fig. 24. 
 
 Fig. 25. 
 
 Spermatozoa of man : h, apparent 
 nucleus ; 6, body ; t, tail. 
 
 Trichomonas vaginalis, showiugthe 
 large heads, with granules and cilia. 
 
 The only positive proof of semen, however, is the pres- 
 ence of spermatozoa, as shown by the microscope. A 
 convenient method of obtaining the spermatozoa for micro- 
 scopic examination is to cut out a piece of the material 
 stained with the seminal discharge and place it in a watch- 
 glass containing distilled water. After the material has 
 been thoroughly soaked, a drop of the liquid should then 
 be transferred to a glass slide, and the latter placed on the 
 stage of the microscope. In case of examining the hair of 
 the female, to which the spermatozoa cling with great 
 tenacity, the hair should be moistened with a drop of weak 
 ammonia and examined with the microscope after the 
 
102 A MANUAL OF 
 
 liquid has evaporated. The spermatozoa (Fig. 24) present 
 a very characteristic appearance when viewed with the 
 microscope, though resembling somewhat the flagellate in- 
 fusoria, for which they were mistaken when first discovered. 
 A spermatozoon consists of an ovoidal head, which tapers 
 into a filamentary appendage or tail, about ten times as 
 long as the head, and which, when the spermatozoon is 
 alive, vibrates with astonishing rapidity. The spermatozoa 
 vary in number and size, measuring on an average between 
 the 5~5-oth and the -g^th of an inch. The movements of 
 the spermatozoa are arrested by water and cold, retarded 
 by acids, and stimulated by alkalies. The spermatozoa 
 retain individual life long after the death of the body ; 
 they may be seen moving about so long as from eighty to 
 one hundred hours after death. 1 Indeed, if the vaginal 
 mucus be examined even a week after sexual intercourse, 
 the spermatozoa may be sometimes found still living and 
 quite active. In the dried condition the spermatozoa may 
 be identified years after death. 
 
 Spermatozoa are found in the semen of man from the age 
 of puberty to a very advanced period of life — ninety years 
 and upward. Spermatozoa are often absent, however, in 
 the semen, for example, in that of young men addicted 
 to excessive venery or suffering from debilitating diseases. 
 The absence of spermatozoa from stains cannot, then, be 
 regarded as proof that such stains are not seminal in 
 origin. In old seminal stains, as the spermatozoa are fre- 
 quently found in fragments, the medical examiner should 
 be extremely cautious under such circumstances in not mis- 
 taking for them the fibres of organic bodies that might acci- 
 dentally be present. The only living animalcule that might 
 be mistaken for a spermatozoon is the trichomonas vagi- 
 1 Taylor: op. cit., p. 669. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 103 
 
 nalis (Fig. 25) occasionally found in the vaginal mucus of 
 
 uncleanly females. The trichomonas vaginalis is, however, 
 readily distinguished from a spermatozoon, in that its head 
 is much larger, granular, and armed with a row of from 
 four to six cilia. In connection with the subject of the 
 rape of children, it should be mentioned that death not 
 unfrequently results from mortification or peritonitis brought 
 on by violent laceration of the vagina or perineum. 
 
 Rape upon Adult Women. — In cases of alleged rape 
 upon adult women, the medical examiner may be ques- 
 tioned as to the possibility of a healthy, vigorous adult 
 woman being overcome by one man. No positive an- 
 swer should be giveu to so general a question, as all 
 such cases must be judged according to particular cir- 
 cumstances. The relative size of the man and woman, 
 whether the woman's life had been threatened, her con- 
 dition at the time, whether she was in full possession of her 
 faculties, or stupefied by drink, whether narcotized, hyp- 
 notized, or under the influence of anaesthetics, must all 
 be taken into careful consideration before the examiner 
 commits himself to the expression of a positive opinion. 
 The question has often been asked of the medical expert 
 whether a woman could be raped while asleep. The 
 Medical Faculty of Leipsic decided in 1669 that question 
 in the affirmative: "dormientem in sella virgiuem insciam 
 deflorari posse." Notwithstanding, it seems incredible 
 that a woman could sleep so soundly as to be unconscious 
 of having sexual intercourse. Such, indeed, was the 
 opinion of Valentin, who, in commenting upon the above 
 decision, shrewdly observes: " Non omnes dormiunt qui 
 clausos et conniventes habent oculos." x 
 
 1 Valentini, Michaelis Bernhardi: Novellas Medieo-legcdes, Frankfort 
 ad Moenuni, 1711, Introd. Part II., pp. 30, 31. 
 
104 A MANUAL OP 
 
 It should be mentioned, in this connection, that excit- 
 able, emotional women, under the influence of ether and 
 chloroform, especially if the period be that of their menses> 
 are very apt to imagine that they are having sexual inter- 
 course with their husbands, lovers, or even with the sur- 
 geon or dentist who may be operating upon them. So 
 true is this that it is of the utmost importance for surgeons 
 and dentists to insist upon the presence of witnesses during 
 the performance of operations upon women under the in- 
 fluence of anaesthetics. Indeed, in the absence of witnesses 
 under such circumstances, professional men have been 
 charged and convicted of rape, though without doubt en- 
 tirely innocent of the crime, and, extraordinary as it may 
 appear, even though the women were never at any time 
 examined medically. 1 Unfortunately, in the case of alleged 
 rape upon adult women, the medical examination usually 
 made is postponed so long that even if the crime has been 
 committed all traces of it have disappeared. If the woman 
 has offered much resistance, bruises will usually be found 
 upon the thighs and legs, and sometimes also upon the 
 arms and trunk. The most important proofs of rape upon 
 adult women are, however, derived from the condition of 
 the sexual organs and the hymen, and the presence of blood 
 and semen. Among such proofs may be mentioned the 
 soreness, swelling, laceration of the vulva and vagina, 
 rupture of the hymen, the presence of blood and semen 
 upon the persons and clothes of the woman and man. 
 
 But it must be remembered that frequently women 
 affected with leucorrhoea or vaginitis, in both of which dis- 
 eases there is a discharge from the vagina simulating that 
 produced by violence, take advantage of their condition to 
 charge innocent men with having committed rape upon 
 1 Philadelphia Medical Examiner, December, 1854, p. 705. 
 
MEDICAL JUKISPKUDENCE AND TOXICOLOGY. 105 
 
 them. Further, while the discharge in leucorrhcea is 
 mucous in character, that of intense vaginitis may be so 
 purulent as to make it impossible to distinguish it from 
 that of gonorrhoea. Under such circumstances, the fact 
 that a man has gonorrhoea would not be proof that he had 
 committed an assault upon the woman charging him with 
 rape, since the purulent discharge in the woman might be 
 due to vaginitis rather than to gonorrhoea acquired from 
 the man. 
 
 In the case of alleged rape upon adult women, as upon 
 children, much importance cannot be attached to the pres- 
 ence or absence of the hymen as disproving or proving a 
 rape, for the reasons already given. If there be, however, 
 other signs of violence, a ruptured or lacerated hymen 
 would be strong corroborative evidence of a rape having 
 been committed. 
 
 Rape upon the Dead. — Occasionally the medical exam- 
 iner may be called upon to determine whether a woman 
 found dead had been violated before death. In the absence 
 of witnesses, and in view of the fact that the prosecutrix can 
 make no statement, the evidence will be necessarily entirely 
 of a medical character. But in such cases, even if all the 
 signs of sexual intercourse were present, it would be im- 
 possible for the medical examiner to state whether the 
 woman had or had not given her consent. Even on the 
 supposition that the woman had been violated before death, 
 it might be impossible to state positively whether the rav- 
 isher and the murderer were one and the same person. 
 Indeed, a woman found dead and violated may have been 
 murdered first and violated afterwards, and not necessarily 
 by the same person, for, horrible as the thought may be, 
 violation of the dead is less rare than might be supposed. 
 Indeed, it was of such common occurrence in ancient times 
 that classical writers refer to the necessity of undertakers 
 
106 A MANUAL, OF 
 
 being watched to prevent them violating the bodies of 
 women committed to their charge. In the case of very 
 young girls found dead and violated, the probability is 
 that the child had been ravished and then murdered, the 
 ravisher hoping by that means to escape the consequences 
 of his crime. 
 
 It would hardly be supposed that a rape could or would 
 be committed by a female upon a male. As a matter of 
 fact, nevertheless, such cases have occurred. 
 
 Unnatural Grimes. — Though not germane to the subject 
 of this section, crimes against nature, committed either 
 with man or beast, unnatural crimes, sodomy, psederastia, 
 tribadism, bestiality, may as appropriately be considered 
 in their medico-legal relations here as elsewhere. While 
 of frequent occurrence in the East, such practices are 
 rare in America, and are criminal and punishable by 
 imprisonment for a term of years. In cases of sodomy 
 both parties are held to be equally guilty, unless the 
 person on whom the act was committed refused consent, 
 or was a minor, an idiot, or feeble-minded. In recent 
 cases laceration of the sphincter ani, bruises and fis- 
 sures, and blood about the anus may be observed. Un- 
 less, however, the examination be made very soon after 
 perpetration of the act, all traces will have disappeared. 
 Characteristic appearances are presented by persons addicted 
 to such practices. Among the most conspicuous may be 
 mentioned a funnel-shaped condition of the anus, which is 
 usually enlarged, smooth, and destitute of ruga?. 1 Chancres 
 and venereal warts are also not uncommonly present. 
 
 1 "Multo magis frequentem tarn nefande coitus usum significare 
 poterit ipsius. Podicis constitutio, qui cum ex Natura rugosus existat, 
 ex hnjus modi congressu laevis, ac planus efficitur, obliterantur enim 
 rugae illse in ani curriculo existerites, ob assiduam membri attritionem " 
 (Zacchias, Pauli: a, Quaestionum Medico-legqlium, Lib. v., Tit. i., Quaest. 
 i., p. 383; b, Lib. ii., Tit. ii., Quaest. ii., p. 288). 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 107 
 
 CHAPTER IX. 
 
 Signs of Pregnancy — Uncertainty of Duration of Pregnancy — Preco- 
 cious Pregnancy — Unconscious Pregnancy — Pregnancy in the Dead. 
 
 The subject of pregnancy is an important one medico- 
 legally, as women, on the one band, frequently deny that 
 they are pregnant, in order to avoid disgrace or to procure 
 an abortion, and on the other hand as often affirm that 
 they are pregnant, having no reason to think that they are 
 in that condition, in order to extort money, to defraud the 
 heir-at-law, to stay capital punishment, to avoid attendance 
 upon a trial, etc. Actions for damages against physicians 
 and others involving questions of pregnancy often arise in 
 cases in which it is claimed that errors in diagnosis were 
 committed, or that slanderous reports were circulated 
 against the character of a virtuous woman. A pregnant 
 female was exempted by the old Roman law from capital 
 punishment, 1 and the law is the same in most modern 
 countries. Hence, the summoning of twelve matrons or 
 discreet women in old times under the writ of de ventre 
 inspiciendo to determine whether a woman was pregnant 
 or quick with child — an office now performed by the city's 
 physician or by a jury of physicians. 
 
 The signs of pregnancy may be described as being of 
 two kinds : uncertain and certain. The former kind, as 
 the name implies, is, from a medico-legal point of view at 
 least, but of little importance as compared with the latter. 
 
 1 "Quod prsegnatis muiieris danmata? poena differatur quoad pariat" 
 (Beck, op. cit., vol. i. p. 250). 
 
108 A MANUAL OF 
 
 Among the uncertain signs of pregnancy may be men- 
 tioned the suppression of the catarnenia, morning sickness, 
 enlargement of the abdomen, quickening, development 
 of the breasts, kiesteine in the urine, the violet color 
 of the vagina. 
 
 Suppression of the menses, when occurring after inter- 
 course, only in a woman who had hitherto been regular, 
 may be regarded as a very probable sign of pregnancy. 
 As the menses may continue, however, throughout preg- 
 nancy, as they may only appear during that condition, as 
 they may never appear at all, even in women who bear 
 children, and as they are also absent in certain diseases, it 
 is evident that neither their absence nor their presence can 
 be regarded as a proof of pregnancy or non-pregnancy. 
 But it should be mentioned that not unfrequently women 
 desiring to conceal their pregnancy stain their linen with 
 blood and even with menstrual blood, borrowed for that 
 purpose. 
 
 Nausea is usually an accompaniment of pregnancy, 
 occurring frequently as early as the second or third week 
 after conception. It generally passes away about the 
 time of quickening, but may continue throughout the 
 whole period of pregnancy. In many cases of pregnancy 
 nausea is absent ; on the other hand, it is of frequent 
 occurrence in many diseases. But little importance can 
 therefore be attached to nausea alone as a sign of preg- 
 nancy. 
 
 The enlargement of the abdomen in a pregnant woman 
 becomes evident at the end of the third month, the 
 uterus then rising out of the pelvic cavity. By the end 
 of the fifth month the uterus is halfway between the 
 pelvis and the umbilicus, and at the sixth month at the 
 umbilicus. During the seventh month it is at a point 
 
MEDICAL JURIS PRUDE NO K AND TOXICOLOGY. 109 
 
 midway between the umbilicus aud ensiform cartilage, 
 reaching at the end of the eighth month the ensiform 
 cartilage. During the last month the tumor widens and 
 falls forward. Enlargement of the abdomen may be due, 
 however, to ovarian dropsy and tumors, ascites, flatus of 
 the intestines, impacted feces, enlargement of the spleen 
 and kidney, and distention of the bladder. The medical 
 examiner would certainly not be justified, therefore, in 
 expressing the opinion that a woman was pregnant simply 
 because there was enlargement of the abdomen. 
 
 Quickening is the first perception by the mother of the 
 movements of the foetus. These movements, which occur 
 usually some time between the sixteenth and the twenty- 
 fourth week, may be due either to the uterus or to the 
 foetus. Nervous, excitable women, especially those want- 
 ing children, frequently imagine, however, they are preg- 
 nant, mistaking the movements of their intestines or 
 the contractions of their abdominal muscles for those 
 of a foetus. Quickening, being entirely a subjective 
 symptom, is, therefore, a very unreliable sign of preg- 
 nancy. 
 
 The breasts usually develop during the period of preg- 
 nancy, becoming larger and fuller as the secretion of milk 
 increases. Large veins make their appearance, the nipples 
 become more prominent, the areola widens and darkens in 
 hue, especially in brunettes. Enlargement of the breasts, 
 however, is not a proof of pregnancy, inasmuch as it occurs 
 in cases of uterine fibroids, and in various other ovarian 
 aud uterine disorders. Even the secretion of milk would 
 not warrant the statement that a woman was pregnant, 
 since milk is secreted occasionally by unimpregnated 
 women, young girls, and even by men. Indeed there have 
 been cases in which the secretion of milk bv men has been 
 
110 A MANUAL OF 
 
 so copious that they have been able to perform, for years, 
 the office of wet-nurse. 1 
 
 By kiesteine is understood the fatty pellicle which forms 
 on the urine of pregnant women that has been standing 
 some days. It appears to consist of a combination of 
 casein and phosphates. As kiesteine is not peculiar to the 
 urine of pregnant women, being found sometimes in the 
 urine of men, its presence cannot be regarded as a proof 
 of pregnancy. The violet color of the vagina, appearing 
 about the fourth week of gestation, due to venous conges- 
 tion, may be regarded as a valuable sign of pregnancy, 
 but an uncertain one, since it is not invariably present. 
 
 Ballottement. — Among the so-called "positive signs" of 
 pregnancy are included ballottement, change in the body 
 and cervix of the uterus, the active movements of the 
 child, the pulsation of the foetal heart, the uterine and 
 umbilical sounds. By ballottement is determined the pres- 
 ence of a foetus about the fifth or sixth month of pregnancy. 
 In performing it, the woman is made to stand upright and 
 the finger of one hand is introduced into the vagina up to 
 the os uteri, while the other hand is placed upon the abdo- 
 men, so as to steady the uterine tumor. If the tip of the 
 finger be now suddenly pushed up against the os uteri, a 
 sensation, should a foetus be present, will be felt like that 
 of a body rising and falling in a liquid. This is, how- 
 ever, an uncertain sign of pregnancy, since any floating 
 tumor in the uterus will impart the same sensation to the 
 finger as that due to the foetus. 
 
 At about the fifth month of pregnancy, the os uteri 
 
 is directed backwards, and has a velvet-like feeling ; the 
 
 shortening of the cervix becomes evident at this time and 
 
 continues until the ninth month, when the cervix ceases 
 
 1 Dunglison : Human Physiology, eighth edition, vol. ii. p. 520. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. Ill 
 
 to be distinguishable from tlic body of the uterus. The 
 active motions of the child can usually be felt about 
 the fifth month of pregnancy, or even earlier, by 
 placing a cold hand upon the surface of the abdomen. 
 Intestinal movements must not be mistaken, however, 
 for those of a foetus. It should be remembered also that 
 not unfrequently in cases of pregnancy the movements 
 of the foetus are not perceptible. 
 
 The uterine sound, a peculiar blowing or whistling 
 sound, synchronous with the maternal pulse, and due 
 probably to the passage of blood through the uterine 
 arteries and placental vessels, can usually be heard over 
 most of the abdomen as early as the middle of the third 
 month of pregnancy, but more distinctly as pregnancy 
 advances. As uterine sounds can, however, be heard in 
 cases of enlargement of the uterus as from tumors, such 
 signs are very unreliable signs of pregnancy, and the same 
 may be said of the umbilical sounds due to the flow of 
 blood through the umbilical vessels. 
 
 Pulsation of the Foetal Heart. — Indeed, of all the so- 
 called " certain signs " of pregnancy, the pulsation of the 
 foetal heart is the only certain and positive one, and then 
 only when it can be so distinctly heard as to be counted. 
 The foetal sound is not synchronous with the pulse of the 
 mother, the foetal heart beating at a rate of one hundred 
 and thirty-six beats to the minute, and even faster. It 
 resembles the ticking of a watch, and is heard over different 
 parts of the abdomen, but best between the ilium and the 
 umbilicus on either side. It may be heard as early as 
 the middle of the fifth month, but much more distinctly 
 as pregnancy advances. 1 
 
 1 Scanzoni: Lehrbueh der Geburtshulfe, Vierte Auflage, "Wien, 1867, 
 vol. i. S. 160. 
 
112 A MANUAL OF 
 
 Corpus Luteum. — Importance was attached at one time 
 to the presence or absence of a corpus luteum, or the yellow 
 body developed through modification of the lining mem- 
 brane and contents of the Graafian follicle from which an 
 ovum had escaped, as proving or disproving pregnancy. 
 A foetus is not unfrequently found, however, in the uterus 
 where there is no trace of a corpus luteum in either ovary ■ 
 and, on the other hand, a well-developed corpus luteum, 
 undistinguishable from that of pregnancy, may be found 
 in the ovary of a woman who had never been pregnant, 
 and even in that of a virgin. The presence or absence 
 of a corpus luteum cannot then be regarded as having 
 any importance in medico-legal cases involving questions 
 of pregnancy. 
 
 Responsibility of Mistaken Diagnosis. — As the so-called 
 "certain signs" of pregnancy, with the exception of the 
 pulsation of the foetal heart, are only relatively more cer- 
 tain than the uncertain signs, the medical examiner should 
 be extremely cautious, under any circumstances, in stating 
 positively that a woman is pregnant, and especially if she 
 be unmarried and of previously good character. On more 
 than one occasion has the reputation of a virtuous woman 
 been ruined and the happiness of her family destroyed by 
 a too confident examiner mistaking a condition of disease 
 for that of pregnancy. When once the virtue of an inno- 
 cent woman has been thus impugned, and her previously 
 good character taken away, though in time the injustice 
 of the charge will surely be proved, reparation will come 
 too late, and no atonement can be made for the wrong 
 done the woman or the misery inflicted upon her family. 
 Apart from the injury due to a mistake in diagnosis under 
 such circumstances, the examiner should remember that as 
 
Plate l. 
 
 Fig. 1.— Ovary of woman two days after menstruation, showing earliest stages of trans- 
 formation of a ruptured and bloody Graafian follicle into a corpus luteum. 
 
 Fig. 2.— Ovary of woman nine days after menstruation: the dark spot is the cicatrice- 
 the surrounding yellow circle is the corpus luteum shining through the transparent tissue" 
 
 Fig. 3.— Ovary of woman at term of pregnancy, showing corpus luteum with firm white 
 central clot. 
 
 Fig. 4.— Ovary of woman twenty davs after menstruation: besides laree fresh corpus 
 luteum are seen two smaller old ones, and Graafian follicles of different sizes (Daltox). 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 1 L'3 
 
 the best obstetricians may be mistaken, his own reputation 
 as a medical expert may be at stake. 
 
 Cases of supposed pregnancy differ in one respect from 
 other cases demanding the attention of the medical jurist 
 — namely, there is no necessity that a positive opinion 
 should be expressed upon the subject. No harm can result 
 from the medical examiner refusing to state positively 
 whether a woman is pregnant or not. It is far better to 
 give the woman, if unmarried and of good character, the 
 benefit of the doubt, than positively commit yourself to 
 the expression of an erroneous opinion in the case. It 
 should always be remembered that nature will soon answer 
 so positively the question whether a woman is or is not 
 pregnant that there will be no necessity of the examiner 
 weighing the relative value of the uncertain and certain 
 signs of pregnancy. 
 
 Duration of Pregnancy. — The determination of the dura- 
 tion of pregnancy under certain circumstances, as in cases 
 involving questions of legitimacy and inheritance, may be- 
 come a matter, medico-legally, of the greatest importance. 
 It may as appropriately be mentioned here as elsewhere that 
 the ordinary period of gestation is nine calendar months 
 (270 to 276 days), or ten lunar months (280 days), the physi- 
 ological presumption being that parturition occurs at the 
 period which would correspond to the tenth menstrual pe- 
 riod since the last one. The greatest difference of opinion 
 prevails, however, as to what shall constitute the longest 
 and shortest possible periods of gestation. The difference 
 of opinion in this respect depends to a great extent upon 
 our ignorance as to the exact moment of conception. As 
 conception may take place at any moment of the period 
 intervening between the menses, it is evident that there 
 may be a difference on this account alone of twenty-eight 
 8 
 
114 A MANUAL OF 
 
 days in the period of gestation, according as conception was 
 supposed to have taken place immediately before the period 
 at which the menses would have occurred had not concep- 
 tion taken place, or immediately after the last menses 
 which actually did occur. Further, the duration of preg- 
 nancy varies very much in different women on account of 
 personal idiosyncrasies, as well as on account of other 
 causes not understood. Obstetricians have claimed that 
 mature children have been born as early as from 210 
 to 217 days, 1 and as late as from 313, even to 325, 
 days after sexual intercourse, there being a difference 
 between these very exceptional extremes of as much as 
 96 days. Cases are not rare, however, in which the 
 difference in the duration of gestation in cases of mature 
 children amounts to as much as 44 days, the two ex- 
 tremes of gestation being 249 and 293 days respectively. 
 It should be mentioned in this connection that while a child 
 born after a period of protracted gestation is neither larger 
 nor better developed than one born after the average period, 
 a child born only seven months after sexual intercourse is 
 always immature and imperfect — readily distinguishable 
 from one born after the average period. 2 It is for this 
 reason that the statement that a mature child is born seven 
 months after sexual intercourse must be regarded as most 
 exceptional. In tropical countries women become preg- 
 nant at a much earlier age than in temperate climes. Thus, 
 in India and Abyssinia it is no uncommon occurrence for 
 girls of only eleven and twelve years of age to bear children. 
 Pregnancy has been known to occur, however, even in 
 children of only eight and nine years of age. On the other 
 
 1 Beck : op. cit., vol. i. p. 599. 
 
 2 Montgomery : Signs and Symptoms of Pregnancy, second edition, 
 London, 1856, pp. 523, 546. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. L15 
 
 hand, it is well known that women of from fifty to sixty 
 years of age and even older have borne children, giving 
 birth to twins, in some rare instances, even at that advanced 
 age. 
 
 Unconscious Pregnancy. — Under certain circumstances 
 it may become a question whether a woman can become 
 pregnant while unconscious. There can be no doubt of the 
 possibility of such an occurrence, as it is well known that 
 women have borne children in consequence of having 
 been ravished when in a state of unconsciousness induced 
 by the use of narcotics or anaesthetics. 
 
 Pregnancy in the Dead. — It not unfrequently occurs that 
 the medical examiner is required to determine whether a 
 woman was pregnant at the time of her death, as, for exam- 
 ple, in cases where the charge is that of seduction and murder. 
 In considering the subject of putrefaction, it will be remem- 
 bered that attention was called to the remarkable fact that 
 the unimpregnated uterus will resist decomposition longer 
 than any other organ in the body months after burial ; 
 therefore, it becomes possible to say whether a woman died 
 pregnant or not. On the other hand, even after years of 
 interment, if the woman died pregnant and the foetus had 
 reached the period of ossification, traces of its bones will 
 be found among those of its mother. 
 
116 A MANUAL OF 
 
 CHAPTER X. 
 
 Foeticide — Development of Embryo — Formation of Placenta, of Moles 
 — Changes Undergone by the Uterus during Pregnancy — Of the 
 Means of Producing Foeticide — Abortion from Natural Causes. 
 
 The unlawful expulsion of the foetus constitutes foeticide, 
 or criminal abortion. By the term abortion or miscarriage 
 is understood, medically, the expulsion of the foetus before 
 the seventh calendar month of gestation ; that is, before it is 
 viable or would survive. After this period the expulsion 
 is called " premature labor." Legally, however, such a dis- 
 tinction is not made; the unlawful expulsion of the foetus at 
 any period of gestation being regarded as abortion. At one 
 time the law also recognized a distinction between an abor- 
 tion produced before and after quickening, the punishment 
 being more severe in the latter than in the former instance. 
 At the present time the criminality of the act is the same, 
 whatever may be the period of gestation at which the 
 abortion is committed. 
 
 Foeticide, although an extremely common crime, rarely 
 becomes the subject of trial unless it involves the death of 
 the mother, in which case it is regarded as murder. The 
 proofs that a criminal abortion has been committed are 
 derived from the condition of the foetus or fcetal remains, 
 whether expelled from the uterus or still retained within 
 it, and from the condition of the mother. 
 
 Development of the Human Embryo. — The human em- 
 bryo, 1 at one of the earliest periods of development yet 
 obtained, that is, about from ten to fourteen days after con- 
 ception, consists (Fig. 26) of a tube, the primitive neural 
 canal, more or less open on top; from the under part of 
 
 1 Haeckel : Anthropogenie, Vierte Auflage, Erster Theil, Leipzig, 1891, 
 S. 365. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 117 
 
 which hangs a globular-like bag. The latter, through subse- 
 quent constriction, divides into an upper and lower portion 
 
 Fig. 27. 
 
 Fig. 26. 
 
 Human embryo, natural size, fourteen 
 days old (Haeckel). 
 
 Fig. 28. 
 
 Human embryo, magnified ten 
 times, about ten days old : a, um- 
 bilical vesicle ; c, b, d, primitive 
 spinal cord ; e, remains of amnion 
 (Haeckel). 
 
 Human embryo, natural size, three 
 weeks old (Haeckel). 
 
 continuous with each other, which become respectively the 
 primitive alimentary canal and the umbilical vesicle. 
 
 The embryo, not longer than the one-twelfth of an inch, 
 and inclosed within the amniotic folds, does not lie naked 
 within the uterus ; but within the zona pellucida (Fig. 27) or 
 the original membrane which inclosed the yelk, or the con- 
 tents of the egg. The zona pellucida being covered, however, 
 with little villous-like processes, is now known and hence- 
 forth as the chorion. By the 21st day of uterine life the 
 embryo (Figs. 28, 29), having attained a length of about the 
 
118 
 
 A MANUAL OF 
 
 one-sixth of an inch, rudimentary eyes and ears, the mouth, 
 three cerebral vesicles, bronchial arches and clefts, umbilical 
 vesicle, allantois and amnion are all developed. At the end 
 of the first month, the embryo, being one-half an inch 
 
 Fig. 29. 
 
 Fig 30. 
 
 Human embryo magnified, 
 three weeks old : a, eye ; m, 
 mid-brain; o, ear; k, visceral 
 arches ; c, heart (Haeckel). 
 
 Human embryo, natural size, six weeks 
 old (Haeckel). 
 
 long and weighing perhaps about twenty grains, is still 
 further developed and is provided with rudimentary limbs. 
 By the end of the sixth week the embryo (Fig. 30) has 
 grown larger, and the limbs are better developed, attaining 
 at the end of the second month (Fig. 32) a length of one 
 inch, and weighing about one-eighth of an ounce. The 
 fingers aud toes are also now indicated, and ossification 
 has begun in the lower jaw, clavicle, ribs, and vertebral 
 bodies. At the third month the embryo (Fig. 31) varies 
 in length from 2 to 4 inches and weighs from 1 to 4 
 ounces ; the sex can usually be distinguished by the ex- 
 ternal genitalia, and the placenta is beginning to be formed. 
 Formation of the Placenta. — It will be observed that the 
 
Plate 'J. 
 
 sa.ss° 
 
 - •- -. ■- 
 
 • -. > ; 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 119 
 
 villous processes of the chorion, which have hitherto cov- 
 ered the latter membrane throughout its whole extent, are 
 now limited to that portion of it in contact with the de- 
 cidua scroti na, or that part of the hypertrophied mucous 
 membrane of the uterus into which the villous process s 
 
 Fig. 31. 
 
 Human embryo, natural size, three months old. (Haeckel.) 
 
 of the chorion still remaining insinuate themselves. The 
 fusion of the two constitutes the placenta (PI. 2, Fig. 1). 
 Of the remaining portion of the hypertrophied mucous 
 membrane of the uterus, that part which ultimately grows 
 around the ovum is known as the decidua reflcxa, and 
 
120 
 
 A MANUAL OF 
 
 that in contact with the wall of the uterus, the decidua 
 vera. 
 
 The villous processes of the chorion, when examined 
 with the microscope, present so characteristic an appearance 
 (Fig. 33) that their presence may be accepted as positive 
 
 Fig. 32. 
 
 Fig. 33. 
 
 mm.' 
 
 Human embryo magnified, eight Compound villosity of human 
 
 weeks old : v, fore-brain ; m, mid- chorion, ramified extremity : from 
 
 brain; h, hind-brain; n, after-brain; a three months' foetus, magnified 
 
 c, heart ; /, upper extremity ; b, lower thirty diameters (Dalton). 
 extremity ; s, tail (Haeckel). 
 
 proof of the existence of the embryo, even if not a trace of 
 the latter be found. 1 The general appearance of a villous 
 process is like that of a sea-weed originating in the cho- 
 rion by a trunk which divides and subdivides into filament- 
 ous branches, swollen here and there, terminating in 
 rounded bulbous extremities, and consisting internally of 
 a finely-granular substance containing nuclei. At first the 
 
 1 Dalton, John C. : Human Physiology, seventh edition, Philadelphia, 
 1882, p. 647. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 121 
 
 villou.s processes of the chorion arc without bloodvessels, 
 but with the development of the allautois they become vas- 
 cular through prolongation of the terminal allantoic vessels, 
 which are disposed in loops. The placenta (PI. 2, Fig. 2) 
 or after-birth, consisting essentially of the interlacement of 
 the bloodvessels of the embryo with those of the mother, 
 is a flattened fleshy, vascular, dish-like mass, round or ovoid 
 in shape and with a diameter of from six to eight inches. 
 It is the organ by means of which food and oxygen are 
 conveyed from the blood of the mother to that of the 
 embryo. The process by which this is accomplished is, 
 however, by osmosis, as there is never at any period of 
 gestation an anastomosis of the maternal and foetal blood- 
 vessels. 
 
 Such being the structure and development of the pla- 
 centa, it is evident that, just in proportion as the foetal and 
 maternal portions of the placenta become more and more 
 intimately fused together, the greater will be the difficulty 
 experienced and risk run in the expulsion of the foetus from 
 the uterus. It is for this reason that an abortion committed 
 after the third month of gestation may be attended with such 
 fatal consequences, the hemorrhage resulting from the rup- 
 ture of the bloodvessels being at times very great. Indeed, 
 at a late period of gestation the maternal bloodvessels become 
 dilated into great sinuses, veritable blood lakes. On the 
 other hand, if gestation has not advanced beyond the third 
 month, the embryo may, under certain circumstances, be 
 expelled entire from the uterus, very much as a glove is 
 removed from the fingers, without any serious conse- 
 quences. 
 
 Subsequent Changes Undergone by the Human Embryo. — 
 The subsequent changes undergone by the embryo during 
 the last six months of pregnancy are of interest, medico- 
 
122 A MANUAL OF 
 
 legally, as enabling the examiner to state the probable 
 age of a foetus obtained from a supposed case of abortion. 
 At the fourth month the fcetus is 5 to 6 inches long and 
 weighs about 3 ounces, the umbilical cord measuring 
 about 7 inches in length. At the fifth month the foetus 
 has attained a length of 6 to 7 inches, weighs from 5 to 
 7 ounces, and is covered with the vernix caseosa ; the hair 
 of the head and body, or lanugo, is quite distinct, and 
 the umbilical cord is about 12 inches long. If abor- 
 tion occurs at this period of gestation, the membranes 
 are first ruptured, and then the foetus is expelled from 
 the uterus. At the sixth month of pregnancy the foetus 
 varies in length from 9 to 10 inches, weighs a pound 
 or more, and meconium is usually found in the intestines. 
 At the end of the seventh month the foetus is usually 
 14 inches long, weighs two and a half to three pounds, 
 the eyes are open, the membrane of the pupil is disappear- 
 ing, one testicle has descended into the inguinal canal. If 
 the child should be born at this period, the arms and legs 
 will be bent in the position they assumed in the womb, 
 and it will be viable. At the eighth month the foetus is 
 sixteen inches long, weighs between three and four pounds ; 
 the skin has become thicker, and is covered with fine soft 
 hair ; one testicle, usually the left, has descended into the 
 scrotum. At the end of the ninth month, or at full term, the 
 foetus varies in length from eighteen to twenty inches, and 
 weighs on an average seven pounds. The intestines are 
 nearly filled with meconium; the bladder contains urine; 
 both testicles have descended into the scrotum. 
 
 As aiding in determining the age of the foetus, it may be 
 mentioned that at full term the umbilical cord is usually 
 inserted about eight to ten lines below the centre of the 
 body ; whereas, at an earlier period of gestation, the point 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 123 
 
 of insertion is at the middle of the body. The general 
 development of the brain, the extent to which the cere- 
 bellum is covered by the cerebrum, the particular fissures 
 that are present will also serve to determine the age of the 
 foetus. The importance of the presence or absence of an 
 osseous deposit in the inferior epiphysis of the femur has 
 already been referred to (p. 45). It should be mentioned, in 
 connection with the subject of the length and weight of the 
 foetus at full term, that these may vary considerably. 1 Thus, 
 for example, it is well known that children have been 
 born at full term who measured as much as twenty-four 
 and even thirty-two inches, and who weighed as much as 
 seventeen and three-quarter pounds, 2 and eighteen pounds 
 and two ounces, 3 respectively. On the other hand, chil- 
 dren at full term not unfrequently weigh only from four 
 to six pounds. There is usually no difficulty experienced 
 in recognizing an embryo in situ, or even amid the 
 contents expelled from a uterus in cases of abortion, 
 unless the latter be committed in the very early periods 
 of gestation. 
 
 Holes. — Under certain circumstances the medical ex- 
 aminer may be called upon to determine whether peculiar 
 growths, either formed in the uterus or expelled from it, 
 are polypi or membranous in character, as due to dys- 
 menorrhea, or what are known as molesS It is most 
 important that the true nature of the latter, when present, 
 should be recognized, as moles, being due to disease of the 
 
 1 As to variability in size and weight presented by the foetus at differ- 
 ent periods of intra-uterine life, compare Casper, vol. iii. pp. 15-17 ; 
 Guy and Ferrier, p. 88; Tidy, part ii. p. 59; Wharton and Stille, 
 vol. iii. p. 75; Woodman and Tidy, pp. 647, 712. 
 
 2 Owens : Lancet, December, 1838, p. 477. 
 
 3 Meadows : Medical Times and, Gazette, August 4, 1860, p. 105. 
 
 4 Montgomery : op. cit., pp. 255, 269, 326, 353. 
 
124 A MANTJAL OF 
 
 placenta or of the foetal membranes, are as much proof 
 of a pregnancy having existed as the presence of the 
 embryo itself. Moles, when due to disease of the placenta, 
 are either fleshy or fatty. A fleshy mole consists of layers 
 of a fibrinous material inclosing a cavity in which the 
 remains of the foetus are sometimes formed. While the 
 cause of fleshy moles is obscure in some instances, they 
 appear to be due to hemorrhage into the chorion. A fatty 
 mole differs more particularly from a fleshy one, in that a 
 fatty degeneration is an accompaniment of the early death 
 of the foetus. The hydatiform, or vesicular mole, is due to 
 the villous processes of the chorion becoming infiltrated with 
 serum, and hanging in masses like bunches of grapes. A 
 true hydatid — that is, a helminth of the uterus — is exceed- 
 ingly rare ; indeed, it is very doubtful if it has ever been 
 found. 
 
 The proofs of an abortion having been committed, as 
 derived from an examination of the mother, are not 
 very positive, if the act has been performed at an early 
 period of pregnancy. The hemorrhage and relaxed con- 
 dition of the vagina, for example, and the somewhat dilated 
 condition of the os uteri, might be attributed to menstru- 
 ation. If the pregnancy was, however, far advanced at 
 the time of the occurrence of the abortion, the proofs will 
 usually be sufficiently strong to establish the fact. It is 
 far more difficult, therefore, for a woman to conceal her 
 pregnancy and the fact that an abortion had been com- 
 mitted to save her from exposure, at a late period of ges- 
 tation than at an early one. If death follows within three 
 days after abortion, the post-mortem examination will 
 generally establish the fact that an abortion was committed. 
 If several weeks, however, have elapsed, little or nothing 
 will be learned by the autopsy, as the parts involved will 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 125 
 
 have usually reassumed by that time their usual con- 
 dition. 
 
 Determination of Foeticide. — In every case of foeticide 
 the vagina and uterus should most carefully he exam- 
 ined for metritis and marks of violence which might 
 have been produced by the use of instruments. Wounds 
 of the vagina would rather indicate that they had not 
 beeii made by a professional abortionist, but by one 
 who was inexperienced in such work and who had been 
 rendered nervous in attempting to perform the opera- 
 tion. If the neck of the uterus or its fundus be found 
 perforated, or the placenta wounded, the inference to be 
 drawn would be that pointed instruments had been used, 
 though not necessarily, since fatal wounds have been 
 also inflicted by blunt instruments. The most common 
 causes of death in cases of abortion as produced by instru- 
 mental violence are hemorrhage and peritonitis. The 
 stomach and intestines should also be carefully examined 
 in cases of foeticide, as they present, not unfrequently, 
 evidence that irritant poisons have been taken. Remains 
 of cantharides, tops of savin, ergot may be found ; or the 
 oils of savin, tansy, pennyroyal may be recognized by their 
 odor or by appropriate chemical means, such as distillation, 
 etc. The shape and size of the uterus should be carefully 
 noted in cases of foeticide, as they enable the examiner to 
 determine approximately at least the age of the fcetus. 
 
 The normal uterus in the unimpregnated condition meas- 
 ures about two and a half inches in length, one inch and three- 
 quarters in breadth, and one inch thick. As pregnancy 
 advances, the uterus increases gradually in size — very little 
 change being noticeable, however, during the first month. 
 During the second month, the increase is considerable, 
 By the end of the third month it has attained a length of 
 
126 
 
 A MANUAL, OF 
 
 five inches, including one inch for the cervix. At the end 
 of the fourth month, the uterus is five inches long from 
 the fundus to the beginning of the cervix, and at the end 
 of the fifth, sixth, and seventh month it is six, seven, and 
 eight inches long, respectively. At eight months the 
 uterus varies in length from nine to nine and a half inches, 
 and at nine months from between ten and a half to twelve 
 inches in its total length. While the thickness of the 
 walls of the uterus at full term is about the same as that 
 in the unimpregnated condition, or from one-third to 
 
 Fig. 34. 
 
 Fig. 35. 
 
 Cervix uteri (at about the sixth 
 month of utero-gestation) showing 
 little or no absorption. 
 
 Cervix uteri (at about six weeks 
 later than Fig. 34) showing evident 
 absorption. 
 
 two-thirds of an inch within a few hours after delivery, 
 they may become, through contraction, at least two inches 
 thick. 
 
 The changes in the shape of the uterus presented at 
 different periods of gestation are also very characteristic. 
 From being flat and pyriform, the uterus, after impregna- 
 tion, becomes globular ; the cervix also, as already men- 
 tioned, gradually shortens towards the end of the fifth 
 month, losing about a quarter of its length each succeed- 
 
MKDICAL JURISPRUDENCE AND TOXICOLOGY. 127 
 
 ing month, until, at the end of the ninth month, it has 
 disappeared entirely (Figs. 34, 35, 36), the form of the 
 uterus being then ovoid. After delivery at full term the 
 uterus begius usually to contract, its size being reduced 
 within two days to six inches in length and four in breadth. 
 
 Fig. 36. 
 
 Cervix entirely disappeared and expanded over uterine contents. 
 
 By the end of the first week it has so contracted as to 
 measure usually from 5 to 6 inches in length. At the end 
 of the second week the uterus is about four inches long 
 and one and a half inches broad. By the end of the sec- 
 ond month it has returned to its normal size. In those 
 cases, however, in which death occurring at full term is 
 due to hemorrhage, no contraction of the uterus will have 
 taken place. If the woman, however, has survived for a 
 few days, the uterus will be found more or less contracted. 
 During pregnancy the round ligaments and Fallopian tubes 
 increase in size and become more vascular ; the broad 
 ligaments are gradually effaced through the great develop- 
 ment. 
 
 Means of Producing Foeticide. — Among the means 
 first tried by women to bring on a miscarriage may be 
 mentioned the effects of violence, such as submitting 
 to a severe beating, jumping from high places, as tops 
 of fences, gates, etc., venesection, emetics, and drastic ca- 
 
128 A MANUAL OF 
 
 thartics. 1 As a general rule, however, except in the case 
 of very feeble or weakly women, or in those who are pre- 
 disposed to miscarriage, such measures fail to produce an 
 abortion. The emmenagogues, or the drugs known popu- 
 larly as abortives, are then next resorted to, on account of 
 the power they are supposed to possess of inducing uterine 
 contractions and of thus causing the expulsion of the foetus. 
 Among these the most commonly used may be mentioned ' 
 ergot or spurred rye, cotton-root, savin, or the tops of the 
 juniperus sabina, tansy, pennyroyal, and rue. But large 
 doses may be taken of these drugs without causing uterine 
 contraction, while the oils of savin and tansy have 
 frequently caused death, through gastritis or peritonitis 
 being produced through their irritant properties. 
 
 All such means having failed to produce an abortion, 
 instrumental violence, as a last resource, is made use of as 
 the only certain means of inducing uterine contractions 
 and of so insuring the expulsion of the foetus. The rupture 
 of the foetal membranes, however skilfully preformed, is a 
 most dangerous operation, always liable to be followed by 
 the most serious, if not fatal, consequences, death being 
 frequently caused, as already mentioned, by either hemor- 
 rhage or peritonitis. When the operation is performed by 
 a professional abortionist, long, narrow, sharp-pointed in- 
 struments are made use of, but when self-inflicted, which 
 is not unfrequently the case, the woman uses any articles 
 that may serve her purpose, such as knitting-needles, pen- 
 holders, long wires, glove-stretchers, etc. 
 
 Abortion from Natural Causes. — It should be mentioned, 
 in connection with the subject of foeticide, that abortion very 
 frequently results from natural causes. Indeed, with some 
 
 lr rardieu: Etude Medico-legale sur I' Avortement, troisieme edition^ 
 Paris, 1868, pp. 28, 99. 
 
MEDICAL JUE1SPEUDENCE AND TOXICOLOGY. 12!) 
 
 women it appears to be habitual, abortion occurring at every 
 pregnancy, especially in theearly months of gestation, though 
 every effort has been made to prevent it. As might be ex- 
 pected, the tendency to abortion is most marked at the men- 
 strual periods. Predisposition to abortion appears to be due 
 to causes which affect the mother, such as syphilis, small- 
 pox, albuminuria, etc., or those which affect the child, as 
 death of the ovum, disease of the placenta. Advantage 
 is no doubt often taken of this natural tendency to abort by 
 producing abortion criminally. As natural abortion usually 
 occurs at about the third or fourth month of pregnancy, 
 and as this period is also the one at which a criminal 
 operation is performed, the fact that the foetus comes away 
 entire would indicate that the abortion was due to natural 
 causes, or at least not to instrumental violence. If, how- 
 ever, the foetus be expelled first and the ruptured mem- 
 branes afterwards, the conclusion would be that instruments 
 had been used. 
 
 Abortion may sometimes be feigned by women, in order 
 to extort money on the charge of seduction and consequent 
 pregnancy. The examination of the woman will usually 
 be sufficient, under such circumstances, to disprove the 
 charge. The criminality of foeticide is not excused by the 
 fact that the woman was not pregnant, or by the fact that 
 the pregnancy was extra-uterine. Under certain circum- 
 stances it may become necessary to perform an abortion, as 
 in cases, for example, where the deformity of the pelvis 
 makes the delivery of a living child at full term a physical 
 impossibility. In all such cases the attending physician 
 should insist upon a consultation being held ; and the 
 patient and her family, should be fully informed as to the 
 nature of the case before so serious an operation is under- 
 taken. 
 
 9 
 
130 A MANUAL OF 
 
 CHAPTER XI. 
 
 Infanticide — Live Birth — Appearance of Infant Born at Full Term — 
 Means of Determining whether Child has Breathed — Docimasia Pul- 
 monum — Objections to Hydrostatic Test — Docimasia Circulationis — 
 Size of Liver and Contents of Stomach in New-born Child— Exam- 
 ination of Mother — Signs of Recent Delivery — Means by which 
 Infanticide is Committed. 
 
 By infanticide is meant, medico-legally, the murder 
 of the new-born child, it being immaterial whether the 
 child is murdered immediately or a few days after its 
 birth. The law assumes, until it is proved to the con- 
 trary, that every child is born dead, on account of the 
 fact that so many children are brought into the world who 
 are either dead or die shortly after birth. Inasmuch as 
 this is the law, the prosecution, and not the defendant, 
 must prove that the infant alleged to have been murdered 
 was born alive. For this reason great difficulty is usually 
 experienced in convicting a woman charged with the crime 
 of infanticide. Apart from this difficulty she is often de- 
 livered in the absence of witnesses, or the child is con- 
 cealed or destroyed. The jury also sympathizes to such an 
 extent with a woman accused of this crime that conviction 
 cannot easily be secured. Medico-legally, to be born alive 
 implies complete expulsion of a living child from the 
 mother. 1 A child, for example, is not born alive if any 
 portion of it, except the umbilical cord, is retained within 
 the vulva. By this figment of the law, therefore, the de- 
 struction of a living child, if only partly born, does not 
 constitute murder. 
 
 1 Guy and Ferrier: op. cit., p. 101; Tidy: op. cit., part ii. p. 248; 
 Taylor: op. cit., p. 592. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 131 
 
 Appearance of an Infant Born at Full Term. — In 
 infanticide the child is generally born at full term. But, 
 inasmuch as children are frequently brought into the 
 world at an earlier period of gestation, either by natural or 
 artificial means, it is important for the medical examiner, 
 in cases of infanticide as well as of foeticide, to be able to 
 state, from an inspection of the infant, its probable age at 
 birth. The general appearance presented by an infant 
 born alive at full term is as follows : Remains of the 
 vernix caseosa or sebaceous matter are usually found be- 
 hind the ears and under the arm-pits ; the hair is dry and 
 clean ; the eyes are half open, and cannot be kept closed ; 
 the ears do not lie close to the head ; the caput succedaneum, 
 or swelling on the back of the head, is well marked ; the 
 thorax is distinctly arched, and the diaphragm much de- 
 pressed. A dead-born child is usually covered with the 
 vernix caseosa ; the hair is agglutinated ; the eyes are 
 closed ; the ears lie close to the head ; the thorax is flat- 
 tened and unexpanded ; the lungs lie in the posterior part 
 of the thorax, are granular, and do not crepitate upon 
 pressure. 
 
 In case of the death of the foetus some time before 
 birth, the body will be found flaccid and flattened, as if 
 it had been macerated ; the cuticle may be more or less 
 detached, especially upon the abdomen ; the head lies flat, 
 howsoever it may be placed, the cranial bones moving 
 readily upon one another; the cellular tissue is infiltrated 
 with bloody serum. The proofs of a child having breathed, 
 and therefore of having lived, though not necessarilv of 
 having been born alive in the legal sense, are derived from 
 the condition of the respiratory, circulatory, and abdom- 
 inal organs. 
 
 3Ieans of Determining whether the Child has Breathed. — 
 
132 A MANUAL OF 
 
 Wliile the vaulted character of the thorax, the compara- 
 tive depression of the diaphragm, the relation of the larynx 
 to the epiglottis, the situation, volume, color, consistence, 
 absolute or relative weight, the specific gravity of the lungs, 
 may all be important under certain circumstances in en- 
 abling the examiner to determine whether an infant has 
 breathed, nevertheless the hydrostatic test is the only one 
 that can be relied upon, and even that with certain quali- 
 fications, to be presently mentioned. The principle of the 
 hydrostatic test, or the docimasia pulmonum, is based upon 
 the fact that while the lungs of an infant that have been 
 aerated will float when placed in water on account of the 
 inspired air, those of an infant that have not been aerated 
 will sink. To apply the hydrostatic test, the lungs should 
 be removed from the chest of the infant and put in a suf- 
 ficiently capacious vessel containing distilled water at 60° 
 F. If the lungs float upon the surface of the water, that 
 will prove that they have been aerated. It is desirable also 
 that each lung should be divided into a dozen or more pieces, 
 compressed, and then tested separately in the same manner. 
 If after compression all the pieces float, very complete aeration 
 would be indicated. It must be admitted that the hydro- 
 static test, while it serves to determine whether the lungs 
 of the infant had or had not been aerated, does not neces- 
 sarily prove that the child had breathed, still less had been 
 alive in a medico-legal sense, although it may establish a 
 strong presumption of the fact ; since the head of the 
 infant may be retained sufficiently long in the uterus or 
 the vagina, as in certain elbow or breech presentations, 
 for the infant to breathe though subsequently born dead, 
 and, though not probable, it is not impossible that the 
 air found in the lungs of the infant may have been 
 artificially introduced, developed through putrefaction, 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 133 
 
 or be emphysematous in nature. Apart from the diffi- 
 culty of artificially inflating the lungs of an infant in 
 situ in cases of infanticide, nothing of that kind would 
 be attempted, since it would be the object of the de- 
 fendant to prove that the infant had been born dead, and 
 not alive. As a general rule, there is no great difficulty 
 experienced in determining whether the buoyancy of a lung 
 is due to air inspired or to gases developed within it 
 through putrefaction, since the air in the latter case is not 
 found in the air-vesicles of the lungs, but in the cellular 
 tissue and in the form of large bubbles, which disappear 
 completely under pressure. Moreover, lungs in a state of 
 putrefaction differ in appearance very much from healthy 
 lungs, being greenish-yellow in color, having but little con- 
 sistence, and emitting a fetid odor. It may be mentioned, 
 also, in this connection, that as the lungs of the infant do 
 not putrefy as rapidly as the other organs, if these organs are 
 found undecomposed, then any buoyancy exhibited by the 
 lungs could not be due to putrefaction. As it is very doubtful 
 whether emphysema is ever spontaneously developed in the 
 lungs of an infant, the objection that the air in the lungs 
 could be developed in this way is without foundation. 
 On the other hand, it may be objected that the fact that 
 the lungs sink when immersed in water does not necessarily 
 prove that the infant had not breathed, since the unaerated 
 condition of the lungs might be due to disease. AVhile it 
 is true that the density of the lungs will be so much in- 
 creased by pneumonia or congestion that they will sink in 
 water, these diseases occur so rarely in new-born children 
 that but little importance need be attached to such an ob- 
 jection. Notwithstanding that the value of the hydrostatic 
 test has been questioned, that it cannot be expected to prove 
 absolutely that the child has breathed, still less been born 
 
134 A MANUAL OF 
 
 alive, medico-legally, yet if the lungs of an infant do float 
 in water, the examiner will be warranted, under ordinary 
 circumstances, in stating that the infant had breathed, and 
 in all probability had been born alive. The test of an 
 infant having been born alive, or rather of having 
 breathed, based upon the changes undergone by the heart 
 and certain bloodvessels, after respiration has been estab- 
 lished, and known as the docimasia circulationis, is of 
 rather limited application, as will become apparent when 
 the differences between the foetal and adult circulations 
 are considered. 
 
 Foetal Circulation. — The principal peculiarities in which 
 the circulation of the foetus differs from that of the adult are 
 that little or no blood flows through the lungs of the foetus, 
 the placenta being the organ by means of which the blood is 
 aerated, and that the right side of the heart communicates 
 with the left, the blood being, therefore, neither arterial nor 
 venous, as in the adult, but mixed. In the foetus (PI. 3), 
 part of the blood flows directly from the rightauricle through 
 the foramen ovale into the left auricle, instead of indirectly 
 by the right ventricle, pulmonary artery, lungs, and pul- 
 monary veins ; part of the blood from the right ventricle 
 through the pulmonary artery by the ductus arteriosus 
 into the aorta. Further, the blood flows in the foetus from 
 the placenta by the umbilical vein, and its continuation 
 the ductus venosus, to the vena cava and to the right 
 side of the heart, and thence through the latter as just de- 
 scribed, little or none going to the lungs, to the aorta, and 
 so back by the umbilical arteries to the placenta. Such 
 being the main features of the foetal circulation, with the 
 inspiration of air and the separation of the infant from 
 the placenta by division of the umbilical cord the fora- 
 men ovale closes, the umbilical vessels, the ductus arte- 
 
p 
 
 Left auricle. 
 
 Left ventricle. 
 
 Liver 
 
 Portion of 
 small intestine. 
 
 [Kidney. 
 
 Diagrammatic View of Foetal Circulation: a, arch of the acta : a', its dorsal part: 
 a", lower end : ws, superior vena cava : vci, inferior vena where it join? the right auri- 
 cle : vci', its lower end ; .".-, subclavian vessels: .;', right jugular vein": <\ common carotid 
 arteries : tour curved dotted arrow-lines are carried through the aortic and pulmonary 
 opening, and the auriculo-ventricular orifices : >la. opposite to the one passing through 
 the pulmonary artery, marks the place of the ductus arteriosus : a similar arrow-line 
 is shown passing from the vena cava inferior through the fossa oralis of the risrht auri- 
 cle, and the foramen ovale into the left auricle : hv, the hepatic veins : vp. vena portse : 
 X to vci, the ductus venosus : >n\ the umbilical vein : ua, umbilical arteries : uc, umbil- 
 ical cord cut short : i, i , iliac vessels. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 135 
 
 riosus, and the ductus venosus shrivel up, and, ceasing to 
 be pervious, become fibrous cords. The blood then flows 
 through the heart and lungs, and the adult circulation is 
 established. 
 
 Under ordinary circumstances, if the foramen ovale, 
 ductus venosus, and ductus arteriosus are found open, the 
 examiner would be warranted in stating that the foetus 
 had not been born alive, and that, therefore, in all prob- 
 ability, if any crime had been committed, it would be that 
 of foeticide, and not of infanticide. Not unfrequently, how- 
 ever, several days or even weeks may elapse before the 
 blood ceases to flow through these vessels, and as the for- 
 amen ovale may remain, under certain circumstances, open 
 through life, obviously too much importance must not be 
 attached to the open or closed condition of the heart and 
 vessels as evidence of the infant having been born dead 
 or alive. The drying- up of the part of the umbilical 
 cord remaining attached to the umbilicus after division, 
 that usually takes place within two or three days after 
 delivery, together with its subsequent separation and cica- 
 trization, may be regarded as proof of the child having 
 been born alive, since, although the cord withers and 
 dries up in a child born dead as well as in one born 
 alive, it always remains attached in the former to the 
 umbilicus, never separating spontaneously. The liver of 
 the foetus is larger than that of a recently born infant, 
 and that of the infant is larger than that of an eight or 
 ten months old child. 
 
 Liver and Contents of the Stomach in a New-born Cliild. 
 — Too much importance, however, must not be attached 
 to the size of the liver as positive proof of the infant 
 having breathed, since the difference in the size of the 
 liver in a recently born child, as compared with its size 
 
136 A MANUAL OF 
 
 at earlier or later stages of development, is only relative. 
 The presence of milk or of farinaceous and saccharine 
 articles of food in the stomach or intestine of an infant 
 would be strong evidence that it had lived some time after 
 birth. Unfortunately, the remains of food are not very 
 frequently found in the alimentary canal of infants alleged 
 to have been destroyed. In certain cases of infanticide it 
 may become of importance to determine the age of the new- 
 born child and the time that has elapsed since its death. 
 Its age can approximately be determined by ascertaining 
 if it presents all the characters of a fully-matured foetus 
 that have already been described. It is not often possible 
 to state exactly the time elapsing between the birth and 
 death of an infant, as so many conditions have to be taken 
 into consideration, such as the season of the year, the tem- 
 perature, the character of the place, and the surroundings 
 of the infant. 
 
 Examination of the Mother : Signs of Recent Delivery. — 
 In all cases of infanticide the reputed mother should be 
 examined as well as the infant. The examination should 
 be made as soon as possible, for, if delayed beyond a week 
 or ten days, the woman may have so recovered as to pre- 
 sent no signs of having been recently delivered. Should 
 the examination be made within three or four days after 
 delivery, pallor of the face and weakness will be noticed ; 
 the skin will be found moist, soft, and relaxed ; the eyes 
 somewhat sunken. The pulse is soft and usually quick. 
 The uterus can be felt through the wall of the abdomen, 
 which feels soft, and presents transverse livid lines, later 
 becoming white and shining, and known as the linece albi- 
 cantes. The breasts are full and knotty, and often exude 
 a watery milk. The external genitalia are swollen, the 
 vagina is capacious, the os uteri is low down, and the 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 1 ->7 
 
 niuco-sangumeous discharge from the uterus, known as 
 the lochia, and characterized by its peculiar odor, is usually 
 present. No one of these signs can be relied upon as 
 proof that a woman has recently been delivered ; but, if 
 they all be present together, they would constitute a very 
 strong presumption of it. Should the woman have died 
 shortly after delivery, not only would the signs just men- 
 tioned be present, but in addition the uterus would be 
 found enlarged, measuring between nine and ten inches in 
 length ; its cavity lined with remains of the decidua and 
 the point of attachment of the placenta marked by a 
 gangrenous-looking spot. In all cases of infanticide, the 
 mother not only endeavors to conceal the fact that she has 
 given birth to a child, but more especially to conceal the 
 body of the child. The concealment of pregnancy is not 
 an offence in the eye of the law ; but the concealment of a 
 birth, constituting a misdemeanor, renders the woman 
 committing it liable to punishment. 1 As the woman, how- 
 ever, who is convicted upon this charge is punished upon 
 the ground of having concealed the body of the dead in- 
 fant rather than upon that of having concealed its de- 
 livery, she makes every effort to get rid of the child. 
 
 Means of Committing Infanticide. — Among the different 
 means made use of to destroy the new-born child may 
 be mentioned suffocation, immersion in privies, strangula- 
 tion, drowning, fracturing of the skull, burning, neglect, 
 wounds, hemorrhage of the navel, exposure to cold, and 
 poisoning. In fully four-fifths of cases of infanticide 
 death is due to asphyxia in one form or another. Statis- 
 tics show that fifty per cent, of infants criminally de- 
 stroyed are suffocated, twelve per cent, immersed in 
 privies, ten per cent, strangled, and live per ceut. 
 
 1 Tardieu : Etude Medico-legale sur P Infanticide, Paris, 186S, p. 99. 
 
138 A MANUAL OP 
 
 drowned. Infants are not unfrequently also destroyed 
 by fractures of the skull and by neglect. Death caused 
 by burns, wounds, hemorrhage of the navel, and exposure 
 to cold occurs less often, however, in cases of infanticide, 
 and in frequency in about the order mentioned. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 139 
 
 CHAPTER XII. 
 
 Legitimacy — Inheritance — Protracted Gestation — Premature Delivery 
 — Viability — Procreative Power in the Male and Female — Impotence 
 — Sterility — Tenancy by Courtesy — Paternity — Affiliation — Super- 
 fee tat ion — Doubtful Sex — Hermaphrodism — Presumption of Death — 
 Presumption of Survivorship — Personal Identity of the Living. 
 
 Cases involving the questions of legitimacy and inherit- 
 ance are not often decided by the testimony of the medical 
 expert alone, the evidence necessary to prove that a child 
 is the offspring of adultery being of another character. In 
 all such cases, however, questions arise relating to the 
 length of time in which gestation may be prolonged or 
 shortened. 
 
 Protracted Gestation. — The subjects of protracted gesta- 
 tion and premature delivery having already been consid- 
 ered in connection with the signs of pregnancy, it only 
 remains to point out their bearing in relation to cases of 
 legitimacy and inheritance. The law assumes that even- 
 child born in wedlock is legitimate unless it can be shown 
 that the husband and wife had been separated for a longer 
 time than that accepted as the average period of gesta- 
 tion, or that the husband was impotent. The difficulty, 
 however, that would at once present itself in such a case 
 is due to the impossibility of stating exactly what consti- 
 tutes the accepted period of gestation. It is true that the 
 average period of gestation is 280 days ; nevertheless, there 
 are authenticated cases, as already mentioned, in which 
 gestation was prolonged to 313 or even to 325 days, or 
 delivery was premature, as at 210 to 217 days. 
 
 But it must be admitted that the strongest possible evi- 
 dence would be required to prove the legitimacy of a child 
 
140 A MANUAL OF 
 
 whose birth was shown not to have occurred until 313 
 days after the absence or death of the husband. 
 
 Premature Delivery. — As regards the relation of pre- 
 mature birth to questions of legitimacy and inheritance, 
 there is no doubt that eight, seven, and even six months' 
 infants may survive. 1 It has been stated that in very 
 exceptional instances even a foetus but little over five 
 months old may be viable. In cases, for example, where 
 a living infant acquires the right of inheriting and 
 transmitting property, the point that will have to be 
 established is not whether the infant was viable in the 
 sense that it would survive, but was it alive at the time 
 of its birth, involving in turn the determination of what 
 is meant by the expression being born alive. In a broad 
 sense the foetus must be regarded as alive at any stage of 
 its development ; the ovum, indeed, must be alive, since 
 the embryo or foetus results from the development of a 
 live ovum, not a dead one, impregnated by living sperma- 
 tozoa. Leaving out of consideration, however, what might 
 be regarded as merely metaphysical distinctions, as a mat- 
 ter of fact that which constitutes a live birth will depend 
 upon the significance attached to that expression by the 
 law of the land, whatever that may be. In the United 
 States and in England neither breathing nor crying is 
 considered essential to establish the fact that a child was 
 born alive. It is enough if the whole body has been 
 brought into the world and the heart has throbbed, or 
 if a movement of any kind has been made. In Scot- 
 land and Germany crying, and in France respiration, 
 is requisite. That crying should not be regarded as 
 indispensable in proving a live birth is obvious, since 
 
 1 According to Haller (Elementa Pkysiologice, tomus octavus, Lausanne, 
 1778, p. 423) : "Ante septimum mensem foetus non potest superesse." 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 141 
 
 a child might be born alive, and yet peradventure it 
 might be born dumb. 1 Tlie term bom alive or viable 
 being so understood, medico-legally, it might be stated 
 with perfect propriety that a foetus but six inches long, 
 weighing only eight ounces, not more than four months 
 old, was born alive, was viable — having moved its arms 
 and legs, opened its mouth, etc. — though it died within 
 half an hour of its birth. 2 The law assumes that a child 
 born in wedlock is legitimate unless it can be proved that 
 the husband was impotent — by which it is meant that he 
 was physically incapable at the alleged period of concep- 
 tion of begetting children. 
 
 Impotence may be due to masturbation, to the opium 
 and the alcoholic habit, diseases of the nervous system, 
 blows upon the head and back, absence, deficiency, or 
 malformation of the penis, as hypospadias, epispadias, 
 fistula in perineo, castration, cancer or absence of the 
 testicles, absence of spermatozoa from the semen, etc. 
 
 In connection with the absence of the testicles it should 
 be mentioned that their mere absence from the scrotum 
 does not involve impotence, since such a condition may be 
 simply due, as in cry psorch ides, to the testicles not having 
 descended into the scrotum from the inguinal canal. Of 
 the conditions causing impotence some are susceptible of 
 treatment ; others are not. The procreative power in the 
 male, or the age of puberty, begins at between fourteen to 
 fifteen years of age, with the full development of the 
 testicles, the power of fecundation depending upon the 
 presence of active spermatozoa in the semen. The pro- 
 creative power may continue to an advanced period of life, 
 spermatozoa being found, as already mentioned, in the 
 
 1 Coke: Institutes, Philadelphia, 1S53, vol. i. 29b. ma. 
 
 2 British and Foreign Medical Review, vol. vi. p. 236. 
 
142 A MANUAL OF 
 
 semen of very old men. The impotence of old men ap- 
 pears to be due to the sluggishness of their spermatozoa 
 rather than to their absence from the semen. It should 
 be mentioned that there may be impotency without ster- 
 ility, as in those cases in which sexual intercourse is 
 prevented by malformation of the penis; and, on the other 
 hand, sterility without impotency, as in cases of castration. 
 
 The procreative power begins in the female, as well 
 known, earlier than in the male, at about from twelve to 
 thirteen years of age, and even earlier in tropical countries. 
 In the female, as in the male, unfruitfulness may exist 
 without incapacity for sexual intercourse, and vice versa. 
 Sterility in the female may be due to debility, leucorrhoea, 
 dysmenorrhoea, amenorrhoea, menorrhagia, absence or dis- 
 ease of the uterus or ovaries, imperforate vagina or hymen, 
 occlusion of the uterus, etc. It is an interesting fact that 
 while a woman may be sterile with one man she may be 
 fertile with another, it frequently happening that a woman, 
 married for years without issue, in contracting a second 
 marriage may bear children. As the law regards a child 
 as legitimate, though not conceived in wedlock, the mother 
 marrying afterwards, and her condition being recognized 
 by the husband at the time of the marriage, and as a child 
 born after the death of its mother is legitimate, though 
 the marriage-tie be dissolved by the death of the mother, 
 it follows that a child, though conceived before marriage 
 and born after the death of the mother — that is, neither 
 conceived nor born in wedlock — would nevertheless be 
 legally regarded as legitmate. 
 
 Grounds for Divorce. — Impotence or sterility may con- 
 stitute grounds for divorce proceedings on the part of hus- 
 band or wife, provided it can be proved that the incapacity 
 for sexual intercourse existed at or before the time of 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 1 \'-> 
 
 marriage. If such incapacity supervened, however, after 
 marriage, as due to disease, there would be no grounds 
 for such proceedings. Tn such cases a medical examina- 
 tion would, of course, be necessary, and while such an 
 examination could not be made compulsory, any refusal 
 on the part of either of the contending parties to submit 
 to the same would certainly be injurious to the cause of 
 the party so refusing. 
 
 So-called " frigidity of constitution," or unwillingness to 
 submit to sexual intercourse, would not constitute grounds 
 for legal divorce, absolute proof being required of incapacity 
 for sexual intercourse or of severe and intense pain being 
 suffered by indulging in it, as in cases of vaginismus, etc. 
 
 Tenancy by Courtesy. — In cases where a husband acquires 
 a life-interest in the estate of his wife, a child having been 
 born during the life of the latter, " tenancy by courtesy " 
 as it is called, the medical examiner may be called upon to 
 prove not only that the child was born alive, but also that 
 it was born while its mother was living, in order that 
 the child may inherit. The proofs of a live birth have 
 already been considered. 
 
 With reference to the legal qualification of a child 
 having been born during its mother's lifetime the only 
 difficulty that might present itself would be in the case of 
 a child removed from its dead mother by the Cesarean 
 section, in which instance, if the letter of the law was car- 
 ried out, the husband would be debarred from inheriting. 
 The interpretation of the clause providing that the child 
 must be capable of inheriting will depend upon what the 
 law chooses to regard as a monster — the latter not being 
 capable of either inheriting or transmitting property. It 
 is very difficult, however, to say what constitutes a 
 monster legally. If a monster be defined as a creature 
 
144 A MANUAL OF 
 
 which has not the shape of mankind, 1 then a headless 
 or double-headed or double-bodied creature would be 
 excluded from inheriting. On the other hand, difficulty 
 will be equally experienced in disposing of a property 
 if a creature with two heads, with or without two bodies, 
 be regarded as two individuals, and every creature with 
 a single head, whether disomatous or not, as only one 
 individual. 2 
 
 Paternity and Affiliation. — In connection with the sub- 
 jects of legitimacy and inheritance, that of paternity and 
 affiliation may as appropriately be considered here as else- 
 where. The question of paternity presents itself under 
 various circumstances, as, for example, in cases of bastardy, 
 where the alleged father is compelled to support the child, 
 or where a bastard child claims to be the heir of an estate, 
 or where a child is born ten months after a second marriage, 
 the woman having married a second time within a month of 
 the death of her first husband. In such cases the paternity 
 is determined by the likeness of the child to the parent, the 
 color, features, attitude, habits, gestures, voice, personal de- 
 formities being taken into consideration. In certain cases, 
 questions of affiliation arise, as in the case of a woman 
 having had intercourse with two men within a few days 
 of each other and giving birth to a child, one of the men 
 being affiliated as the father rather than the other. In 
 connection with such cases, the medical examiner should 
 bear in mind that, in the lower animals at least, the im- 
 press of the first sire may be often seen in the foal begotten 
 by the second one. In cases involving the capability of 
 
 ^lackstone: Commentaries on the Laws of England, Philadelphia, 
 1877, Book II. p. 246. 
 
 2 St. Hilaire: Histoire general et particulaire des Anomalies de I' Organi- 
 sation chez l' Homme, Bruxelles, 1837, tome iii. p. 331, 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 145 
 
 inheriting and transmitting property, the' question of 
 superfcetation, or the possibility of a woman conceiving a 
 second time when already pregnant, may present itself. 
 
 Superfcetation. — In cases of superfcetation either two chil- 
 dren are born at the same time, one of which, however, is 
 immature, or two children are born at different times, both 
 of which are mature cases of superfcetation of the first kind. 
 Superfcetation may be explained on the supposition that there 
 has been a twin conception, one of the embryos, however, 
 developing more rapidly than the other ; or that the uterus 
 was double, as is always the case in the marsupial animals, 
 like the kangaroos, etc. Cases of the second kind can, 
 however, only be explained by supposing that the woman 
 had sexual intercourse with one or two different men and 
 conceived successively. That superfcetation may be due 
 to repeated sexual intercourse and to successive conceptions 
 there can be no doubt; there are well-authenticated cases 
 of a woman having given birth to children of different colors 
 as the result of intercourse with a white and a black man 
 successively. It is also well known that double concep- 
 tion occurs in animals — a mare, for example, covered 
 successively by a horse aud an uss, giving birth to a horse 
 and a mule. 
 
 Double Sex : Hermaphroditism. — Not infrequently, on ac- 
 count of divorce proceedings, questions in regard to legiti- 
 macy of offspring or capability of inheriting, etc., the atten- 
 tion of the medical examiner is called to individuals in whom 
 the sex is doubtful, or who are said to be hermaphrodites. 
 While, as a general rule, there is no difficulty in distinguish- 
 ing the sex in such cases, nevertheless, on account of the 
 manner in which external and internal generative organs 
 develop in certain exceptional cases, it becomes very difficult, 
 if not impossible, at least during life, to state positively 
 10 
 
146 A MANUAL OF 
 
 whether an individual is a male or a female. At an early 
 period of intra-uterine life, at six weeks or thereabouts, it 
 is impossible to determine the sex of the embryo. The 
 external organs of generation are as yet undeveloped, and 
 
 Fig. 37. 
 
 Diagram of the Wolffian bodies, Mullerian ducts, and adjacent parts previous 
 to sexual distinction (as seen from before) : sr, the suprarenal bodies ; r, the 
 kidneys ; ot, common blastema of ovaries or testicles ; W, Wolffian bodies ; 
 w, Wolffian ducts ; m m, Mullerian ducts ; gc, genital cord ; ug, sinus urogeni- 
 tals ; i, intestines ; cl, cloaca (Quain). 
 
 the internal organs consist (Fig. 37) of what may be 
 called two indifferent bodies, the ducts of Muller and the 
 Wolffian bodies. In case of such an embryo developing 
 into a male, the two indiffereut bodies will become testicles, 
 which, in descending, push the abdominal walls ahead of 
 
MEDICAL JURISPRUDENCE AND TOXICOLOOY. 147 
 
 them, giving rise in this way to the formation of the 
 scrotum, which they ultimately occupy. The Wolffian 
 bodies are transformed into the epididymis, vas deferens, 
 etc., the ducts of Miiller becoming atrophied. 
 
 On the other hand, should such an embryo develop into 
 u female, the two indifferent bodies would become ovaries 
 and remain in the abdominal cavity, and the ducts of 
 Miiller would be transformed into the vagina, uterus, and 
 Fallopian tubes, the Wolffian bodies becoming atrophied. 
 The penis and clitoris, developing later than the internal 
 generative organs, consist essentially of the same parts, 
 the only difference between them being due to the fact that 
 the two folds of skin which remain distinct, as the labia 
 minora in the female, grow around and underneath, as the 
 skin of the penis in the male ; while the two cutaneous 
 folds constituting the labia majora of the female, in fusing 
 together in the middle line, form the scrotum in the male. 
 
 Such being the development of the generative organs, it 
 is readily seen, on the supposition that an individual is 
 really a male, that, if the testicles in such a case were to 
 remain in the abdominal cavity, the labia majora and 
 minora failing at the same time to coalesce in the middle 
 line, and the penis to remain undeveloped, such an indi- 
 vidual might be easily mistaken for a female. On the 
 other hand, if the clitoris, a highly erectile organ, was 
 very much developed, and permitted sexual intercourse, 
 such an individual might be considered a male, it being 
 supposed that the testicles had not descended ; the absence 
 of a scrotum being in that way explained. 1 
 
 It is obvious, from what has been said, that a true 
 human hermaphrodite, that is a human creature in which 
 a full functionally complete set of organs are united in one 
 1 Beck : op. cit., vol. i. pp. 169, 170, 172, 175. 
 
148 A MANUAL OF 
 
 individual, is a physical impossibility. For, even on the 
 supposition that the Mullerian ducts and Wolffian bodies 
 would be simultaneously transformed into vagina, uterus, 
 epididymis, vasa deferentia, etc., one of the indifferent 
 bodies into an ovary, the other into a testicle, a penis would 
 not be developed simultaneously with a clitoris, since being 
 essentially one and the same structure one or the other is 
 alone developed. That the clitoris and the penis are 
 essentially homologous organs is still further proved by 
 the fact that urination is accomplished by the clitoris in 
 the female of certain animals, rodents, and others exactly 
 as by the penis in the male of the same species. It need 
 hardly be added that, while there is no authenticated case 
 proving that a true human hermaphrodite has ever existed, 
 such a disposition of the generative apparatus not unfre- 
 quently occurs among the lower animals, as snails, tape- 
 worms, etc. 
 
 In cases where an estate descends to the first-born male, 
 if the offspring should be of doubtful sex, the peculiarities 
 constituting the individual a male would have to be de- 
 termined by the medical expert. In such doubtful cases 
 the decision might be postponed until the child arrives at 
 the age of puberty, when the secretion of healthy active 
 spermatozoa would establish the sex. It is important, with 
 reference to the attaining of majority, that the exact day 
 and hour of a child's birth be accurately noted — a person 
 attaining a legal majority the first instant of the day before 
 the twenty-first anniversary of his or her birth-day, though 
 forty-seven hours and fifty-nine minutes less than the com- 
 plete number of days, counting by hours on the principle 
 that a part of a day is medico-legal ly equal to the whole 
 of a day. 1 
 
 1 Taylor : op. cit., p. 599. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 149 
 
 Presumption of Death. — It not uii frequently happens 
 that a person leaves his home and is not heard of for 
 many continuous years, perhaps never again. The law 
 presuming such a person to be dead, the executor is 
 justified in settling the estate. The length of time 
 usually assumed legally as warranting the presumption 
 of death is seven years from the time the person was 
 last seen or heard of. 1 A woman who had not heard 
 of her husband for that number of years might marry 
 again, therefore, without rendering herself liable to the 
 charge of bigamy, even if it was afterwards shown that 
 the first husband was living at the time of the second mar- 
 riage. In cases where property is inherited, and in life- 
 insurance cases, so long a time as seven years is not usually 
 considered necessary by the courts, settlements being often 
 made in two years of the period within which the person 
 was presumed to have died. The presumption of death is 
 usually determined by a jury on the general evidence 
 submitted. 
 
 Under certain circumstances, however, as in cases where 
 the person presumed to be dead was suffering from some 
 disease at the time last seen or heard of, medical testimony 
 would be taken as to the probable issue in such a case. 
 
 Presumption of Survivorship. — When several persons, 
 members of the same family, for example, are lost at 
 sea or are burned in a fire, the law usually assumes that 
 they perished together. But, in the disposition of an 
 estate thus left, it may be a matter of difficulty to de- 
 termine who is the heir-at-law, and medical testimony 
 may be taken to aid in determining what member of 
 the family, if any, survived the others. Suppose that the 
 persons dying were father and son, and that the son 
 1 Beck : op. cit., vol. i. p. 643 ; Tidy : op cit., part i. p. 385. 
 
150 A MANUAL OF 
 
 survived the father, even though it were for a moment, the 
 wife would inherit. Suppose that two persons were related 
 to each other as testator and legatee, and that the latter 
 should die first, the legacy would then lapse. If, however, 
 the legatee survived the testator, then his heirs would in- 
 herit. A husband, as already mentioned, inherits from his 
 wife if their child survives the death of the mother, even 
 for only a moment. 
 
 While no positive statements can be made by the medi- 
 cal examiner in cases involving the presumption of sur- 
 vivorship, there are, nevertheless, certain general probabili- 
 ties that should be taken into consideration. Thus, for 
 example, if a number of persons of different ages perish 
 together, it would be a fair presumption that the very old 
 and very young, other things being equal, would not sur- 
 vive as long as those of middle age. In the case of a man 
 and woman being drowned, it is to be presumed that, on 
 account of greater physical strength, the man survived 
 longer than the woman. Young people and old persons 
 appear to succumb more quickly to the effects of cold than 
 adults. The latter, however, do not resist the effects of 
 heat as well as the former. As regards the effects of cold 
 and heat upon the human system, more particularly in 
 reference to questions of survivorship, the general physical 
 condition, the kind of clothing, the extent to which alcohol 
 has been indulged in, would have to be taken into consid- 
 eration. It is well known that the aged can do without 
 food better than the young. In cases of death from star- 
 vation, the presumption would be, therefore, in favor of 
 the former surviving rather than the latter. 
 
 Personal Identity of the Living. — In cases involving 
 the inheritance of property, medical testimony is occa- 
 sionally taken in identifying a certain individual as the 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 151 
 
 rightful heir — the evidence upon which the identification 
 depends being the presence of scars, deformities due to 
 fractures, etc. Similarly, in cases of assault or of robbery, 
 the assailant must be identified. As the identity of a per- 
 son, whatever the nature of the case, civil or criminal, is 
 usually established by the members of the family, friends 
 or acquaintances, and not by a physician, it is unnecessary 
 to dwell upon the subject of the personal identity of the 
 living. 
 
 In this connection it may be stated, however, that among 
 the more important means of identification may be men- 
 tioned the size of the person, the dress, kind of voice, the 
 presence of moles, scars, deformities, cicatrices, naevi, tattoo 
 marks, etc. 1 In relation to the subject of personal identity, 
 a few words with reference to the distance at which per- 
 sons can be seen and sounds heard do not appear inappro- 
 priate. A man of ordinary height may be seen on a clear 
 day and on level ground at a distance of from two to three 
 miles, though not necessarily recognized. The recognition 
 of a person depends not only upon being seen, but upon 
 the appreciation of the peculiarities afforded by his size, 
 gait, complexion, color of hair and eyes, etc. Even the 
 best known persons are not always recognized at a distance 
 of one hundred and nine yards; less well-known ones not 
 being recognized even though but thirty yards away. Well- 
 known persons cannot be recognized in the clearest moonlight 
 twenty yards away, and by starlight at a distance exceed- 
 ing twelve feet, though the light from a flash of light- 
 ning or from a pistol-shot may enable a person to recognize 
 another as a thief or an assailant. The distance at which 
 sounds cau be heard, such as the report of a gun or a pis- 
 tol, being dependent upon the condition of the atmosphere, 
 1 Woodman and Tidy: op. cit., pp. C39-641. 
 
152 A MANUAL OF 
 
 moisture, direction of the wind, is too variable to be posi- 
 tively stated. As well known, however, the velocity of 
 sound being at mean temperature about 1130 feet in a 
 second, if a flash of light is seen and a report is heard 
 afterwards, on the supposition that they were simultane- 
 ously produced, the distance separating the person who 
 fired and the one hearing the report can be calculated. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 1 -h\ 
 
 CHAPTER XIII. 
 
 Feigned Bodily Diseases — Hypnotism — Life Insurance — Medical Mal- 
 practice — Medical Registration. 
 
 Feigned bodily diseases very frequently demand the 
 attention of the medical examiner, especially in the 
 cases of soldiers, sailors, and prisoners, who resort to any 
 and every pretext to shirk their duties ; and of civilians, 
 who hope in this way to avoid serving on juries, appearing 
 as witnesses, or to escape military service. It is almost 
 incredible what malingerers will resort to in order to ac- 
 complish their purpose, indulging in the most disgusting 
 performances : swallowing feces, urine, blood, mutilating 
 themselves as occasion may require. Disease is sometimes 
 simulated by simply lying, or by mimicry, or cunning ; 
 at other times by the aid of trusses, splints, bandages, 
 spectacles, crutches, and such means. The motives in- 
 ducing a person to simulate disease are usually fear, gain, 
 laziness, notoriety. Thus, for example, it is not unusual, 
 especially abroad, where military service is compulsory, 
 for such as are liable to cut off a finger, break a tooth, or 
 put out an eye, to avoid conscription. The hope of gain 
 is a very common motive, as in the attempts so often 
 made to obtain damages for injuries incurred in railroad 
 accidents. Beggars and others, to escape work and to get 
 into hospitals or almshouses, often feign disease. 
 
 Hysterical persons, especially women, will stoop to every 
 kind of deceit, and submit even to harsh treatment, through 
 a pure love of notoriety. While there is no kind of dis- 
 ease or injury which malingerers will not simulate in order 
 
154 A MANUAL OF 
 
 to accomplish their purpose, whatever that may be, among 
 the most common of these may be mentioned the feigning 
 of fever, heart disease, consumption, hsematuria, inconti- 
 nence of urine, epilepsy, paralysis, catalepsy, deafness, 
 dumbness, blindness, tumors, wounds, etc. 1 All such cases 
 of malingering demand the greatest patience and tact on 
 the part of the medical examiner. Not only one but 
 several visits may be required before the examiner can be 
 satisfied that the case is one of malingering. The visits 
 should be paid at an hour when the suspected person is 
 least likely to expect them. The parts of the body said to 
 be diseased or injured should be examined unclothed, 
 thoroughly exposed, all dressings and bandages being re- 
 moved. No attention or importance should be attached 
 to the statements of either the person supposed to be ma- 
 lingering, or of his relatives or friends. The prescribing 
 of some disagreeable medicine, or the suggestion of using 
 anaesthetics, and performing a dangerous operation, may 
 sometimes frighten the individual into confessing im- 
 posture. 2 In some obstinate cases, however, all means, 
 even of a severe character, fail to elicit confession. 
 
 Relation of Hypnotism to Crime. — The question of the 
 possibility of a crime being committed by an individual 
 when hypnotized at the suggestion of another, and the 
 responsibility so incurred by one or both, is still one of 
 discussion. It is true that experiments have been made 
 which show the remote possibility of crime being com- 
 mitted under such circumstances, as in the case, for example, 
 
 1 Malingerers appear to have been as common in ancient as in mod- 
 ern times. Even so far back as tbe time of Galen rules were given for 
 the guidance of the physician in detecting such frauds {London Med. 
 Gazette, vol. 17, p. 989). 
 
 2 Zacchias : op. cit., Lib. iii., Tit. ii., Quaest. ii., p. 288. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 155 
 
 of a hypnotized woman at the command of another plunging 
 a dirk into a manikin dressed up as a woman. But it must 
 be admitted that there is no evidence whatever that a 
 murder has ever thus taken place. 1 In hypnotized persons, 
 women especially, hysteria constitutes so important a factor, 
 and hysteria is so often simulated, that it would become 
 difficult if not impossible for the medical examiner to state 
 positively to what extent a woman acting in the manner 
 just described should be held responsible. 
 
 Life-insurance. — A life-insurance may be regarded as a 
 contract, the deed being termed a policy, whereby a company, 
 in consideration of a premium paid in instalments or in a 
 lump sum, agrees to pay a definite sum to the heirs of the 
 insured at death, or at some definite period of life. In 
 the case of the former, the amount insured for being pay- 
 able only at death, it becomes incumbent upon the heirs to 
 prove most positively, and to the entire satisfaction of the 
 company, that the insured person is actually dead. For 
 example, in cases of persons who have disappeared, who 
 went to sea and were never heard of again, questions as to 
 presumption of death or of survivorship may demand the 
 attention of the medical examiner. The question as to the 
 general health of an applicant for a policy of insurance, 
 the tendency to disease through inheritance, alcoholism, 
 excessive use of tobacco, or other causes, is that which 
 brings the medical profession in the most intimate relation 
 with the insurance companies. In almost all the lawsuits 
 
 1 The attention of the writer has been called to two cases of murder, 
 as reported in the daily papers, in which it was alleged that the defence 
 offered was that the accused had committed the crime, when hypno- 
 tized, at the instigation of the hypnotizer. In one case the hypnotized 
 was adjudged innocent of the crime of murder, the hypnotizer guilty. 
 
156 A MANUAL OP 
 
 in contested life-insurance policies the points contested are 
 with reference to what was actually meant by certain 
 medical terms, such as diseases, habits tending to shorten 
 life, etc. 
 
 It is astonishing what a difference of opinion prevails 
 among even intelligent people as to what constitutes a tem- 
 perate person, many an individual who takes several 
 drinks of brandy or whisky a day considering himself per- 
 fectly temperate, and so stating to the medical examiner, 
 utterly unconscious of his health being gradually under- 
 mined, and of his life being shortened by the daily use of 
 alcohol. It is due to such a difference of opinion as to the 
 effect of alcohol upon the system that the question of in- 
 temperance has given rise to so much discussion in cases 
 of life-insurance. While it is undoubtedly true that there 
 have been exceptional instances of individuals enjoying 
 good health and living to a good old age who had been in 
 the habit of drinking, and more particularly whisky, all 
 their lives, nevertheless it cannot be denied that, as a 
 general rule, the habitual use of alcohol in perverting 
 nutrition induces disease of the heart, liver, and kidneys, 
 and so tends to shorten life. It should be mentioned, 
 however, that if the habits of the individual at the time of 
 insurance were temperate, the fact that intemperance was 
 subsequently developed would not debar the heirs from 
 recovery upon the policy. 
 
 What has just been said of the use of alcohol with 
 reference to the shortening of life applies equally to the 
 influence of the morphia habit. The concealment of the 
 fact that an applicant for a policy of life-insurance was an 
 opium-eater at the time of application would justify the 
 company in refusing to pay the heirs the insurance. 
 
 There is no doubt that insanity also tends to shorten 
 
MEDICAL JURISPBUDENCE AMD TOXICOLOGY. 157 
 
 life, and with the view of avoiding future complications 
 which might arise upon this point, every insurance policy 
 should contain a direct question on insanity; the insurance 
 company reserving to itself the privilege of insuring or not, 
 according to the particular circumstances of the case. 
 
 Litigation in cases of life-insurance not unfrequently 
 arises in consequence of the insured person committing 
 suicide after the taking out of the policy. Under such 
 circumstances a company would certainly be justified in 
 refusing to pay the insurance, if it could be proved that 
 the suicide was committed with the intention of paying off 
 debts or leaving money to the heirs. If, however, the 
 suicide was due to insanity, clearly developed after the 
 policy had been taken out, the heirs would undoubtedly 
 be entitled to the payment of the insurance. 
 
 From what has just been said of the relationship of the 
 alcohol and opium habit, insanity, suicide, to life-insurance, 
 it is obvious that, for the interest of the company, as well 
 as for that of the insured, a most thorough examination 
 should be made as to the health of the individual at the 
 time of the application for the policy. Not only should 
 all the printed questions of the policy be satisfactorily 
 answered by the applicant, but the latter should be most 
 carefully questioned orally by the medical examiner of the 
 company. It is the concealment of the true state of the 
 health of the applicant, either fraudulently or unintention- 
 ally, at the time that the policy was taken out, which gives 
 rise to most of the lawsuits in cases of life-insurance. 
 
 Medical Malpractice. — Actions for damages for large 
 amounts are so often brought against physicians on the 
 charge of malpractice, that it is well for the medical pro- 
 fession to realize that the law affords, even to the most dis- 
 tinguished of its members, under such circumstances, no 
 
158 A MANUAL OF 
 
 especial protection. In order, therefore, to avoid the annoy- 
 ance and loss of time always entailed by such suits, howso- 
 ever they may terminate, it is most important that practi- 
 tioners should never guarantee or contract to effect a cure, 
 even in the simplest kind of cases. Whatever the nature 
 of the difficulties arising in the case may have been, however 
 improbable that they should have occurred, or that they 
 could have been foreseen, is immaterial, the law not accept- 
 ing any such excuses for the failure on the part of the prac- 
 titioner to fulfil his contract to cure. 
 
 Such being the case, how unwise would it be for a 
 surgeon to promise that he will cure a deformity when 
 the operation involved may be followed by pyaemia and 
 death ! or for the gynaecologist to guarantee the safe re- 
 moval of an abdominal tumor when there is always a risk 
 that a fatal peritonitis may follow the operation ! All 
 that a practitioner can be expected to say is that he will 
 do the best he can for his patient. The law only demands 
 that he will exhibit in the practice of his profession a fair 
 and competent degree of skill. It must be admitted, how- 
 ever, that it becomes difficult, if not impossible, to say, 
 under certain circumstances, just what constitutes legally a 
 reasonable or ordinary amount of professional skill. It 
 is evident that the skill indispensable to the success of a 
 physician or surgeon practising in a metropolis must be far 
 greater than that demanded of one practising in a village. 
 The legal term ordinary skill is, therefore, far from being 
 a definite one, and from the very nature of the case must 
 have a varied application. Not only ordinary skill, such 
 as is demanded in the successful performance of a surgical 
 operation, must be exhibited, but ordinary care and attention 
 in the after-treatment must be paid the patient as well. 
 The bandaging, the dressings, the diet must be all care- 
 
MEDICAL JUEISPRUDENCE AND TOXICOLOGY. 159 
 
 fully looked after, as neglect of the same, involving 
 possibly the occurrence of secondary hemorrhage, morti- 
 fication, pysemia, or even only deformity, will render the 
 practitioner justly liable to a suit for damages. 
 
 On the other hand, a practitioner should not be held 
 responsible for not prescribing some particular remedy or 
 for the failure of some one remedy to cure, since the 
 greatest difference of opinion prevails among therapeutists 
 as to the efficacy of all so-called " remedies." It is still 
 a question among medical jurists whether a practitioner 
 renders himself liable to prosecution in deviating some- 
 what from the usual manner of performing an operation, 
 as, for example, in vaccinating on some part of the arm 
 other than the part usually selected for that purpose. As 
 a matter of fact, it may be mentioned, however, that in one 
 instance in which the virus was introduced nearer to the 
 elbow than usual and serious inflammation followed, the 
 court ruled that the attending physician was responsible for 
 all the bad consequences attending the case. As the law 
 recognizes no particular school of medicine, homceopathists, 
 eclectics, botanists, herb doctors have about the same stand- 
 ing legally as regular members of the profession. Every 
 practitioner is supposed, however, to practise according to 
 the system of medicine taught in the school of which he is 
 a graduate. It might be supposed, therefore, that if a vio- 
 lent remedy was administered or a surgical operation per- 
 formed, by an individual who had received no medical 
 education whatever, in the event of serious consequences, 
 death ensuing, the law would hold such a person crimi- 
 nally responsible. But, strange to say, there have been 
 cases, as, for example, when a prolapsed uterus, being mis- 
 taken for a placenta, was torn out by a midwife and a 
 fatal hemorrhage ensued ; and yet the court ruled that 
 
160 A MANUAL OF 
 
 there was not sufficient evidence to convict the prisoner of 
 the crime of murder, and he was acquitted. It is to be 
 hoped, since the law, in Pennsylvania at least, requires 
 the registration of all physiciaus, that any one convicted 
 of practising medicine without the diploma of a reputable 
 school will be summarily dealt with. 
 
 Medical Registration. — In this connection, for the benefit 
 of young physicians just beginning the practice of their pro- 
 fession, it does not appear superfluous to quote the full text 
 of the registration law : " It shall be the duty of every prac- 
 tising physician and of every practitioner of midwifery, on or 
 before the first day of July next ensuing (the day on which 
 the law goes into eifect), to report his, her or their names and 
 places of residence to the health officer at the office of the 
 board of health, and it shall be the duty of the health 
 officer to have the same properly registered in index form 
 in suitable books. In the event of any of the persons above 
 specified removing to any other place of residence, it shall 
 be their duty to notify the health officer of the fact within 
 thirty days after such removal, except where the persons 
 removing shall cease to act in such official capacity as 
 makes them subject to the provisions of this act." 
 
 Suits brought against physicians for malpractice are 
 usually for damages — civil rather than criminal in char- 
 acter. By far the greater number of such cases are purely 
 for the purpose of black-mail, the plaintiff usually securing 
 the services of counsel with the understanding that if he 
 wins the suit, his fee will be part of the damages awarded. 
 Among such cases may be mentioned those in which a 
 shortening of a limb, the stiffness of a joint, a certain 
 deformity are alleged as having been due to the neglect 
 of the surgeon in the treatment of a fracture or of a dis- 
 location. In all such cases it is incumbent upon the 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 161 
 
 plaintiff to prove that the alleged injury or disease; was 
 due to the attending surgeon, and that the same might 
 have been foreseen and avoided by proper treatment. 
 Malpractiee can only be proved when it is shown that 
 the practitioner has set aside established principles and 
 neglected to make use of means universally held by the 
 profession to be necessary in a given case. It must be 
 shown, however, that in all probability the treatment 
 according to such established principles would accomplish 
 the desired end, that such treatment never proves detri- 
 mental, and that it is sanctioned by the general practice of 
 the profession. 
 
 It should be mentioned in this connection that gratuitous- 
 ness will not exempt a practitioner from a charge of mal- 
 practice if it can be proved that his treatment was im- 
 proper, or that he neglected the patient. On the other 
 hand, a patient who refuses to co-operate with his physi- 
 cian cannot recover damages for any injury so sustained, 
 unless the latter can be shown to have been due to mal- 
 practice. As it has been decided that a physician who 
 takes with him, to a confinement case, any one except a 
 physician or a student of medicine, renders himself liable 
 for damages; except in cases of necessity, it would be well 
 under any circumstances for him to obtain the consent 
 of the patient before introducing a stranger into the sick- 
 room. 
 
 In connection with the general subject of medical mal- 
 practice it may be mentioned that apothecaries render 
 themselves liable to suits for damages or even to criminal 
 prosecution, if it can be shown that, through their igno- 
 rance or carelessness, or that of inexperienced clerks in the 
 putting up and selling of medicines, serious or fatal con- 
 sequences ensued. 
 11 
 
162 
 
 A MANUAL OF 
 
 CHAPTER XIV. 
 
 Insanity — Varieties of Insanity — Idiocy — Mania — Dementia — Medico- 
 legal Relations of Insanity — Criminal Responsibility — Medico-legal 
 Terms in Insanity — Feigned Mental Diseases. 
 
 Insanity. — The subject of insanity has so extensive a 
 range as to render it impossible within the limits of this 
 work to do more than indicate its salient features, more 
 especially from a medico-legal point of view. Every 
 practitioner should appreciate the importance of the fact 
 that at any moment he may be called upon to visit a person 
 said to have lost his reason, and should be qualified, there- 
 fore, to express an opinion as to his sanity. 
 
 Fig. 38. 
 
 Fig. 39. 
 
 Idiocy (Feeeiee). 
 
 Epileptic Mania (Fereiee). 
 
 Varieties of Insanity. — Systematic writers upon the sub- 
 ject of insanity differ very much in the manner in which 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 1 63 
 
 they classify the different varieties of insanity. For our 
 present purpose insanity may be conveniently regarded as 
 being of three kinds — Idiocy or Amentia, Mania, and 
 Dementia. 1 
 
 Insanity - 
 
 Amentia 
 
 ( Imbecility 
 1 Ic 
 
 Idiocy 
 
 Mania Proper 
 
 Melancholia 
 
 Partial Intellectual 
 
 Moral 
 
 Partial Moral 
 
 Kleptomania 
 
 Pyromania 
 
 Dipsomania 
 
 Homicidal 
 
 Suicidal 
 
 Puerperal 
 
 Dementia — Paralytic (Paresis) 
 
 Mania 
 
 Idiocy (Fig. 38) differs from all other kinds of mental 
 disease in being congenital, depending upon an arrest of 
 cerebral development. There are various degrees of it, vary- 
 ing from a condition in which there is an entire absence of 
 mind to one in which there is a glimmering of intelligence, 
 as in imbecility. Imbeciles are usually docile, and, in 
 some instances, can be taught, by careful management, to 
 talk and even to read. The causes of idiocy are usually 
 syphilis, intemperance (of the parents), consanguineous 
 marriages. Idiots can generally be recognized by the small 
 size of the head (except in the case of congenital hydro- 
 
 1 Ray, I. : A Treatise on the 3ledical Jurisprudence of Insanity, fifth 
 edition, 1871, pp. 84, 430, 577 ; Georget : Be la Folie, Paris, 1820, p. 101 ; 
 Mandsley, M. D. : Physiology and Pathology of the Mind, London, 1868, 
 p. 253. 
 
164 A MANUAL OF 
 
 cephalus, in which the head is very large), thickness of the 
 lips, enlargement of the tongue, salivary glands, and tonsils, 
 vaulting of the hard palate, irregularity of the teeth, with 
 tendency to decay, deficiency of the lobules of the ear, de- 
 fective vision, weakness in the fingers and thumbs. Idiots 
 are not only characterized by the absence or deficiency of 
 intellectual power, but also by undue development of the 
 animal part of their nature, as shown by their filthy 
 habits, gluttony, etc. Upon post-mortem examination, 
 the convolutions and fissures in the brain of an idiot are 
 usually found less numerous and less complicated in their 
 arrangement than in the brain of an intelligent person. 
 Together with the deficiency of the gray matter of the cor- 
 tex, due to so simple a type of brain, important parts 
 of the latter, such as the basal ganglia, corpus callosum, 
 cerebellum, may be undeveloped or even entirely absent. 
 Neither idiocy nor imbecility is likely to be mistaken for 
 mania or monomania, for, although the intelligence in the 
 latter conditions is perverted and irregular, hallucinations 
 being common, there is not that entire absence of it which 
 is so characteristic, of idiocy. However, as we shall see 
 presently, idiocy, in some respects, resembles dementia. 
 It need hardly be added that idiots are entirely irrespon- 
 sible, both from a civil and criminal point of view. 
 
 Mania (Fig. 39) is understood as a general perversion of 
 the mental faculties, accompanied usually with more or less 
 excitement, which in certain cases may amount even to 
 fury. The reasoning powers are not absolutely lost, but 
 are rather confused, disturbed, disordered. There is no 
 orderly sequence of thoughts; ideas follow each other 
 without any relationship. At one moment the maniac 
 may be tractable, pious in his expressions, singing hymns ; 
 at another ungovernable, abusive, blasphemous. He sings, 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 165 
 
 (lances, laughs, then cries, tears off his clothes, breaks any- 
 thing that he can lay his hands on, often at such times 
 exhibiting great strength. The skin is dry and hot; the 
 eye has a very characteristic expression, a fixed, wild, bril- 
 liant sort of stare. The pulse and respiration arc usually 
 quick and the temperature high. The appetite is generally 
 voracious. The urine and feces are often voided involun- 
 tarily. Sexual desire is usually increased, and when so 
 occurring in women is known as nymphomania; in men 
 as satyriasis. 
 
 One of the most striking features of mania is the total 
 alteration wrought in the feelings of one so affected towards 
 the members of his family; the maniac becoming suspicious 
 of and hating those whom he had formerly naturally loved. 
 When haunted by delusions, which is not unfrequently the 
 case, he may become so dangerous as to necessitate physical 
 restraint. Systematic writers upon the subject of insanity 
 consider mania to be of different kinds, distinguishing the 
 varieties, as mania proper or intellectual mania, which we 
 have just described, melancholia, partial intellectual mania, 
 moral mania, partial moral mania, kleptomania, pyromauia, 
 dipsomania, and homicidal, suicidal, puerperal mania. But, 
 whatever views may be held by systematists concerning dif- 
 ferent kinds of insanity, moral, emotional, intellectual, etc., 
 it should be understood that the law recognizes only one 
 kind of insanity — that which affects the mind, the latter 
 being adjudged as unsouud when affected with delusions 
 that cannot be dispelled. 
 
 Melancholia may be regarded as a variety of mania, 
 differing more especially from the latter in being charac- 
 terized by depression rather than excitement, by the patient 
 refusing food rather than partaking of it eagerly. The 
 face is pale and pinched, the eyelids droop, the pupils are 
 
166 A MANUAL OF 
 
 dilated. The patient sits for hours at a time doing noth- 
 ing, brooding over melancholy thoughts ; he is often of a 
 religious nature, suspicious of being persecuted, burned, 
 poisoned, etc., often dirty in habits, soiling his clothes and 
 linen, utterly indifferent to his personal appearance. 
 
 Partial intellectual mania is characterized by the fact 
 that the person who suffers from this form of mental dis- 
 ease is possessed of some one notion contrary to his own 
 experience, as well as to all common sense. He may 
 imagine that his stomach is full of lizards and snakes; or, 
 if the individual be a woman, that her uterus contains 
 hydatids, and that she is pregnant by the devil, as was 
 believed in a well-known case. 1 
 
 As it is still a question whether there is any such form 
 of mania as moral mania, that is, of a morbid perversion 
 of the natural affections, temper, and habits of an individual 
 without any noticeable derangement of the intellect, 2 it is 
 only necessary, in this connection, to say that no sudden 
 outburst of this form of mania should be admitted as ex- 
 cusing or palliating any crime. There are no well-authenti- 
 cated cases, for example, of persons becoming suddenly 
 affected with an insane desire to commit murder, and unless 
 it can be clearly shown that, previously to the commission 
 of such a crime, the defendant had given evidence of being 
 insane, the plea of moral insanity should not be enter- 
 tained by the court, but the defendant should be punished to 
 the full extent of the law. 
 
 Kleptomania, or the disposition to steal, is exhibited so often 
 by persons in good circumstances that this peculiarity cannot 
 
 1 Esquirol, E. : Des Maladies mentales, tome premier, Paris, 1838, p. 
 495. 
 
 2 Pritchard: Treatise on Insanity, 1837, p. 16; Pinel: Traite medico- 
 philosophique sur I' Alienation mentale, deuxieme edition, Paris, 1809, p. 
 155. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 107 
 
 be attributed to want, but to some aberration of the intellect. 
 In all trials of kleptomaniacs, it must be proved that the 
 defendant is incapable of appreciating what constitutes the 
 crime of theft; otherwise the plea of this form of insanity 
 would be the favorite defence of all professional thieves. 
 
 Pyromania, or the insane desire to set fire to anything, 
 barns, dwelling-houses, churches, is a less common form of 
 mania than kleptomania. It appears to be ofteu associated 
 with epileptic insanity. No doubt this form of mania, like 
 the so-called " moral mania," is made a convenient plea for 
 the defence of crime, as in cases of arson. Dipsomania, 
 or the craving for drink, differs from the desire for liquor 
 shown by those who indulge daily in the use of alcohol 
 in the circumstance that it is followed by long remissions 
 in the thirst for it. During these periods there is not only 
 no desire, but often a loathing, for it. With the return of 
 the craving, the individual will literally soak himself with 
 spirits for days and weeks at a time, often secluding him- 
 self and shunning society of all kinds. 
 
 In this connection, the responsibility of drunkards may 
 be as appropriately considered here as elsewhere. Undoubt- 
 edly, irresponsibility would be inferred by the law in the 
 case of a person whose mind had been weakened by habitual 
 drinking, unless it could be shown that, at the moment of 
 the commission of an act — such as the signing of a deed — 
 the individual was fully conscious of the nature of the 
 contract. A murder committed by a drunken man would 
 not be excused, however, by the law, if he had got volun- 
 tarily drunk before perpetrating the crime. If it could be 
 proved, however, under such circumstances, that his mind 
 had been hopelessly diseased by drink, he would be held 
 irresponsible. In all such trials, an extenuating circum- 
 stance would be the fact that the defendaut had no grudge 
 
168 A MANUAL, OF 
 
 or malice against the deceased, but Lad committed the 
 murder when under the influence of drink. It may be 
 mentioned, in connection with the responsibility of drunk- 
 ards, that somnambulists cannot be held responsible for their 
 acts, for, in such a condition as that of somnambulism, there 
 can be, from the very nature of the case, no motives to 
 commit crime, the intellect being in abeyance. 
 
 Homicidal mania is characterized by an irresistible 
 impulse to commit murder. In instances of this kind 
 of insanity, it will be generally learned, from the previous 
 history of the case, that the individual had been injured 
 at some previous period, as by a fall upon the head, in 
 consequence of which he had become more or less morose 
 and melancholic at times. The maniac may murder a 
 number of persons at once, the victims, not unfrequently, 
 being members of his own family, to whom he had been 
 previously devotedly attached ; there is an entire absence 
 of motive to commit the crime. Further, the maniac 
 makes no effort to escape from the consequences of his act, 
 as an ordinary sane murderer would do. He may even 
 boast of what he has done, saying that he had been directly 
 inspired to do what he did. 
 
 Suicidal mania, known also as monomania, is exhibited 
 in the disposition to take one's own life. While, in most 
 cases of suicide, the verdict of the coroner's jury — the 
 latter actuated, no doubt, by kindly feelings for the family 
 of the deceased — is death by his or her hands while labor- 
 ing under temporary insanity, there can be no doubt that 
 perfectly sane persons commit suicide. In ancient times it 
 was a common custom for persons who were at war to take 
 their own lives rather than take the chances of falling into 
 the hands of their conquerors and run the risk of torture 
 and death. It is a matter of everyday occurrence for 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 169 
 
 men who have failed in business to commit suicide rather 
 than to face their creditors, disaster, and financial ruin. 
 Indeed, so many suicides are committed, not only intention- 
 ally, but intelligently, that it becomes very often difficult 
 to say that the self-destruction was due to insanity. The 
 disposition to commit suicide is, in many instances, un- 
 doubtedly inherited, inasmuch as it is well known that the 
 members of certain families for generations have been in 
 the habit of taking their own lives. A remarkable feature 
 in suicide is the regularity with which it occurs, and the 
 frequency with which it is committed in the same way. 
 Indeed, under certain circumstances, the perpetration of 
 the act and the uniformity of the means by which it is 
 accomplished may not inappropriately be said to be 
 epidemic. 1 
 
 Puerperal insanity, which is one of the most distressing 
 kinds of mania, attacks women after delivery, within a 
 period varying from a few days to several weeks. It 
 occurs usually before the stoppage of the lochia ; albu- 
 min appears in the urine, and the flow of milk is sup- 
 pressed. A woman suffering from this form of mania 
 may be either foul-mouthed or taciturn and pious in her 
 talk, and may often be troubled with religious delu- 
 sions. She may either totally neglect her infant, or 
 take such a dislike to it that she sooner or later destroys 
 it, and frequently in the most horrible manner. It should 
 be remembered, therefore, by the medical jurist, that, in 
 certain cases of infanticide, the mother may have been 
 afflicted with puerperal insanity, and that under such cir- 
 cumstances she should not be held responsible for the con- 
 sequences of her actions. 
 
 1 Buckle : History of Civilization in England, chap. i. p. 25 ; Morselli, 
 H. : Suicide: An Essay on Comparative Moral Statistics, Kew York, 188:2. 
 
170 A MANUAL OF 
 
 Dementia (Fig. 40), beginning with a simple enfeeblernent 
 of the intellect, terminates with an entire extinction of the 
 
 Fig. 40. 
 
 Dementia (Paresis) (Ferrier). 
 
 mental powers. This form of disease is characterized by 
 absence of ideas, accompanied by depression, rather than, as 
 in mania, by exaggerated mental activity, with excitement. 
 It may follow acute mania or melancholia ; is often due to 
 disease of the brain, the result of injury, and is frequently 
 incidental to old age. The countenance in dementia is 
 pale, and the expression is a peculiarly vacant one. A 
 most striking feature is loss of memory, the patient, in an 
 advanced stage of the disease, forgetting even what has 
 transpired within a moment or two. Individuals affected 
 with this disease act in an undecided, silly, childish 
 manner, repeating themselves in conversation, appearing 
 neither to like nor dislike their former friends and associates, 
 moving about in an aimless, listless way. A disposition 
 is often exhibited in this disease to hoard up articles of no 
 value. 
 
 Paralytic dementia, also known as general paralysis or 
 paresis of the insane, appears to be due more especially to 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 171 
 
 disease of the gray matter of the convolutions of the brain. 
 This form of disease may be caused by syphilis, alcoholism, 
 excessive mental work. The first symptoms of general 
 paresis of the insane arc a certain fretfulness, irritability 
 of manner, accompanied by carelessness in dress, etc. 
 The patient becomes deluded with the idea of being 
 possessed of great wealth or great physical strength. As 
 the disease advances, the muscular power becomes much 
 weakened, and the gait unsteady. The tongue trembles 
 when protruded, the. lips are tremulous, and difficulty 
 is experienced in pronouncing certain words. Vision 
 becomes affected. A bloody, gelatinous-like swelling of 
 the ear develops, the so-called " hsematoma aims," the 
 contents of which, resembling the extravasations under 
 the dura mater in pachymeningitis, appear to be due to a 
 degeneration of the branches of the carotid artery. The 
 prognosis in general paresis of the insane is always un- 
 favorable, death taking place within a period varying from 
 two to ten years. 
 
 Medieo-Legal Relations of Insanity. — Having de- 
 scribed, in a geueral way at least, the most important 
 forms of mental disease, it remains now to consider 
 them in their medico-legal relations. Should a per- 
 son be determined to be insane, the first question to be 
 considered is as to the decree of the insanity, and more 
 especially as to the civil and criminal responsibility of 
 the individual. As out of this twofold inquiry arise all 
 medico-legal questions of insanity, there should be no 
 misunderstanding as to what is meant by civil and 
 criminal responsibility. Civil responsibility implies the 
 capability of managing one's own business, taking an 
 intelligent part in the ordinary affairs of civil life, 
 making contracts, wills, etc. Criminal responsibility 
 
172 A MANUAL OF 
 
 renders the perpetrator of any crime, such as theft, arson, 
 murder, liable to punishment, supposing the person suf- 
 ficiently sane at the time of the commission of the deed 
 to be held responsible. In all cases of insanity the 
 practitioner who assumes the responsibility of giving ad- 
 vice should have had a great deal of experience in treat- 
 ing insanity, and should exercise great caution before he 
 advises that a person should be deprived of his liberty 
 and placed under restraint. Before positively expressing 
 the opinion that the patient is insane, and setting forth the 
 facts upon which such an opinion is based, the physician 
 should satisfy himself, beyond doubt, that the person 
 alleged to be insane is really so. Not only one visit, but 
 several visits may have to be made before all doubts as to 
 the insanity of the patient are removed. In case the 
 practitioner advises that the patient be treated at home, it 
 should be distinctly understood that he is relieved of all 
 responsibility for the restraint, that being assumed by the 
 friends or the members of the family. The form of cer- 
 tificate by which an insane person can be removed to an 
 asylum is fixed by statute, and no other form is valid in 
 America. In Pennsylvania the certificate must be signed 
 by two respectable physicians, who have practised medi- 
 cine for five years, both of whom must have examined the 
 patient within one week of their signing the certificate, and 
 who both must testify under oath that it is absolutely 
 necessary for the safety of the individual and the public 
 that the patient shall be placed under restraint in an 
 asylum. The physicians signing the certificate should not 
 be related by blood or marriage, or be officially connected 
 in any way with the asylum in which the patient is to be 
 confined. Practitioners cannot be too cautious in signing 
 a certificate for the placing of a patient in an insane 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 1 7.'i 
 
 asylum, false commitment rendering them liable to heavy 
 punishment by an action at law. It should be remem- 
 bered that, in many instances, physicians have been de- 
 ceived by relatives interested in the management or dis- 
 posal of an estate, and induced by their misrepresentations 
 of the state of mind of the patient to sign a certificate con- 
 signing him or her to an insane asylum. 
 
 Judgment and caution must be exercised in signing the 
 discharge of a patient from an asylum by the physician in 
 charge, as well as in signing one of commitment. Patients 
 are usually removed from an asylum by the members 
 of their family or friends at the discretion and with the 
 approval of the superintendent. In America there is no 
 law preventing the liberation of the insane on recovery, 
 except in cases of homicidal lunatics, who have been com- 
 mitted to an asylum by an order of the court. 
 
 The opinion of the practitioner is occasionally asked 
 as to the capacity of an individual to make a will, to 
 sign a contract, or to many. It should be remembered, 
 strange as it may appear, that less mental capacity is 
 required by law to make a will than to permit the 
 managing of property or the enjoyment of personal 
 liberty. The courts have ruled in many instances 
 that patients, even when confined in iusane asylums, 
 have made good wills, and have held as valid the 
 most absurd wills, it having been shown that such wills 
 were in perfect accordance with the life of the eccen- 
 tric, but not therefore necessarily insane, testator. In 
 order, however, that a will should be valid, the law 
 requires that the testator should be sane, at least at the 
 time of the making of the will. A will made when the 
 testator was under the influence of liquor, or narcotized, 
 or afflicted with the delirium of fever, would not be held 
 
174 A MANUAL OF 
 
 as valid. A person would not be disqualified, however, 
 from making a will when poisoned by arsenic or strych- 
 nia, provided his mind was clear, and the same may be 
 said of a person suffering from typhoid fever, paralysis, 
 or epilepsy. When a physician is consulted as to the 
 capacity of a person to make a will, the examination of 
 the testator should be made in private, or only in the 
 presence of the nurse, or perhaps of one member of the 
 family. The physician should satisfy himself that the 
 testator is not under the influence of liquor, or of any 
 drug; that he fully realizes the importance and the 
 nature of the act he is about to perform ; that he is not 
 affected by any delusions ; and that no undue influence has 
 been brought to bear upon him. 
 
 A most delicate question for the physician to answer, 
 and his advice is often asked upon the subject, is that of 
 the propriety of one person marrying another who has 
 been insane, or in whose family insanity is hereditary. 
 While, as a general rule, all marriages of such a character, 
 as well as those in which there is a tendency in the con- 
 tracting parties to inherit any disease, are to be discouraged, 
 any advice to the contrary that may be given by the 
 physician will not prevent their taking place, and nothing 
 will be gained by his opposition. The family physician is 
 often called upon to give advice as to the best means of bring- 
 ing up children begotten by such unfortunate marriages. 
 Hygienic treatment is all that can be recommended in 
 such cases. It ought to be insisted upon, however, that 
 the children should have pure country air, plenty of 
 out-door exercise, plain but nutritious food ; that all ex- 
 citement, especially at the age of puberty, should be 
 avoided ; and, above all, that little or no mental effort 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 175 
 
 should be required, even though the child should thereby 
 grow up comparatively uneducated. 
 
 Criminal Responsibility of the Insane. — Of nil the ques- 
 tions which the subject of legal medicine gives rise to, 
 there is none more difficult or more worthy of consid- 
 eration than that of the relations of insanity to criminal 
 responsibility. In nearly every trial for homicide, how- 
 ever brutal or revolting the crime, no matter how out- 
 rageous or aggravated' the circumstances may be, after 
 every other plea has been urged, the defence, as a last 
 resource, attempts to prove that the murderer was insane. 
 It might be supposed that the sophistry, flimsy rubbish, 
 unworthy of being dignified by the name of argument, 
 advanced by adroit counsel, could speedily be disposed 
 of in all such cases by limiting the discussion to simply 
 determining whether the defendant was afflicted with 
 any mental disorder due to disease. The difficulty, 
 however, which at once arises consists in deciding what 
 shall constitute a test of the existence of a mental dis- 
 order. At one time it was universally admitted that an 
 individual was responsible unless totally deprived of his 
 understanding and memory — not knowing what he was 
 doing any more than an infant, brute, or wild beast. The 
 knowledge of right and wrong was later considered as a 
 test of responsibility in criminal cases. This test was 
 afterwards so qualified that the knowledge of right and 
 wrong was to have relation only to the particular act of 
 which the individual was accused ; and it was still fur- 
 ther modified in its being held that the person accused 
 must have a knowledge of the consequences of the act. 
 There can be no doubt, however, that insane persons 
 have not only been fully conscious of the criminality 
 of their acts, but have realized as well their conse- 
 
176 A MANUAL OF 
 
 quences and the punishment to which they rendered 
 themselves liable. 
 
 The knowledge of right and wrong, the consciousness 
 of criminality, the realization of liability to punishment 
 being possessed by insane persons, have in recent times 
 led to the claim that only those individuals should be held 
 irresponsible who have lost all power of control over 
 their actions. The test of irresponsibility may be said to 
 be, in this view then, the proof of a want of will-power — 
 the power of choosing between good and evil being de- 
 stroyed by disease. The accused would not, however, be 
 held irresponsible if the crime was committed under the 
 influence, temporarily, of liquor, or of a violent burst of 
 passion, the latter condition being often attributed to im- 
 pulsive or emotional insanity — a form of mental disorder 
 for the existence of which there is no evidence. 
 
 Not unfrequently, medical experts in insanity are also 
 called upon by the courts to state whether a criminal 
 under sentence of death is insane, in order to stay exe- 
 cution. 
 
 Medico-Legal Terms Defined. — In connection with cases 
 of insanity certain legal terms are frequently made use of 
 rather loosely, such as illusions, hallucinations, delusions, 
 lucid intervals; but these terms should be defined, in 
 order that the medical examiner may be qualified to 
 answer intelligently in court questions involving their 
 use. An illusion may be defined as a false impression 
 due to a material basis, the impression being, however, 
 distorted through some defect in the avenue of sense, 
 or of the perceptive centre, as in the mistaking a tree 
 for a man at night. Hallucinations differ from illusions 
 in being perverted impressions, but without a material 
 basis, at least immediately. A person afflicted with this 
 
MEDICAL JUEI8PEUDENCE AND TOXICOLOGY. 177 
 
 disorder imagines lie hears .strange voices, sees people 
 where there are none, etc. Delusions may ho defined as 
 beliefs in something purely imaginary, as when a pauper 
 imagines he has become a millionaire, or when a million- 
 aire believes he lias lost everything. Should a delusion be 
 so strong as to affect the disposal of an estate by will, as 
 when a parent has come to hate, for no reason, his chil- 
 dren, whom he had formerly loved, the capacity to make 
 a will should be disputed. If, however, the delusion with 
 which an individual is affected is not connected in any 
 way with the act about to be performed, the responsibility 
 of such a person would not be questioned. By a lucid 
 interval is meant a temporary intermission of insanity, 
 during which period the individual recovers his reasoning 
 powers. It may last for months, weeks, or only for a few 
 minutes. It not unfrequently occurs in mania, and occa- 
 sionally in dementia, but never in idiocy or imbecility. 
 Duriug a lucid interval the law recognizes the power of a 
 person to sign a contract, to make a will, to exercise civil 
 rights, etc. 
 
 Feigned Mental Diseases are usually considered by 
 Writers upon medical jurisprudence separately from 
 feigned bodily disorders. The expression mental dis- 
 ease, whether feigned or not, regarded as something dis- 
 tinct from bodily disease, is, however, an unphilosophical 
 one, as there can be no disease, mental or otherwise, 
 without some underlying change in organization. What- 
 ever may be the psychological views held as to the 
 nature of mind, whether it be regarded as an entity, a 
 something independent — superadded to the body — an 
 almost obsolete view now — or as a function of the nervous 
 system, and, more especially in man, of the cerebral por- 
 tion of it, a view accepted by all physiologists, is immate- 
 
 12 
 
178 A MANUAL OF 
 
 rial, at least as far as it affects the view universally 
 accepted that a healthy mind is always found in a healthy 
 body. 
 
 In connection with the subject of insanity, and as a 
 mere matter of convenience, the subject of feigned mental 
 diseases may be as appropriately considered here as else- 
 where. Mental diseases are most frequently feigned by 
 criminals, in the hope of escaping imprisonment or 
 capital punishment. It is frequently very difficult to 
 prove in such cases that the criminal is malingering, in- 
 sanity in one form or another being so well imitated. 
 The criminal may keep up the deception for months, dur- 
 ing which he may rave, beat the door, tear up his clothes 
 and bedding, indulge in the foulest language and dirty 
 habits, conduct himself in so outrageous a mauner as to 
 necessitate the use of a strait-jacket — and even then not 
 confessing the fraud. In the investigation of these cases 
 it is most important to determine whether the individual 
 has any motive in simulating insanity — such as that of 
 escaping punishment for some crime. Another point to 
 be determined is, whether the particular crime committed 
 was incidental to a life of crime, perhaps the last act of a 
 long series such as a hardened criminal, but not an insane 
 person, might be expected to commit. Another point to 
 be ascertained is, whether the culprit endeavored to escape, 
 it being well known that insane persons exhibit a perfect 
 indifference to the consequences of their acts. It should 
 be also remembered that insane persons never admit that 
 they are insane ; whereas, those simulating insanity are 
 always anxious to impress every one with the fact that they 
 are really insane. Of the different forms of insanity 
 mania is that which is usually feigned by malingerers. 
 As all maniacs are popularly supposed to be violent, the 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 17!) 
 
 malingerer in attempting to simulate mania is particularly 
 so, usually overacting the part; while the impostor, how- 
 ever, usually sleeps soundly, the maniac is as violent by 
 night as by day. Dementia is less rarely simulated than 
 mania, as it is more difficult to imitate, while the fraud 
 is more readily recognized, being at once disclosed by the 
 slightest reasoning power manifested by the individual. 
 
180 A MANUAL OP 
 
 PART II. TOXICOLOGY. 
 
 CHAPTER I. 
 
 Frequency of Death from Poisoning — Definition of a Poison — Mode of 
 Action of Poisons — Influence exerted on Action of Poisons by Habit, 
 Sleep, Disease, etc. — Evidences of Poisoning derived from Symptoms, 
 Post-mortem Appearances, Chemical Analysis, Experiments upon 
 Animals, Circumstantial Evidence — Character of the Evidence the 
 Chemical Expert may be Expected to give in Cases of Poisoning. 
 
 In most cases of poisoning the duty of the physician 
 making the post-mortem examination is usually limited 
 simply to removing the stomach, intestines, etc., of the 
 deceased person supposed to have been poisoned, and 
 placing them in the hands of the chemist especially 
 employed by the Commonwealth to make an exam- 
 ination of their contents, with the view of deter- 
 mining the cause of death. It is important, how- 
 ever, that every physician should have some knowledge 
 of toxicology ; that is, of the symptoms of poisoning, 
 the nature of poisons, their antidotes, etc., as well as of 
 the medical relations of the subject. The subject of toxi- 
 cology, like that of insanity, is such an extensive one that 
 its thorough consideration would demand a special treatise, 
 far exceeding the scope of the present work. All that the 
 author can hope to accomplish within his prescribed limits 
 is to point out, in a very general way, what his own ex- 
 perience suggests as to the kind of toxicological knowledge 
 the medical expert, who is not an analytical chemist, should 
 possess. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 181 
 
 The readiness with which poisons may be obtained, the 
 facility of administering them, the close resemblance which 
 the symptoms and post-mortem appearances of poisoning 
 frequently hear to those due to disease, account for the fact 
 that so many homicides and suicides are committed by this 
 means. Indeed, statistics show that, excepting the casual- 
 ties due to war, poisoning is the most frequent of all the 
 causes of violent death. 
 
 Poison Defined. — A poison may be defined as a sub- 
 stance which, introduced into the body in a state of health, 
 by the mouth, rectum, skin, lungs, etc., ordinarily causes 
 illness and often death, the injurious effects not being due, 
 however, to purely mechanical action. According to the 
 above definition, a substance would not be a poison which 
 only affected a person when suffering from disease like 
 that of gastritis, rendering him peculiarly susceptible, 
 which is due to personal idiosyncrasy. Nor would frag- 
 ments of glass, or iron, or other hard or sharp substances 
 be classified as poisons, even though they should cause 
 death when swallowed, the injurious effects experienced 
 being due to mechanical action. It need not be added 
 that the particular amount, large or small, of a substance 
 necessary to cause death affords no basis for distinguishing 
 certain substances as poisons from others which are not 
 poisons. Half an ounce of oxalic acid may prove as fatal 
 as half a grain of strychnia. The effects of poisons are 
 both local and remote. In making an impression directly 
 upon the part of the body with which the poison comes in 
 contact, a poison acts locally ; in affecting some distant 
 part of the body it acts remotely. Certain poisons act 
 both locally and remotely — arsenic, for example, affecting 
 the stomach locally, aud the brain remotely. In order 
 that a poison should produce its effects, unless it be a cor- 
 
182 A MANUAL OF 
 
 rosive, it must be absorbed — pass into the blood. 1 That 
 poisons are absorbed is proved by their being found in the 
 blood, brain, and viscera. The rapidity with which this 
 takes place will depend upon their solubility and the rela- 
 tive fullness of the bloodvessels. Absorption will, there- 
 fore, be favored by bleeding or purging through depletion 
 of the vascular system. The effects of a poison injected 
 directly into the blood are almost instantaneous. 
 
 Mode of Action of Poisons. — A poison having once 
 passed into the blood is carried by the latter throughout 
 the system, being either eliminated with the bile, urine, 
 saliva, pancreatic juice, and sweat, or deposited in the 
 liver, spleen, kidneys, heart, lungs, brain, pancreas, mus- 
 cles, or bones. Every organ would appear, therefore, to 
 have a peculiar affinity for some one or more poisons, as 
 shown either by the poison being excreted by a gland, as 
 arsenic by the stomach, or by its being retained within an 
 organ for a longer or shorter period, as lead by the brain 
 and spinal cord. 
 
 The time required for either the elimination or deposi- 
 tion of a poison varies according to the particular poison 
 taken and to the state of the system. Potassium iodide 
 and turpentine may appear in the urine within a few min- 
 utes after being swallowed. Arsenic may be found in the 
 liver in four hours and earlier after it is taken, being usu- 
 ally eliminated from the system within fifteen days if the 
 individual should survive for that length of time. Anti- 
 mony, on the other hand, may be found four months after 
 having been taken, lead and copper over eight months. 2 
 
 The phenomena of nutrition would lead us to suppose 
 
 1 Christison : Treatise on Poisons, fourth edition, Edinburgh, 1885. 
 
 2 Orfila : Annales de Hygiene publique et de Medecine legale, second 
 series, tome iii., Paris, p. 213. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 1 83 
 
 that it is probably only that portion of the poison flowing 
 in the capillaries to which its effects arc due. As this 
 boars but a small proportion to that found in the stomach, 
 which is often in large quantity, it is obvious that death 
 cannot be attributed to the latter, which must be regarded 
 as a surplus, a source of supply, should the poison circu- 
 lating through the system be insufficient to produce its 
 characteristic effects. The exact manner in which death 
 is caused by poison must be admitted not to be as yet un- 
 derstood, though the question has given rise to much dis- 
 cussion. The view has been advanced that poisons act in 
 so altering the composition of the blood as to render it unfit 
 to maintain life. Even if this could be proved, it would 
 not be an explanation of the modus operandi of poisoning. 
 In the present state of toxicological knowledge, all that 
 can be said is that opium, for example, causes narcotism 
 by. acting upon the brain ; prussic acid, asthenia through 
 its effect upon the heart ; strychnia, tetanus by its effect 
 upon the spinal cord. As to why these particular sub- 
 stances act in this peculiar way, no satisfactory answer can 
 be given any more than as to why certain poisons are elim- 
 inated with particular secretions, as mercury with the saliva. 
 As a general rule, the larger the dose of the poison the 
 quicker the action, the exceptions being afforded by sub- 
 stances like arsenic, which, when taken in an overdose, 
 induce vomiting, and are therefore rejected from the sys- 
 tem. Certain poisons undoubtedly act antagonistically 
 towards each other, the effect of the one poison being more 
 or less neutralized by the other. Thus, for example, mor- 
 phia antagonizes atropia, and atropia neutralizes strychnia. 
 Indeed, so true is this in the case of the two latter alka- 
 loids that in strychnia-poisoning atropia should be admin- 
 istered as an antidote. On the same principle, digitalis 
 
184 A MANUAL OF 
 
 might be tried in cases of aconite-poisoning, there being 
 an antagonism between these drugs also. 
 
 The power of poisons to produce their characteristic 
 effects is very much diminished by their prolonged use, 
 enormous amounts of laudanum and morphia, for instance, 
 being tolerated by confirmed opium-eaters, and arsenic by 
 arsenic-eaters. 
 
 Sleep, whether induced naturally or by opium, usually 
 diminishes or retards the action of poisons, especially of 
 the irritant kind. Certain animal substances, which, when 
 introduced into the system, are very poisonous, often in- 
 deed fatal, are, however, when swallowed so modified by 
 the digestive fluids as to be rendered innocuous, as shown 
 by the fact that persons are unaffected after sucking 
 wounds made by poisoned arrows, snake-bites, etc. 
 
 Disease modifies the action of poisons. Persons suffering 
 with apoplexy and inflammation of the brain are very 
 susceptible, for example, to the action of opium. On the 
 other hand, large quantities of opium are tolerated in 
 tetanus and mania-a-potu. The evidences in cases of al- 
 leged poisoning are afforded by the symptoms, the post- 
 mortem appearances, chemical analysis, experiments upon 
 animals, circumstantial evidence. 
 
 Evidence of Poisoning derived from Symptoms. — In con- 
 sidering the symptoms presented by a person supposed to 
 have been poisoned, it is most important to ascertain whether, 
 at the time of the attack, the person was perfectly well, 
 whether the symptoms appeared shortly after the taking of 
 food or drink, and whether any other persons were affected 
 in a similar manner. The great difficulty experienced by 
 the medical examiner in determining, from the symptoms 
 alone, whether a person has been poisoned, arises from 
 the similarity between the symptoms of disease and those 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 185 
 
 due to poison. Tims, for example, the symptoms of ma- 
 lignant cholera, cholera morbus, peritonitis, ulcer of the 
 stomach resemble very closely those due to irritant poi- 
 sons. Indeed, eases of arsenic-poisoning have been mis- 
 taken for attacks of cholera morbus. On the other band, 
 the effects of narcotic poisons resemble in many respects 
 those due to apoplexy, inflammation of the brain, certain 
 cardiac disorders, etc. The above examples among many 
 which might be given serve to prove that the symptoms 
 alone in any case would not warrant the medical examiner 
 in stating positively that a person had been poisoned, nor, 
 on the other hand, in warranting him to attribute to dis- 
 ease an alleged case of poisoning. 
 
 In addition to what has already been said as to the 
 manner of making post-mortem examinations, it is espe- 
 cially important, in connection with poison cases, that the 
 stomach and other viscera should be placed in a perfectly 
 clean glass jar. Otherwise the defence on trial might 
 plausibly argue that the poison found by the chemist was 
 derived from the dirt in the jar, and not from the viscera 
 of the person alleged to have been poisoned. Further, 
 in case the stomach or other viscera are to be submitted to 
 a chemist for analysis of their contents, the physician who 
 makes the post-mortem examination should pack the jar 
 with its contents securely in a box, seal the latter up, and 
 label it. It is desirable, where possible, for the medical 
 examiner to place the box in the hands of the chemist 
 himself. Whoever delivers it, however, should take a 
 receipt for it. The neglect of such precautions on the 
 part of the physician making the autopsy in a poison case 
 may give rise, on trial, to the objection that the stomach, 
 etc., in passing through different hands, may have been 
 tampered with, and the testimony of the chemist who 
 
186 A MANUAL OP 
 
 fouud the poison may be thereby materially weakened. 
 In opening the stomach in poison cases it will be found 
 most convenient to make the incision along the lesser curv- 
 ature; then, after collecting and measuring the contents, 
 to spread the stomach out upon a clean glass plate, the 
 inner or mucous surface being uppermost; the latter should 
 then be examined most carefully both for lesions and the 
 remains of the poison. 
 
 Post-mortem Appearances. — Among the post-mortem 
 signs usually presented in poison cases may be men- 
 tioned redness, softening of the mucous membrane of 
 the stomach and intestines, ulceration and perforation. 
 It need scarcely be mentioned, however, that, as the 
 same signs may be due to disease, the medical exam- 
 iner should be cautious in attributing them, even in 
 suspicious cases, to poison. Not unfrequently remains of 
 poison, such as crystals of arsenic, pieces of phosphorus, 
 vegetable leaves, etc., may be found in the stomach and 
 intestines. In cases of poisoning by prussic acid, opium, 
 nicotine, etc., the odor of these substances on opening the 
 body becomes very perceptible. Occasionally the cheeks, 
 mouth, tongue, and dress of the deceased may be stained, 
 as in cases of poisoning by mineral acids. One of the 
 most convincing of the evidences of poisoning that can 
 be adduced is the discovery of the poison. 1 In order to 
 prove that death was caused by poisoning, the law, how- 
 ever, does not require that the poison should be actually 
 discovered, many criminals having been convicted on other 
 evidence, circumstantial and otherwise. Indeed, if the 
 discovery of the poison was essential to conviction, many 
 criminals would escape, as there is no reliable, certain test 
 
 1 " Tunc demum res certa, erit, ubi venemum ipsum reperietur facile 
 agnoscendum " (Wharton and Stille : op. cit., vol. ii. p. 44). 
 
MEDICAL JURISPRUDENCE and TOXICOLOGY. 187 
 
 for many poisons, especially of the animal and vegetable 
 kinds. On the other hand, the mere finding of a poison 
 within the stomach would not necessarily lead to convic- 
 tion if the lesions usually produced by the poison were not 
 present; and if other proof, such as symptoms, circum- 
 stantial evidence, etc., were absent. Indeed, it might be 
 argued, in such a case, that the poison had been introduced 
 into the stomach after death for some malicious purpose, 
 with the motive perhaps of exciting suspicion and of leading 
 to the conviction of some innocent person. The fact that 
 the poison was found in the liver, spleen, etc. would be a 
 much stronger proof that death was caused by the poison 
 than the finding of it in the stomach alone, as in the 
 former case it would be inferred that the poison had been 
 absorbed. It must be remembered, however, that a poison 
 might be introduced into the stomach or rectum after 
 death, and thence by osmosis pass possibly all through the 
 body, for, although the bony cranium and spinal column 
 would prevent osmosis, nevertheless, if the poison were im- 
 bibed by the nerves, it might possibly be transmitted by 
 the latter not only to the cord, but even to the brain itself. 
 Chemical Analysis. — In making an analysis it is import- 
 ant that the chemist should inform himself as to the nature 
 of the symptoms, as well as of the post-mortem appearances 
 presented, inasmuch as these may serve, to some extent at 
 least, to indicate the nature of the poison taken. In every 
 case the analysis should be made as carefully and as thor- 
 oughly as possible. As a matter of precaution only one 
 portion of the suspected substance should be analyzed at a 
 time, the remaining portion being reserved in case an acci- 
 dent should happen, or there should arise a necessity for 
 future investigation. The substance suspected to be poison 
 ought to respond to all the tests. It is also most import- 
 
188 A MANUAL OP 
 
 ant that the reagents, previous to being used, should have 
 been determined to be pure, so-called " chemically pure " 
 reagents often containing impurities. In many analyses 
 it is of advantage to reduce the bulk of the liquid by 
 evaporation, since the quantity of poison present might be 
 so small as not to respond to the ordinary tests. Not- 
 withstanding, however carefully the analysis may have 
 been made, the chemist fails in many instances to discover 
 any poison. It must be remembered, in connection with 
 failures to find poison in those cases where all the other 
 evidence concurs in showing that poison had been taken, 
 that the latter may have been vomited or have passed out 
 of the system in the feces and urine. The poison, fur- 
 ther, may have been of such a nature as to be unrecogniz- 
 able by any means at present known, or to have been de- 
 composed in the blood or tissues during life or after death. 
 Experiments on Animals. — In those cases where the poison 
 cannot be determined by either the symptoms, post-mortem 
 appearances, or chemical analysis, there remains still another 
 resource — that of experimentation upon animals. For ex- 
 ample, in an obscure case of strychnia-poisoning, some of 
 the suspected matter, found perhaps in the stomach of the 
 deceased, might be injected subcutaneously into a frog, the 
 latter animal, as is well known, being extremely suscep- 
 tible to the effects of that alkaloid. 1 Criminals have been 
 convicted of giving digitalis and aconite in this way, 
 these poisons having been recognized through their char- 
 acteristic effects produced upon animals. It is an interest- 
 ing fact, in this connection, that animals enjoy an immunity 
 from being poisoned by certain plants which, when eaten 
 by man, usually prove fatal ; and, further, that man may 
 
 1 Orfila : Traite des Poisons, troisieme edition, tome premier, Paris, 
 1826, p. 31. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 189 
 
 be poisoned by outing an animal that has previously fed 
 upon such plants. Thus, it is well known that the milk of 
 cattle browsing upon the herbage in certain parts of South 
 America, and the meat of the rabbit which has eaten bel- 
 ladonna, will prove poisonous to human beings partaking 
 of them. 1 
 
 Circumstantial Evidence. — Although the consideration 
 of the circumstantial evidences of poisoning in a crim- 
 inal case does not constitute a part of the duty of the 
 medical examiner, nevertheless a knowledge of all the 
 circumstances bearing upon the case will be of advan- 
 tage. Among such circumstances may be mentioned par- 
 ticularly : Whether the person accused had any motive 
 for poisoning the deceased. Was there any evidence 
 that the accused had recently purchased the particular 
 poisou found, or that he had had any in his possession 
 for some time? Did he give the deceased always his 
 meals? Was medical advice sought, and, if so, was the 
 medicine always given by the accused ? If any matters 
 were vomited during the illness of the deceased, were they 
 submitted to the physician for examination, or thrown 
 away at once and nothing whatever said about them? 
 Was the burial premature and very quiet ? Was an 
 autopsy objected to? It is needless to say that, if the 
 accused acted in such a way, there would be good reason, 
 indeed, to suspect foul play. 
 
 Character of Evidence of the Chemical Expert. — In 
 all criminal cases of poisoning the physician or the 
 chemist, or whoever makes the analysis, must be prepared 
 to answer at the trial such questions as the following : 
 Could the sickness or death be ascribed to poison, and, if 
 so, to what particular poisou ? Would such a poison as 
 
 1 Guy and Ferrier : op. cit., p. 372 ; Beck : op. cit., vol. ii. p. 414. 
 
190 A MANUAL OF 
 
 that alleged to have been given produce death if adminis- 
 tered in sufficient quantity ? At what period was the 
 poison given? Could such a poison disappear so entirely 
 from the system as to leave no trace ? Might the poison 
 discovered in the body of the deceased have been derived 
 from some other source than that which was claimed to 
 show that it had been criminally administered? 1 The an- 
 swers to be given by the medical witness to such questions 
 will largely depend upon what particular kind of poison 
 may have been given, as will become more apparent when 
 the different kinds of poisons will have been considered. 
 
 The effects of poison are simulated occasionally; the 
 imposture will be discovered, however, in time at least, if 
 not by other means. Insane people are frequently deluded 
 with the idea that attempts are being made to poison them, 
 or that they have been poisoned. 
 
 1 Tardieu, A.: Etude medico-legale et clinique sur I' Empoisonnement, 
 Paris, 1867. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 1 !) I 
 
 CHAPTER II. 
 
 Classification of Poisons — Irritant Poisons — Poisoning by Mineral 
 Acids, by Alkalies and their Salts, Noxious Gases — Poisoning by 
 Phosphorus, Arsenic, Antimony, Mercury, Lead, popper, etc — Poi- 
 soning by Oxalic Acid, Carbolic Acid, etc. — Poisoning by Decom- 
 posed Food, Ptomaines, Neurotic Poisons — Poisoning by Opium, 
 Alcohol, Ether, Chloroform, Chloral, Nux Vomica, Strychnia, Bel- 
 ladonna, Stramonium, Tobacco, Lobelia, Hydrocyanic Acid. 
 
 Systematic writers upon the subject of Toxicology vary 
 very much in the manner in which they classify poisons. 
 In this manual, however, poisons will be regarded as con- 
 sisting of only two kinds : Irritants and Neurotics. 1 
 
 Poisons 
 
 Irritants 
 
 f Mineral Acids, Alkalies, Phosphorus, Bro- 
 mine, Iodine, Arsenic, Antimony, Mer- 
 cury, Lead, Copper, Tin, Bismuth, Car- 
 bolic Acid, Trichiniasis, Ptomaines. 
 
 Opium, Alcohol, Anaesthetics, 
 Chloral Hydrate, Carbon Ox- 
 ide, Carbon Dioxide. 
 
 r Cerebral 
 Spinal . 
 
 Neurotics 
 
 Cerebro- 
 spin 
 
 , -J Depressants -J 
 
 . Strychnos Nux Vomica. 
 
 {Stramonium, Hy- 
 oscyamus, Atro- 
 pa Belladonna. 
 
 ( Nicotiana Taba- 
 cum, Lobelia, 
 Aconitum. 
 
 Digitalis, Cocculus 
 Indicus, Acidum 
 Hyd rocy an i cu m . 
 
 Irritant poisons include substances which, when swal- 
 lowed, give rise to an acrid, burning taste, followed by 
 nausea, vomiting, cramps in stomach, purging, the matters 
 1 Taylor : op. cit., p. 78. 
 
 [Asthenics 
 
192 A MANUAL OF 
 
 vomited and purged being often mixed with blood, these 
 symptoms being due to inflammation of the mucous mem- 
 brane of the alimentary canal, terminating not unfrequently 
 in ulcer, perforation, and gangrene. They may possess 
 simple irritant properties or specific ones, and are derived 
 from the mineral, vegetable, and animal kingdoms. The 
 simple irritant poisons include such substances as the min- 
 eral acids and alkalies. Among those possessing specific 
 properties may be mentioned phosphorus, arsenic, anti- 
 mony, mercury, oxalic and carbolic acids, cantharides, 
 poisoned meat, fish, etc. 
 
 Neurotic poisons include such substances as have a spe- 
 cific action upon the brain and spinal cord, causing head- 
 ache, giddiness, drowsiness, stupor, delirium, coma, con- 
 vulsions, paralysis. They are derived from the vegetable 
 kingdom and include substances like opium, chloral, 
 strychnia, atropia, Calabar bean, prussic acid, etc. 
 
 Irritant Poisons. — Poisoning by Mineral Acids. — As a 
 general rule, most cases of poisoning due to mineral acids 
 are accidental in character, suicide being only occasionally 
 committed by such means, and homicides but rarely. As 
 the symptoms, post-mortem appearances, general treat- 
 ment, in poisoning by the different mineral acids, are very 
 much the same, they may be conveniently considered to- 
 gether. The symptoms in cases of poisoning of this kind, 
 which depend more on the degree of concentration than on 
 mere quantity, are a burning sensation in the mouth, fol- 
 lowed by violent pain in the stomach, vomiting of dark- 
 colored coifee-grounds-like matters containing blood, and 
 occasionally portions of mucous membrane. In all cases 
 of poisoning by mineral acids, magnesia, chalk, plaster oif 
 the walls (if nothing better), soap-suds, oil, milk, mucilagi- 
 nous drinks, flaxseed tea, or barley-water may be adminis- 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY! L93 
 
 tered. If undiluted acid has been swallowed, however, 
 there is but little hope that the remedies jnsi mentioned 
 or any others will do much good. The smallest recorded 
 quantity of sulphuric acid known to have destroyed life 
 was one drachm, the shortest known period at which death 
 has taken place being within two hours. 1 
 
 On post-mortem examination stains and corrosions are 
 found on all parts with which the acid has come in con- 
 tact. The stomach is filled with black, yellow, or brown 
 fluid, perhaps distended with gas, its mucous membrane 
 charred or inflamed, perforation not being uncommon in 
 cases of sulphuric acid poisoning. The skin is stained 
 black or dark brown by sulphuric acid, yellow by nitric 
 acid, white by hydrochloric acid. In cases of sulphuric 
 acid poisoning the contents of the stomach should be fil- 
 tered and then treated with any soluble salt of barium. 
 The dense white precipitate produced, insoluble in acid 
 and alkalies, with charcoal and blowpipe will yield barium 
 sulphide, which in turn with a mineral acid gives sul- 
 phuretted hydrogen, recognizable by the black stain it 
 gives to filtering paper dipped into a solution of lead salt. 
 
 The smallest quantity of nitric acid recorded as having 
 destroyed life was two drachms, death having taken place 
 within two hours. 2 
 
 In cases of poisoning by nitric acid, the matters ob- 
 tained from the stomach should be first filtered. The 
 clear acid liquid so obtained should then be heated and a 
 weak solution of potassium carbonate added. Paper dipped 
 into a concentrated solution of the latter will afterwards 
 burn with deflagration. A few drops of the filtered solu- 
 tion evaporated to dryness on a glass slide will give 
 
 1 Christison : op. cit., p. 162. 
 
 2 Wharton and Stille : op. cit., vol. ii. p. 179. 
 13 
 
194 A MANUAL OF 
 
 crystals of potassium nitrate. On making a solution of 
 these crystals and adding a crystal of ferrous sulphate 
 with a drop or two of strong sulphuric acid, the green 
 color of the crystal will change to reddish-brown, due to 
 the formation of ferric sulphate. Morphina and brucina 
 will serve as tests for concentrated nitric acid, being turned 
 red by the acid. Ruddy brown fumes are also given off 
 when nitric acid is poured on copper. In order to extract 
 hydrochloric acid from the stomach it is only necessary 
 to add silver nitrate to the filtered contents, the white pre- 
 cipitate silver chloride formed being readily recognizable 
 by being soluble in liquor ammonia? and precipitable by 
 nitric acid, blackening upon exposure to light and melting 
 into a mass known as horn silver when heated. The fact 
 that hydrochloric acid dissolves gold leaf in the presence 
 of nitric acid affords a convenient test for the concentrated 
 acid, as also the white fumes given off with vapor of am- 
 monia. The smallest quantity of hydrochloric acid known 
 to have destroyed life is half an ounce, the shortest period 
 within which death took place being two hours. 1 
 
 Poisoning by Alkalies. — The alkalies, potassa, soda, and 
 ammonia, are rarely used for homicidal purposes. As 
 potassa and soda are, however, extensively used in the 
 arts, in the manufacture of glass and soap, under the 
 name of pot- and pearl-ashes, soda ashes and soap lees, 
 and ammonia in the form of aqua ammonia? for various 
 household purposes, illnesses and occasionally death have 
 occurred as the result of taking them accidentally. 
 
 The symptoms of poisoning by the alkalies are an acrid, 
 nauseating taste, followed by a burning heat in the throat 
 and stomach, violent abdominal pains, vomiting and purg- 
 ing. Ammonia, being more irritating than potassa or soda, 
 affects the respiratory organs especially, inducing a chok- 
 1 Taylor : op. cit., p. 102. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 195 
 
 ing sensation. In cases of poisoning by any of the alka- 
 lies, vinegar and water, lime or orange juice, oil, which 
 forms -with alkali soap, should be given, opium being 
 administered to relieve pain. The quantity of potassa or 
 soda or ammonia that may prove fatal is variable, death 
 having been caused by half an ounce of caustic potassa 
 and by forty grains in solution and by two drachms of 
 ammonia. 1 Persons have, however, recovered after swal- 
 lowing over an ounce of ammonia. Death may take place 
 from poisoning by alkalies within a few hours or days, or 
 may be protracted several months. In fatal cases, on 
 post-mortem examination, the mucous membrane of the 
 mouth, throat, and gullet will be found corroded, often 
 blackened, and even completely destroyed, the larynx and 
 bronchi being particularly inflamed and softened in cases 
 of ammonia-poisoning. 
 
 In examining the contents of the stomach, as a general 
 rule, the organic matters can be removed by evaporation 
 and subsequent heating ; the ash remaining being digested 
 with distilled water and filtered, the potassa or soda will be 
 found in solution as a carbonate. Potassium compounds 
 give a violet color, sodium compounds a yellow color to 
 the smokeless flame of spirit or gas. The presence of these 
 alkalies can be readily recognized also by means of the 
 spectroscope. Potassium can also be tested for by using 
 tetrachloride of platinum, which throws down a yellow 
 granular precipitate consisting of potassio-platino chloride. 
 In making use of this test, the absence of ammonia must 
 be insured. Soda may be recognized from the white pre- 
 cipitate thrown down by the addition of potassium anti- 
 moniate. Ammonia may be extracted from the stomach 
 by distilling about one-fourth of the liquid, the vapor 
 being carried through a bent tube into a well-cooled re- 
 1 Woodman and Tidy : op. tit., pp. 92, 105. 
 
196 A MANUAL OF 
 
 ceiver containing a small quantity of water acidulated with 
 hydrochloric acid. If no ammonia should be given off, 
 the contents of the retort should be treated with alcohol 
 filtered and redistilled with lime hydrate, by which free 
 ammonia, perceptible from its odor, will be obtained. As 
 ammonia is one of the products of putrefaction, if the con- 
 tents of the stomach should be found in that condition it 
 will be useless to attempt to make an analysis. A con- 
 venient test for ammonia is -platinum tetrachloride, which 
 gives a yellow precipitate. 
 
 The alkaline salts and earth, potassium nitrate or salt- 
 petre, used in medicine and in the manufacture of gun- 
 powder, potassium bitartrate or cream of tartar, potassium 
 sulphate, chlorinated soda and potash or bleaching salts, 
 magnesium sulphate or Epsom salts, the salts of barium, 
 strontium, calcium, and even common salt, have all proved 
 fatal when taken in overdoses or in large quantities. As 
 cases of poisoning from such substances were not homi- 
 cidal in character, but resulted from accident, it will not 
 be necessary to describe the symptoms, post-mortem ap- 
 pearances, etc. It may be mentioned, however, that the 
 proper treatment in such cases, generally speaking, is to 
 evacuate the poison by emetics and mucilaginous drinks, 
 and the administration of antiphlogistic remedies. 
 
 Poisoning by Noxious Gases. — Among the irritant 
 poisons may also be included nitrous acid, sulphurous 
 acid, hydrochloric acid, and chlorine gases. The dele- 
 terious effects of the fumes of such gases are well known, 
 causing irritation and inflammation of the throat, eyes, 
 and air-passages, inducing in some cases even spasm of 
 the glottis. The production of these gases is incidental 
 to various manufacturing processes, nitrous acid gas being 
 generated upon a large scale in water-gilding and brass- 
 
MEDICAL JURISPRUDENCE AM) TOXICOLOGY. 107 
 
 button-making, sulphurous add gas in bakers' ovens, 
 hydrochloric acid gas in potteries. As such cases of poi- 
 soning arc often of a chronic rather than acute character, 
 and but rarely become the subjed of medico-legal investi- 
 gation, it will not be necessary to dwell further upon the 
 noxious effects of these gases. 
 
 Poisoning by Phosphorus. — With the description of phos- 
 phorus poisoning wc begin the consideration of that class of 
 irritant poisons which not only act upon the mucous mem- 
 brane of the alimentary canal, or the part of the body they 
 come directly in contact with, but also upon remote parts 
 of the system — the nervous centres being often especially 
 affected. It is true that some of the alkaline and earthy salts 
 just mentioned possess similar properties to some extent ; 
 but, as poisoning is rarely caused in this way, their specific 
 properties were not referred to. Phosphorus is but seldom 
 used for homicidal and not very frequently for suicidal 
 purposes. Most cases of poisoning of this kind are acci- 
 dental in character, caused by swallowing the phosphorus 
 paste used for destroying vermin, or the tops of lucifer 
 matches. Poisoning by phosphorus is much less common 
 than formerly, the red or amorphous form, which is not 
 poisonous, being so much more used than the yellow 
 variety. In acute cases the symptoms vary at the com- 
 mencement, sometimes setting in rapidly, at others being 
 protracted. As a general rule, within from one to two 
 hours, a peculiar, disagreeable taste is experienced, accom- 
 panied with intense warmth in the stomach and bowels, 
 which gradually turns into a violent, burning pain. Eruc- 
 tations having a garlicky odor, followed by nausea, vomit- 
 ing and purging are not infrequent. The matters vomited 
 are usually dark-colored, and have the garlicky odor of 
 phosphorus. The pupils are dilated, the abdomen dis- 
 
198 A MANUAL OF 
 
 tended, the extremities cold, the pulse weak, the thirst 
 intense. Between the third and fifth day, if the case is a 
 protracted one, jaundice appears, often accompanied with 
 retention of urine and delirium, the patient dying possibly 
 in convulsions or comatose. Recovery is very rare. The 
 most constant symptoms in chronic phosphorus poisoning 
 are weakness and fatigue, pains in the abdomen, with 
 diarrhoea, intermittent toothache, carious teeth, with gums 
 swollen and distended with pus ; the complexion sallow, 
 eruption upon the skin ; falling off of the hair, increase of 
 phosphates in the urine. 
 
 There is no chemical antidote for phosphorus. The 
 poison should be removed as soon as possible. If the 
 patient is seen shortly after taking the poison, the stomach- 
 pump should be used ; otherwise, an emetic of sulphate of 
 zinc or sulphate of copper should be administered, the 
 latter being given in three-grain doses, well diluted, at in- 
 tervals. Magnesia or chalk, in gruel, should be given. 
 If the poison has had time to reach the intestines, purging 
 should be tried ; on no account should oil be given, as the 
 phosphorus would be dissolved, and its absorption greatly 
 promoted. It is most important, as a precautionary 
 measure, that those engaged in phosphorus manufactories 
 should be extremely cleanly in their habits, changiug their 
 clothes after work, washing their faces and hands, and 
 rinsing their mouths with some slightly alkaline wash. 
 Saucers filled with turpentine should be placed about the 
 factory, the fumes appearing to exert a protective effect. 
 The smallest quantity of phosphorus known to have de- 
 stroyed life was one-and-a-half grains in a man, one-eighth of 
 a grain in a woman. The one-fiftieth of a grain has, how- 
 ever, killed a child. 1 Death in cases of acute phosphorus- 
 poisoning usually takes place within a period of from three 
 1 Woodman and Tidy : op. cit., p. 71. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 199 
 
 to six days. In one case recorded death occurred in half 
 an hour. Chronic cases may, however, last for mouths or 
 even for years. 
 
 On post-mortem examination the mucous membrane of 
 the alimentary canal is usually found inflamed, softened, 
 and discolored. In chronic cases the most important 
 change observed is the fatty condition of the liver, kid- 
 neys, heart, muscles, etc., the fat being probably derived 
 from the albumen of the tissues. The best way of extract- 
 ing phosphorus from the stomach is that of Mitscherlich. 
 This method consists in distilling the suspected fluid in 
 the dark with a small quantity of dilute sulphuric acid, 
 the object of the latter being to neutralize the ammonia 
 developed during putrefaction. The vapors are made to 
 pass through a tube kept cool by running water into a 
 receiver, a flash of light appearing every time that the 
 phosphorus vapor condenses in the tube. This method 
 is so delicate that one part of phosphorus may be detected 
 by it in one hundred thousand of substance. 
 
 Bromine and iodine, like phosphorus, are irritant poisons, 
 possessing specific properties as well. Bromine has been 
 used to commit suicide, and iodine in over-doses has caused 
 death accidentally. The symptoms of poisoning by bromine 
 are spasmodic action of the muscles of the larynx and phar- 
 ynx, with great difficulty in breathing, followed by burn- 
 ing pain in the stomach. An ounce of bromine has caused 
 death in seven hours and a half. Iodine in large doses 
 causes a burning heat in the throat, pain in the abdomen, 
 vomiting, purging. In such cases emetics should be ad- 
 ministered. The post-mortem appearances presented are 
 those of an irritant poison. Fatal results have followed 
 from the taking of twenty grains of iodine. Death occurs 
 usually within thirty hours after the taking of the poison. 
 
200 A MANUAL OF 
 
 It may be mentioned that caution should be exercised by 
 the physician in prescribing iodide of potassium, as some 
 persons are very susceptible to its influence. In such cases, 
 headache, abdominal pain, thirst, inflammation of the nos- 
 trils and eyes, salivation, pustular eruption follow its ad- 
 ministration even when given in small doses. 
 
 Poisoning by Arsenic. — Arsenic is found in nature in the 
 metallic form, or in combination with other metals, such as 
 zinc, copper, iron, and with sulphur in the form of orpi- 
 ment and realgar. Arsenic is extensively used in the arts, 
 in the manufacture of enamel, glass, composition candles, 
 vermin-killers, fly-powders ; ship-builders protect their tim- 
 ber from worms, farmers preserve their grain, grooms im- 
 prove the coats of horses, and women their skin, by arsenic. 1 
 Arsenic is so readily obtained and so easily administered, 
 and is so easily suspended in tea, coffee, milk, and soup, 
 etc., that it is of all poisons the most frequently used for 
 homicidal and suicidal purposes. Of the various prepara- 
 tions of arsenic, the important ones, medico-legally, are the 
 white oxide commonly known as arsenious acid, the yellow 
 sulphide or orpiment, the green arsenite of copper or 
 Scheele's green, the liquor potassse arsenitis or Fowler's 
 solution. In whatever form taken, though, whether solid, 
 liquid, or gaseous, or howsoever applied, either as a wash, 
 an ointment, or a plaster, arsenic acts as a poison. 
 
 Arsenious oxide, or white arsenic, the form of arsenic 
 most commonly, made use of for poisoning purposes, oc- 
 curs in commerce as a heavy white, opaque, or translucent 
 powder, or in masses. It is nearly tasteless, and but 
 slightly soluble in cold water, only one-half of a grain 
 being dissolved by an ounce of water; the solubility 
 is increased by hot water, alkali, but diminished by 
 1 Guy and Ferrier : op. cit., p. 436 ; Tardieu : op. cit., p. 323. 
 
MED1CAJ; .IIJKIsritUhKNCK AND TOXICOLOGY. 2<>| 
 
 organic matter. As a general rule, the symptoms of 
 arsenical poisoning develop gradually, being usually de- 
 layed for from half an hour to an hour, or even Longer. 
 
 In certain cases, especially when a large dose has been 
 taken, poisonous symptoms may appear almost immedi- 
 ately. The countenance expresses depression and great suf- 
 fering. A burning pain is experienced in the pit of the 
 stomach, which is increased by pressure; vomiting is in- 
 variably present, the matters vomited consisting of a white 
 gum-like substance or of a brown liquid mixed with bile 
 or blood. Diarrhoea is usually present, accompanied with 
 pains at the anus ; severe cramps are felt in the legs. The 
 throat is hot and constricted, the tongue furred, and thirst 
 is intense. The skin is hot and dry, the head aches, the 
 pulse is rapid and small. The conjunctivas are reddened, 
 the eyes smart, and are suffused, and light is dreaded. 
 Though there are usuallv extreme restlessuess and nervous 
 twitchings, the mind, as a general rule, is clear. Death 
 may occur with convulsions of an epileptiform character, 
 or may resemble, as already mentioned, that of cholera 
 morbus. In some cases death takes place very quickly, as 
 if due to shock. The symptoms in chronic cases of arsenic 
 poisoning, as, for example, where workmen have been ex- 
 posed to the vapors of arsenic, are much less pronounced 
 than in acute ones. The eyes are inflamed and watery ; 
 headache, giddiness, vomiting, diarrhoea may be present ; 
 the skin is affected with an eczema ; there may be some 
 local paralysis ; salivation and even mania have been 
 noticed. 
 
 In cases of arsenical poisoning, if the patient is seen 
 soon after taking the poison, the stomach-pump should be 
 used. If any length of time has elapsed, however, hot 
 milk and water and emetics of sulphate of zinc and mus- 
 
202 A MANUAL OP 
 
 tard should be given. If there has been much vomiting, 
 eggs and milk and magnesia, with sugar in milk, should 
 be administered, the latter forming an insoluble compound 
 with arsenious oxide. Stimulants should be given in a 
 state of collapse, and anodynes for nervousness. The anti- 
 dote in most repute in cases of arsenical poisoning is the 
 hydrated sesquioxide of iron, by which the arsenic is con- 
 verted into the insoluble arseniate of iron. It can be 
 freshly and quickly prepared by diluting the tincture of the 
 chloride of iron, adding ammonia in excess, collecting the 
 precipitate on filtering paper, and carefully washing and 
 administering at once when moist, The hydrated sesqui- 
 oxide of iron so prepared should be given in large doses 
 and frequently, followed later by a dose of castor oil. 
 Freshly-precipitated hydrated peroxide of magnesium has 
 also been proved serviceable as an antidote. Nitrate of 
 potassium may be given also in repeated doses in order to 
 promote the elimination of the poison by the kidneys. It 
 appears that, however large the amount of arsenic taken, 
 no more than two grains need be absorbed to cause death. 
 At all events, that amount has proved fatal, though there 
 have been recoveries after much larger doses. Death 
 usually takes place within twenty-four hours, though it 
 may occur within twenty minutes or be delayed ten to 
 sixteen days after taking the poison. 
 
 On post-mortem examination, the mucous membrane of 
 the stomach will be usually found highly inflamed, present- 
 ing, in some cases, a uniform deep red color; in others 
 only red patches. In some cases the mucous membrane is 
 thickened, in others softened and easily separated. Ulcera- 
 tion of the stomach but rarely takes place. However intro- 
 duced, arsenic appears to have some specific effect upon the 
 stomach. Not unfrequently the small intestine, the cse- 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 203 
 
 cum, and the rectum arc inflamed as well as the stomach. 
 It must be mentioned; however, that in some cases of 
 arsenic poisoning there is an entire absence of any signs oi 
 inflammation, even though there had been symptoms of 
 inflammation during life. 
 
 Arsenic is not a cumulative poison, being only tempo- 
 rarily deposited in the liver and other organs, and rapidly 
 eliminated in the urine and other secretions; accordingly, 
 no trace of it is likely to be found after death, should the 
 person have survived two or three weeks after taking the 
 poison. On the other hand, arsenic, as is well known, 
 being a powerful antiseptic, the bodies of persons poisoned 
 by this means may be so well preserved as to admit of the 
 detection of the poison months aud even years after burial. 
 Under such circumstances the absence of cadaveric odor is 
 noticeable, and there will be frequently observed numerous 
 yellow patches on the abdominal viscera, due to the forma- 
 tion of yellow sulphide of arsenic through the action of 
 sulphuretted hydrogen upon arsenious oxide. In examin- 
 ing the contents of the stomach, the examiner should first 
 carefully look for solid particles of arsenious oxide in the 
 walls of the stomach itself, as well as among its contents. 
 The stomach should then be cut up into small pieces with 
 a perfectly clean pair of scissors, and, together with its 
 contents, placed in a clean porcelain evaporating dish. 
 Distilled water, with one-sixth its bulk of pure hydro- 
 chloric acid, should be added, and the whole gently boiled 
 for about an hour, by which time most of the solid por- 
 tions of the mixture will be disintegrated. After cooling, 
 the mixture should be filtered, the filtrate being after- 
 wards concentrated over a water-bath. In order to ex- 
 tract arsenic from the liver, spleen, or other organs, the 
 tissues should be very finely cut up, and, after being 
 
204 A MANUAL OF 
 
 treated with distilled water and hydrochloric acid, must 
 then be filtered. 
 
 The different tests for arsenious oxide may be regarded 
 as being of three kinds — solid, liquid, and what may be 
 called special tests. Of the solid tests the three following 
 will be found convenient and easy of application : The 
 first test consists in heating upon charcoal the suspected 
 substance ; if the latter be arsenious oxide, the odor of 
 garlic will become very perceptible. The second test is to 
 slowly heat the substance in a narrow glass tube until it 
 sublimes; if arsenious oxide be present, there will be formed 
 on the cool part of the tube a white ring of octahedral crys- 
 tals (Fig. 41), which can be seen by a good magnifier. It is 
 true that calomel and corrosive sublimate will produce white 
 rings under the same circumstances, but they will not con- 
 sist of octahedral crystals. The third test is to heat the sus- 
 pected substance in a reduction-tube (Fig. 42) about three 
 inches long and an eighth of an inch in diameter with dry 
 sodium carbonate and charcoal, the flux being in the pro- 
 portion of about four to one of the substance examined 
 and intimately mixed with it. If arsenious oxide be pres- 
 ent, it will be reduced, metallic arsenic being condensed 
 as a brilliant steel-gray ring upon the upper part of 
 the tube. That the ring so formed does consist of arsenic 
 is still further shown by the fact that it is entirely soluble 
 in sodium hypochlorite. 
 
 The liquid tests are the ammonio-sulphate of copper, 
 the ammonio-nitrate of silver and sulphuretted hydrogen. 
 Ammonio-sulphate of copper, when added to a solution of 
 arsenious oxide, throws down a light green arsenite of cop- 
 per, the precipitate being soluble in ammonia and free 
 acids. The characteristic color does not appear immedi- 
 ately if the arsenic is in very small quantities. The am- 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 205 
 
 monio-sulphate of copper, when used for this purpose, 
 should be freshly prepared by adding to a somewhat dilute 
 
 Fig. 41. 
 
 Crystals of arsenious acid by 
 sublimation, magnified 30 diam- 
 eters. 
 
 Fig. 43. 
 
 Deposit obtained by Marsh's 
 apparatus : a, metal ; b, mixed 
 deposit ; c, arsenious acid. 
 
 Fio. 42. 
 
 Ordinary reduction- 
 tube, with two subli- 
 mates ; the upper, 
 brownish-black ; the 
 lower, the pure metal 
 in an annular deposit. 
 
 solution of sulphate of copper just enough liquor ammo- 
 nia? to throw down a pale blue precipitate. Ammonio- 
 nitrate of silver gives to a solution of arsenious oxide a 
 canary yellow precipitate of arsenite of silver soluble in 
 an excess of ammonia. The reagent can be freshly pre- 
 pared by adding just enough liquor ammonia? to a solution 
 of nitrate of silver to precipitate the brown oxide of sil- 
 
206 A MANUAL OP 
 
 ver. It should be mentioned, however, that as various 
 organic matters which might be present in the contents of 
 the stomach will produce similar colors with both copper 
 and silver, the precipitates of arsenite of copper and silver 
 obtained by the liquid tests should be submitted to further 
 tests, such as that by the reduction method just described. 
 The sulphuretted hydrogen test consists in passing washed 
 sulphuretted hydrogen gas through the solution of the 
 suspected substance slightly acidified with hydrochloric 
 acid. If arsenious oxide be present, there will be precipi- 
 tated the yellow tersulphide of arsenic, soluble in alkalies 
 but insoluble in acids. In dilute solutions the excess of 
 gas may have to be driven off before the precipitate is sep- 
 arated. The sulphide of arsenic so obtained should still 
 further be tested by subliming it with a reducing agent. 
 It should be mentioned, in connection with this test, that 
 somewhat similar precipitates are yielded by cadmium, tin, 
 and selenium in the presence of sulphuretted hydrogen. 
 For all practical purposes the cadmium sulphide need only 
 be considered in this respect, and it should not even prove 
 a source of fallacy ; it is distinguished from arsenic sul- 
 phide in being soluble in acids and insoluble in alkalies, 
 and further in forming a brown oxide instead of a ring 
 when dried and oxidized on charcoal. 
 
 The special tests for the detection of arsenious oxide are 
 known as Marsh's and Reinsch's tests. The principle of 
 Marsh's test is based upon the fact that arsenious oxide is 
 decomposed in the presence of nascent hydrogen, arseni- 
 urettcd hydrogen gas being formed from which the arsenic 
 can be obtained as a brilliant steel or brown-gray deposit 
 in the form of rings. The simplest method of performing 
 Marsh's test is first to generate perfectly pure hydrogen 
 gas and then to add to the materials generating the latter 
 
MEDICAL JUKISPKUDENCE AND TOXICOLOGY. 207 
 
 the solution suspected to contain arsenious oxide. The 
 hydrogen gas may be generated by putting strips of chem- 
 ically pure zinc and diluted sulphuric- acid into a suitable 
 glass vessel provided with two mouths. Through one of 
 the mouths a glass tube should pass down vertically below 
 the surface of the liquid, and through the other mouth a 
 tube bent at right angles by means of which the hydrogen 
 gas generated may issue. The gas should be dried by al- 
 lowing it to pass through a tube containing pieces of fused 
 calcium chloride or pumice-stone moistened with sulphuric 
 acid, then through a horizontal tube of hard German glass 
 about a foot long, turned up at the farthest end and ter- 
 minating in a small point, so that the gas as it escapes will 
 burn in a jet. It is most essential, before lighting the jet 
 of gas, that all atmospheric air be excluded from the tubes, 
 otherwise a violent explosion will ensue. After waiting a 
 sufficient length of time the gas may be lighted, and it will 
 burn with a faintly luminous, scarcely perceptible flame. 
 The purity of the materials used in generating the hydro- 
 gen gas must now be demonstrated. This is accomplished 
 by applying the flame of a large spirit-lamp to the hori- 
 zontal glass tube until it becomes red hot. Should no stain 
 or deposit occur just beyond the heated spot, or no deposit 
 form ou a piece of white porcelain held over the burning 
 jet, the absence of arsenic is assured (Fig. 43). A small 
 quantity of the suspected solution being now introduced 
 through the vertical tube, any arsenious oxide present will 
 be decomposed, arseniuretted hydrogen will be set free, and 
 will burn with a pale blue flame, white fumes being fre- 
 quently evolved having an alliaceous odor. If the latter 
 be made to pass into a short wide glass tube, they will con- 
 dense as a white powder, sometimes crystalline in form, 
 recognizable as arsenious oxide. If a white porcelain 
 
208 , A MANUAL OF 
 
 plate be now placed over the flame of the arseniuretted 
 hydrogen, a deposit is formed consisting of three concen- 
 tric rings, the inner ring being metallic arsenic, the middle 
 ring arsenic and arsenious oxide, the outer ring arsenious 
 oxide. 
 
 It should be mentioned, in connection with Marsh's test, 
 that antimony in the presence of hydrogen will yield a 
 deposit very similar to that due to arsenic. The arsenical 
 deposit can, however, be distinguished from the antimo- 
 nial one, as the former is soluble in a solution of chlori- 
 nated lime, but insoluble in hydrochloric acid, whereas 
 the latter is insoluble in chlorinated lime, but soluble in 
 hydrochloric acid. Further, if the deposit of arsenious 
 oxide be converted into arsenic acid by the addition of 
 nitric acid, and the latter be treated with ammonio-nitrate 
 of silver, the brick-red arsenite of silver will be formed, 
 affording another proof of the presence of arsenic. On 
 placing the flame of a large spirit-lamp just below the 
 horizontal tube, which should have been contracted after 
 heating it in several places, when it becomes nearly red 
 hot a deposit of metallic arsenic will be formed just in 
 advance of the flame, the deposit continuing to increase 
 until it may occupy the whole of the contracted space, or 
 even part of the tube in advance of the latter. This 
 deposit constitutes what is known as the arsenical mirror, 
 and should be exhibited in court as proof that arsenic had 
 been found. 
 
 Reinsch's test consists in boiling bright strips of copper 
 in a hot solution of the suspected substance previously 
 acidulated by hydrochloric acid. Metallic arsenic being 
 deposited upon the strips of copper, the latter are then 
 withdrawn and placed in a reduction-tube and the presence 
 of arsenic demonstrated in the manner already described. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 209 
 
 The freedom from arsenic of the copper strips used in 
 Reinsch's test is shown by the faet that they are not 
 tarnished after having been boiled in hydrochloric acid. 
 As antimony and mercury can be determined in the 
 same manner as arsenic by tin's test, it should be men- 
 tioned that the deposit of antimony is violet, its sublimate 
 amorphous and insoluble in water; that of mercury bright 
 and silvery, its sublimate consisting of bright metallic 
 globules; that of arsenic is steel-gray, its sublimate con- 
 sisting of octahedral crystals slightly soluble in water. 
 
 Aceto-arsenite of copper or Brunswick green, also known 
 as Vienna emerald or Paris green, not unfrequently causes 
 death by poisoning, this pigment being extensively used 
 in the staining of wall-paper, toys, bonbon papers, in 
 coloring artificial flowers, articles of dress, bonnets, etc. 
 Cases of arsenical poisoning from this pigment are usually 
 chronic in character, resulting from living in rooms whose 
 walls are covered with this green paper, the fine dust from 
 which, getting into the lungs, produces the poisonous ef- 
 fects. Death may also result from overdoses of Fowler's 
 solution or liquor potassae arsenitis, from arsenic acid, 
 Scheele's green or arsenite of copper, and orpiment, or 
 the yellow sulphide of arsenic. 
 
 Poisoning by Antimony. — Of the different preparations of 
 antimony the potassio-tartrate, or tartar emetic, is the most 
 important medico-legally, though the chloride is not unfre- 
 quently also a cause of death. The symptoms of antimonial 
 poisoning are a strong metallic taste during the act of swal- 
 lowing, heat, soreness, and constriction of the throat, pain 
 in the stomach, followed by nausea, vomiting, and diarrhoea. 
 The pulse is quick and small, the skin is cold and clammy, 
 cramps are often present in the extremities. The urine is 
 often increased in quantity, but voided with pain. Death 
 14 
 
210 A MANUAL OF 
 
 may take place during the stage of prostration, which is 
 very intense, or may be preceded by delirium and con- 
 vulsions. Insensibility is sometimes produced by the 
 taking of large doses. Cases of chronic poisoning by anti- 
 mony are characterized by great weakness and exhaustion, 
 accompanied by nausea, vomiting, and purging. In cases 
 of antimonial poisoning, should vomiting not have been 
 induced by the poison, the fauces should be tickled and 
 hot water and milk administered, the stomach-pump being 
 used as a last resource. As soon as the poison has been 
 removed from the stomach strong coffee should be given, 
 followed by opium. 
 
 The antidotes are any substances that contain tannin, 
 such as cinchona bark, .green tea, infusion of nutgalls, and 
 decoction of oak bark, etc. As well known, infants and 
 young children tolerate large doses of tartar emetic, espe- 
 cially when suffering from diseases of the larynx and 
 lungs. Three-quarters of a grain has nevertheless proved 
 fatal in a child, and two grains in an adult. 1 The recov- 
 eries reported after the taking of large doses were without 
 doubt due to the poison having been rejected by the stom- 
 ach, vomiting having been promptly induced. Death may 
 take place within a period varying from a few hours to a 
 few days, though it may not take place for many months. 
 The post-mortem appearances usually found are inflamma- 
 tion of the mucous membrane of the stomach and intes- 
 tines, and in some cases of the brain and lungs. The 
 liver is frequently enlarged and softened, and appears to 
 have undergone a fatty degeneration. 
 
 In the extraction of tartar emetic from the stomach the 
 contents of the latter should be diluted with water, filtered, 
 
 1 For the different properties of arsenic and antimony, see Wharton 
 and Stille, op. cit., vol. ii. p. 201. 
 
MEDICAL JURISPRUDENCE AMi TOXICOLOGY. '211 
 
 and acidulated with tartaric acid, and then sulphuretted- 
 hydrogen gas passed through the liquid, by which means 
 
 the orange sulphide of antimony, which is soluble in sul- 
 phide of ammonium, will he precipitated. Should anti- 
 mony fail to be detected by this method, then Marsh's or 
 Ilcinsch's test should be tried. Antimony is absorbed in 
 the system, and may be found in the viscera, blood, urine, 
 the same methods being made use of as iu the case of 
 arsenical poisoning. If the quantity of antimony sus- 
 pected to be present is very small, a coil of pure zinc- foil 
 wound around a platinum foil may be suspended in a 
 weak acidified solution, when the metallic antimony will 
 be deposited upon the platinum. The deposit so obtained 
 should then be washed and digested in nitric acid until 
 it is dissolved, and the solution then evaporated. The 
 residue, being acidified, should then be treated with sul- 
 phuretted hydrogen. It may be mentioned, in this con- 
 nection, as tartar emetic is very often prescribed medici- 
 nally, that the medical examiner should be very cautious 
 in attributing death to poison in case of finding this salt 
 in the stomach, unless it were obtained in quantity far ex- 
 ceeding that of ordinary doses. 
 
 The symptoms and post-mortem appearances presented 
 in cases of poisoning by chloride or butter of antimony 
 resemble rather those produced by mineral acids than by 
 tartar emetic. Chloride of antimony when thrown into 
 water yields a copious white flaky precipitate, the oxy- 
 chloride or powder of Algaroth. The latter is soluble in 
 tartaric acid, and turns orange-red when touched by sul- 
 phide of ammonium. 
 
 Poisoning by Merem*y. — While all the mercurial com- 
 pounds, corrosive sublimate, calomel, red and white precip- 
 itates, red oxide, etc., are more or less poisonous, mercuric 
 
212 A MANUAL OF 
 
 chloride or corrosive sublimate, from a medico-legal point 
 of view, is the most important. 
 
 The symptoms in cases of acute mercurial poisoning ap- 
 pear usually immediately after the poison is taken, a burn- 
 ing pain being at once felt extending from the throat to 
 the stomach. The face becomes flushed. The mouth and 
 tongue look white and shrivelled, as if they had been 
 thoroughly painted with silver nitrate. The breathing is 
 difficult, the pulse thready. The abdomen is painful and 
 swollen, the pain being increased upon pressure. The 
 stools are bloody. The thirst is intense, and a white, 
 stringy, or bloody mucus is vomited. The urine is more 
 or less suppressed. The skin is cold and clammy. Sali- 
 vation usually sets in about the third day. Death gene- 
 rally takes place soon from collapse, though it may be pre- 
 ceded by convulsions and coma. The antidotes, white of 
 egg, or wheat flower mixed with milk, should be given at 
 once, and in most cases continued two or three times daily 
 for some weeks. The white of one egg may be considered 
 as sufficient to neutralize four grains of corrosive subli- 
 mate. As the vapors of mercury are poisonous when in- 
 haled, it not unfrequently happens that those who are en- 
 gaged in working mercurial ores, in looking-glass plating, 
 water-gilders, barometer-makers, are poisoned in this way, 
 the fumes being given off from the metal even at ordinary 
 temperatures. Such cases are usually chronic in character. 
 The symptoms begin with nausea and vomiting. Coppery 
 taste in the mouth and pains in the stomach are constantly 
 occurring. The breath becomes fetid and swallowing diffi- 
 cult. A hacking cough sometimes follows, with haemoptysis. 
 Ultimately salivation becomes very noticeable. The mar- 
 gins of the gums sometimes present a blue line like that ob- 
 served in lead-poisoning, the gums being red, painful, swol- 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 213 
 
 Ion, and eveu ulcerated. Tremors and convulsive move- 
 ments of the limbs finally become well marked, and the 
 patient, soon dies unless actively treated. The smallest 
 quantity of corrosive sublimate known to have proved 
 fatal is three grains. 1 Death usually takes place within a 
 period varying from three to six days, though it has oc- 
 curred within half an hour in some cases, and been pro- 
 tracted in others more than two weeks. 
 
 On post-mortem examination the salivary glands are 
 found enlarged. The abdomen is usually tympanitic. 
 The mucous membrane of the mouth and throat presents a 
 grayish-white color, at times being exceedingly inflamed 
 or corroded, or even in a sloughy condition. The stomach 
 is often very much inflamed, and is frequently covered 
 with a slate-colored layer of finely-divided mercury, or, in 
 cases of putrefaction, with a black precipitate of sulphide 
 of mercury. The intestines and urinary bladder are often 
 also much inflamed. In order to determine the presence 
 of mercury in the stomach the contents of the latter should 
 be mixed and crushed in a mortar, alcohol being added to 
 facilitate filtration. The mixture, being acidified with hy- 
 drochloric acid aud gently warmed, should then be fil- 
 tered, and the filtrate tested by sulphuretted hydrogen and 
 Reinsch's test. In order, however, to obtain corrosive 
 sublimate from the stomach, the contents should be con- 
 centrated by evaporation, and then shaken with a large 
 bulk of ether, which is a powerful solvent of corrosive 
 sublimate. The ether must then be carefully decanted and 
 distilled at a gentle heat, the residue being then appropri- 
 ately tested. Corrosive sublimate may be found in the 
 urine within two hours and in the saliva within four 
 hours after the taking of the poison. In examining the 
 1 Taylor: op. cat., p. 141. 
 
214 A MANUAL OF 
 
 urine about fourteen ounces should be evaporated down 
 to one ounce and acidified and filtered. The filtrate 
 should then be boiled with a piece of bright copper and 
 placed in a reduction tube. The saliva may be tested by 
 observing whether a piece of bright copper becomes tar- 
 nished when placed in saliva acidulated with hydrochloric 
 acid. Among the tests for the mercurous salts may be 
 mentioned liquor calcis, which throws down a black pre- 
 cipitate (black wash). Iodide of potassium gives an olive- 
 green precipitate, chromate of potassium gives a bright red 
 precipitate. With mercuric salts liquor calcis gives a yel- 
 low precipitate (yellow wash). With corrosive sublimate 
 liquor ammonias gives a white precipitate. Iodide of po- 
 tassium gives the scarlet iodide of mercury. 
 
 From a medico-legal point of view it is important for 
 the practitioner to bear in mind that the symptoms of 
 mercurial salivation closely resemble those due to cancrum 
 oris or gangrene of the mouth, as suits for damages have 
 been brought against physicians by their patients on the 
 charge that they had been poisoned by the mercury admin- 
 istered, when they were really suffering from one or other 
 of the diseases just mentioned. 1 Indeed, suits for mal- 
 practice have been instituted in which it was afterwards 
 shown that no mercury in any form whatsoever had been 
 prescribed. In cases of this kind the chemical analysis 
 of the saliva would at once settle the question. 
 
 Poisoning by Lead. — The most important salts of lead, 
 from a medico-legal point of view, are the acetate and 
 carbonate, though other preparations of lead are used for 
 medicinal purposes. Cases of acute lead poisoning are 
 very rare, and when they occur result from accident. 
 Soon after swallowing acetate of lead, or sugar of lead, a 
 1 Christison: op. cit., p. 412. 
 
MEDICAL JURISPRUDENCE AM) TOXICOLOGY. 215 
 
 metallic taste, dryness in the throat., and thirsi are expe- 
 rienced. The most prominent symptom, however, is severe 
 colicky pain, which is intermittent, but is relieved by pres- 
 sure. Constipation is invariably present, the muscular coat 
 of the intestines being paralyzed. The urine is scanty and 
 red, cold sweats, cramps, paralysis of the lower extremities, 
 appear as the case progresses, followed often by tetanic 
 spasms and convulsions. 
 
 In treating cases of acnte lead poisoning emetics should 
 be given, and if vomiting should not be induced by these 
 means then the stomach-pump should be resorted to. The 
 antidotes are the soluble alkaline and earthy sulphates ; 
 the sulphate of magnesium is the best, and should be ad- 
 ministered with eggs, opium being given to allay pain. 
 The amount of acetate of lead that would prove fatal, and 
 the length of time that would elapse before death took 
 place, are uncertain. Cases of chronic or slow lead poi- 
 soning or saturnine poisoning are of very frequent occur- 
 rence, owing to the various ways in which lead in one 
 form or another may be introduced into the system. It may 
 be swallowed in drinking-water or applied in the form of 
 cosmetics or hair-dyes, or inhaled in the form of fumes, as 
 by artists, painters, plumbers, aud workmen engaged in the 
 manufacture of white-lead. 1 
 
 The symptoms that appear first in chronic cases are col- 
 lectively known as lead colic, among which the blue line 
 at the margin of the gums is very characteristic, aud those 
 later as lead palsy. On post-mortem examination in cases 
 of acute lead poisoning, inflammation of the alimentary 
 canal may be found ; but, not unfrequently, no lesion of 
 any kind is present. In cases of chronic poisoning no 
 special lesion is found, with the exception that the intes- 
 1 Guy and Ferrier : op. cit., p. 494. 
 
216 A MANUAL OF 
 
 tines are usually in a contracted condition and the muscles 
 specially affected flabby. Lead, however, is found in the 
 bones, brain and spinal cord, and viscera. In extracting 
 lead from the stomach the contents should be treated with 
 dilute nitric acid in order to form nitrate of lead, the 
 latter being then treated with sulphuretted hydrogen. If 
 the lead has, however, been rendered insoluble by any 
 organic matters normally present, or by the antidotes, then 
 the contents of the stomach should be first incinerated, 
 and the ash treated in the manner just mentioned. The 
 black' precipitate so obtained can be shown to contain lead 
 by reducing it by means of charcoal and the blow-pipe. 
 
 Poisoning by Copper. — The salts of copper are rarely used 
 for homicidal or suicidal purposes. Most cases of poisoning 
 by copper result from accident, being caused, for example, 
 by keeping food, or cooking, in copper vessels. Green car- 
 bonate of copper, or natural verdigris, is formed under such 
 circumstances, and is very poisonous. All the salts of copper 
 are poisonous. The sulphate, or blue vitriol, and the subace- 
 tate or artificial verdigris, are the most important from a 
 medico-legal point of view. In large doses sulphate of 
 copper is a powerful emetic ; fatal results are often on that 
 account prevented, the poisonous matters swallowed being 
 at once rejected by the stomach. Among the other symp- 
 toms presented are thirst, abdominal pain, purging, sup- 
 pression of urine, jaundice. In cases of copper poisoning, 
 vomiting should be induced, or the stomach-pump resorted 
 to in case the poison has not produced that effect. White 
 of egg, mixed with eggs and milk, should be freely ad- 
 ministered. On post-mortem examination the body will 
 be found to present a yellow color. The mucous mem- 
 brane of the stomach is usually inflamed, and its contents 
 are of a blue color. An ounce of sulphate of copper has 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 217 
 
 proved fatal ; but the quantity necessary to destroy life, as 
 well as the period at which death occurs, is variable. 1 In 
 extracting a salt of copper the contents of the stomach 
 should be evacuated and treated with dilute hydrochloric 
 acid and filtered; the filtrate being then treated with sul- 
 phuretted hydrogen. The blackish-brown precipitate of 
 sulphide of copper should then be converted into the 
 nitrate by the addition of nitric acid, and the latter salt 
 tested. A convenient test for salts of copper is liquor am- 
 monia?, which gives a blue precipitate; the latter, when 
 dissolved in an excess of ammonia, forms a beautiful sap- 
 phire-blue. 
 
 Poisoning by Zinc, Bismuth, etc. — Cases of poisoning from 
 zinc are comparatively rare. Of the different preparations, 
 the sulphate and chloride, the latter often used as a disin- 
 fectant, need only be considered. The symptoms of poison- 
 ing by zinc resemble those due to sulphate of copper. Half 
 an ounce to an ounce has proved fatal. In some instances 
 death has occurred within fourteen hours. The post-mortem 
 appearance presented is inflammation of the alimentary 
 canal. The best antidote is albumen. Bismuth, more 
 particularly the subnitrate, deserves mention on ac- 
 count of its being frequently adulterated with arsenic. 
 Indeed, the finding of arsenic, when the cause of death 
 was alleged to be poisoning, has been accounted for 
 on the supposition that it was given in the subnitrate 
 of bismuth administered. 2 With respect to the prepa- 
 rations of chromium, it should be mentioned that not 
 unfrequently fatal cases of poisoning have resulted from 
 persons eating cakes and buns colored yellow by means of 
 chromate of lead. Although the various preparations of 
 
 1 Woodman and Tidy : op. cit., p. 175. 
 
 2 Wharton and Stille: op. cit., vol. ii. pp. 283, 571. 
 
218 A MANUAL OF 
 
 tin, iron, silver, gold, and manganese may all prove fatal 
 when taken in large doses, as they are so unlikely to be 
 used for poisoning purposes, and of thus becoming the 
 subject of medico-legal inquiry, their special consideration 
 can be dispensed with. 
 
 Poisoning by Oxalic Acid. — Of the irritant poisons 
 of vegetable origin, oxalic acid is the most important. 
 Resembling sulphate of magnesium or Epsom salts, for 
 which it is readily mistaken, and being easily procured 
 either as oxalic acid' or as salt of sorrel, salt of lemons, 
 potassium oxalate, it is not unfrequently taken by acci- 
 dent or for suicidal purposes. The symptoms of poisoning 
 by oxalic acid are a hot, burning, acid taste during swal- 
 lowing, followed by pallor, clammy perspiration, extreme 
 prostration, abdominal pain, accompanied with vomiting. 
 If the poison be diluted, the vomiting may be protracted. 
 In some cases, however, there is no vomiting at all ; in 
 others it may continue incessantly until death The nerv- 
 ous system appears to be also remotely affected, as, in cases 
 of recovery from oxalic acid poisoning, spasmodic twitch- 
 ings of the facial muscles, temporary loss of voice, numb- 
 ness and tingling of the legs have been observed In 
 treating cases of oxalic acid poisoning, magnesia, plaster 
 from the walls, chalk or carbonate of calcium, should be 
 given ; the last is the best remedy, as it forms with oxalic 
 acid the inert calcium oxalate. Vomiting should after- 
 ward be induced by an emetic of sulphate of zinc. Alka- 
 lies and their carbonates should not be given, however, 
 under any circumstances, as the salts formed would be as 
 poisonous as the oxalic acid. The mucous membrane of 
 the mouth, tongue, and throat appears as if bleached. The 
 stomach is often black, and even gangrenous, though per- 
 foration is rare. It often contains a dark-brown liquid. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. '21 9 
 
 One drachm of oxalic acid lias proved fatal. 1 Death may 
 take place very quickly, or may be protracted several days. 
 Through the addition of acetate of lead to the contents of 
 the stomach previously filtered oxalate of lead is precipi- 
 tated; the latter being treated with sulphuretted hydrogen, 
 oxalic acid is set free and the lead is precipitated as sul- 
 phide of lead. 
 
 A convenient test for oxalic acid is calcium sulphate, 
 which gives a white precipitate of calcium oxalate soluble 
 in mineral, but insoluble in vegetable acids. It may be 
 mentioned, in this connection, that both tartaric and acetic 
 acids have proved fatal when taken in doses of an ounce. 
 In the treatment of such cases, magnesia, chalk, or the 
 alkaline carbonates may be given. 
 
 Poisoning by Carbolic Acid. — Carbolic acid, sometimes 
 called coal-tar creasote, is so extensively used as an anti- 
 septic and is so powerful a poison that it demands at least 
 brief mention. The symptoms of poisoning are vertigo 
 and intoxication, accompanied by intense burning pain 
 in the mouth and stomach, with vomiting of frothy 
 mucus. The pupils are contracted ; the pulse rapid and 
 intermittent. The urine is frequently suppressed ; what- 
 ever is passed is dark-colored and smoky ; convulsions and 
 coma often supervene. In treating such cases oil and de- 
 mulcent drinks, sulphate of sodium or Glauber's salts may 
 be administered, and the stomach-pump should be used. 
 With any treatment, however, there is but little chance of 
 recovery. Six or seven drops having caused the most dan- 
 gerous symptoms, it is to be expected that death will 
 follow almost immediately after the taking of any large 
 quantity. Indeed, death has been known to take place 
 within ten minutes after swallowing about an ounce of car- 
 1 Taylor : op. cit., p. 105. 
 
220 
 
 A MANUAL OF 
 
 bolic acid, though life may be protracted two or three days. 1 
 As a general rule, after death the mouth, oesophagus, and 
 stomach are found white and corroded. The lungs are usu- 
 ally found much congested ; the brain occasionally so. Car- 
 bolic acid can be usually found in the urine by agitating 
 the latter with an excess of ether, removing the ether by 
 means of a pipette and evaporating. The minute oily 
 residue left has the character of that acid. The best gen- 
 eral test for carbolic acid is probably its odor. 
 
 Poisoning by Vegetable Substances. — There are a number 
 of well-known substances, such as croton oil, the oil of 
 
 Fig. 44. 
 
 Fig. 45. 
 
 Leaf of the Croton tiglium. 
 
 Colchicum autumnale : a, flower- 
 ing plant ; b, stigmas ; c, leaves and 
 fruit. 
 
 the seed of Croton tiglium (Fig. 44), ergot of rye, the 
 
 fool's parsley {JEthusa cynapium), elaterium obtained from 
 
 1 Woodman and Tidy : op. cit., p. 516. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 221 
 
 the wild cucumber, water dropwort {CEnanihe crocata), 
 castor-oil beans, seeds and wine of colchicum (Fig. 
 45), cow bane (Ciouta virosa), oil of savin procured from 
 the toys of juniperus sabina, yellow jessamine, veratrum 
 viride, and the other species of hellebore, all of which 
 possess poisonous properties of an irritant character. As 
 cases of poisoning by these substances arc usually accidental 
 in character and unlikely to become the subject of medico- 
 legal inquiry except in the case of oil of savin often used 
 as an abortive, it will' not be necessary to dwell upon their 
 characteristic properties. 
 
 Poisoning by Eating Fungi. — The symptoms caused by 
 eating poisouous fungi, often resembling those due to poison 
 administered with homicidal intent, demand some consider- 
 ation on the part of the medical jurist. As is well known, 
 while certain fungi may be eaten usually with impunity, 
 there are others which invariably prove poisonous. The 
 symptoms which follow the eating of poisonous mushrooms, 
 and which usually appear within an hour, are giddiness, 
 thirst, abdominal pain, vomiting, purging, sweats, dimness 
 of vision, delirium, convulsions, and coma. 1 Death usually 
 takes place within twenty-four hours. In treating such 
 cases the stomach-pump should be used and an emetic of 
 sulphate of zinc and castor oil should be administered. On 
 post-mortem examination the stomach and intestines are 
 usually found inflamed and may even be gangrenous. The 
 contents of the stomach should be carefully searched for the 
 gills and spores of the mushroom suspected to have been the 
 cause of poisoning, the particular fungus being by these 
 means identified. 
 
 Poisoning by Decomposed Food. — The irritant poisons 
 of animal origin are cantharides and the poisons devel- 
 1 Casper : op. cit., vol. ii. p. 61. 
 
222 
 
 A MANUAL OF 
 
 Cantharis vesicatoria (Spanish fly). 
 
 oped under certain circumstances in food. The symp- 
 toms of poisoning from the powdered Cantharis vesica- 
 toria (Fig. 46), or the tinc- 
 Fig. 46. ture of cantharides, are pain 
 
 in swallowing, a burning 
 sensation in the mouth and 
 stomach, thirst, vomiting, 
 and bloody stools, priapism, 
 inflammation and swelling 
 of the genitalia, and occa- 
 sionally convulsions and de- 
 lirium. In treating a case 
 of poisoning from such a 
 cause, emetics and thick 
 warm liquids should be administered, opiates should 
 be given in the form of enema, and suppositories and 
 leeches applied. On post-mortem examination the mu- 
 cous membrane of the alimentary canal and urino-genitary 
 tract will be found inflamed. Portions of the wings and 
 wing-cases of the insect, which resist putrefaction for a 
 long time, should be looked for, especially in the large in- 
 testine. An ounce of the tincture of cantharides has 
 proved fatal, death taking place in twenty-four hours. 
 
 Poisoning by Micro-organisms, Bacteria, etc. — Apart 
 from trichinosis produced by eating raw pork, the mus- 
 cular tissue of which is infested with the minute worm, 
 the Trichina spiralis (Fig. 47), poisonous effects are fre- 
 quently produced by eating food in a state of putrefaction 
 induced by micro-organisms, bacteria, etc., or food con- 
 taining ptomaines or " cadaveric alkaloids," so called on 
 account of the manner of their production and of their 
 effects when introduced into the system. The poison- 
 ous effects frequently produced by eating meat, sausage, 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 22-i 
 
 cheese, fish, mussels, and puff-paste, appear to be due 
 
 to the presence of either micro-organisms or ptomaines. 1 
 The symptoms and post-mor- 
 
 Trichina spiralis, coiled within its 
 cyst (X50). 
 
 tern appearances in all such Fig. 47. 
 
 cases are those of an irritant 
 poison — giddiness, nausea, 
 cramps, vomiting, purging — 
 the mucous membrane of the 
 alimentary canal being found 
 inflamed. As to what par- 
 ticular micro-organism should 
 be attributed the changes de- 
 veloped in food, making it 
 poisonous ; as to the exact na- 
 ture of the ptomaines which 
 cause poisoning when intro- 
 duced into the system in some 
 persons, but give rise to no 
 
 inconvenience whatever in others, considerable difference 
 of opinion still prevails among bacteriologists and. toxicolo- 
 gists. It is to be regretted, particularly from a medico- 
 legal point of view, that so little has been definitely estab- 
 lished with reference to the nature of such organisms and 
 poisonous principles, inasmuch as attempts have been 
 made in cases of undoubted poisoning to account for the 
 latter on the supposition that the person was poisoned by 
 the food eaten rather than by the poison actually adminis- 
 tered with homicidal intentions. 
 
 Neurotic Poisons. — With opium we begin the consid- 
 eration of neurotic poisons, or that class of poisons which 
 affect more particularly the great nervous centres — the 
 brain and spinal cord. The symptoms produced by neu- 
 1 Fliigge : op. cit., p. 567. 
 
224 
 
 A MANUAL OF 
 
 rotic poisons are usually headache, giddiness, drowsiness, 
 stupor, delirium, convulsions, paralysis, there being, how- 
 ever, little or no inflammation of the mucous membrane of 
 the alimentary canal, as was seen to be so common in cases 
 of poisoning by irritants. The post-mortem changes in cases 
 of neurotic poisoning are but few, and not well marked — 
 more or less fulness of the cerebral vessels being observed, 
 but rarely accompanied with effusion of serum or blood 
 in the brain. 
 
 Cerebral Neurotic Poisons. — Poisoning by Opium. — 
 In addition to the different preparations of opium that 
 are used medicinally there are a number of patent medi- 
 cines which contain this drug or some of its alkaloids, 
 among which may be mentioned Godfrey's cordial, Dalby's 
 carminative, Winslow's soothing syrup, Locock's pulmonic 
 wafers, Battley's liquor, etc. It is on this account that so 
 many cases of poisoning are due to opium, the drug being 
 
 taken, in one form or another, 
 either accidentally or suicidal- 
 ly, or administered to others 
 with homicidal intent. 
 
 Opium, the concrete juice 
 of the unripe capsule of the 
 poppy {Papaver somniferum ; 
 JFig. 48), is a complex sub- 
 stance containing a number 
 of active principles, the chief 
 of which are morphia, me- 
 conic acid, narcotina, codeia, 
 narceine, thebaine, papaver- 
 ine. From a medico-legal point of view, however, morphia 
 and meconic acid are the most important of these principles, 
 as by their reactions the presence of opium is recognized. 
 
 Papaver somniferum (capsule of the 
 opium poppy). 
 
MEDICAL JUKISPKUDENCE AND TOXICOLOGY. 225 
 
 The symptoms of opium poisoning arc giddiness, 
 drowsiness, stupor, profound sleep, flushed face, slow and 
 stertorous breathing, eyes closed and pupils contracted, in- 
 sensible to light, pulse rapid and small or dec and slow, 
 skin moist and cool. The patient, from being aroused 
 and kept awake only with difficulty, soon passes into a 
 completely comatose condition, death taking place from 
 apoplexy, collapse, convulsions, though usually tran- 
 quilly. 
 
 These symptoms miay appear within a few minutes after 
 taking the drug, or be protracted for several hours, accord- 
 ing to the condition of the system and the mode of ad- 
 ministration; opium, as is well known, acts more powerfully 
 on a full than an empty stomach, when the person is at 
 rest than when taking exercise, and in a liquid rather than 
 in a solid form. The effects of taking opium habitually 
 and for a long time are emaciation, loss of appetite, con- 
 stipation, failure in mental and physical vigor, neuralgic 
 pains, premature old age, and death. The smallest 
 quantity of opium known to have produced death is four 
 grains. 1 The amount that can be taken without producing 
 death, however, by those persons habitually using opium 
 is almost incredible. Indeed, over four thousand drops of 
 laudanum have been taken daily by a person with whom 
 the author is intimately acquainted, and De Quincey is said 
 to have taken as much as nine ounces. Death may take 
 place within an hour or be delayed several hours. If the 
 patient survives over twelve hours, the chance of recovery 
 is good. 
 
 The post-mortem changes in cases of opium poisoning 
 are neither well-marked nor constant. Occasionally the 
 cerebral vessels are found in a turgid condition, with some 
 1 Christison : op. cit., p. 713. 
 15 
 
226 A MANUAL OF 
 
 sub-arachnoid effusion of serum at the base of the brain or 
 around the spinal cord. 
 
 In treating cases of poisoning by this substance, the opium 
 should be removed by means of the stomach-pump as soon 
 as possible, or by an emetic such as sulphate of zinc or 
 mustard water. Cold water should be dashed over the 
 face and chest in order to overcome the increasiug lethargy. 
 Strong coffee should also be administered, and the patient, 
 to be kept aroused, must be made to walk between two 
 attendants. Atropia should be administered hypodermat- 
 ically, the effects upon the pupils being carefully watched. 
 Should all such remedies fail, then electro-magnetism may 
 be resorted to. The symptoms of poisoning by morphia, 
 the most important of the principles of opium, differ only 
 from those produced by the drug itself in manifesting 
 themselves sooner and in tending to produce convulsions 
 more frequently. One grain of morphia has in more than 
 one instance proved fatal, and less than a grain when ad- 
 ministered hypodermatically. 1 The external application of 
 morphia has also been followed by fatal results when applied 
 externally to an abraded surface. The post-mortem ap- 
 pearances presented in cases of morphia poisoning do not 
 differ from those already described as being caused by 
 opium. 
 
 There is no direct chemical test for opium. As every 
 watery solution contains, however, meconate of morphia, if 
 the latter salt can by any means be shown to exist in the 
 contents of the stomach, the vomit, or the tissues, then in 
 this indirect way the presence of opium may be considered 
 as having been demonstrated. The principle of the analy- 
 sis is based upon the possibility of decomposing the meco- 
 nate of morphia that may be present, and then re-obtaining 
 1 Wharton and Still4 : op. cit., vol. ii. p. 338. 
 
MEDICAL JURISPRUDENCE ANJ) TOXICOLOGY. 227 
 
 tlio acid and salt constituting the alkaloid ' as meconate of 
 lead and acetate of morphia. The process consists in fil- 
 tering the contents of the stomach — any solid matters being 
 finely divided and well mixed with liquid. If acetic acid 
 be added and then acetate of lead, meconate of lead will be 
 precipitated, acetate of morphia remaining in solution. The 
 mixture is then filtered and tested in the following manner : 
 The solution containing the acetate of morphia is divided 
 into two parts. To one part is added a solution of perch lo- 
 ride of iron, by which a greenish-blue color is produced. 
 To the other part, evaporated to dryness, nitric acid is 
 added, by which a yellow color becoming orange-red is 
 developed. The precipitate containing the meconate of 
 lead is diffused in water, through which sulphuretted hy- 
 drogen is then passed, by which sulphide of lead is pre- 
 cipitated and meconic acid left in solution. To the latter, 
 on the addition of perchloride of iron, a blood-red solution 
 will be formed. It must be remembered, however, that 
 even in cases where there was every reason to suppose that 
 opium had been given, and when the analysis was made 
 with the greatest care, not a trace of either meconic acid 
 or morphia could be found. 
 
 Poisoning by Alcohol. — The poisonous effects of alcohol 
 are either of an acute or chronic character. The symp- 
 toms of acute alcoholic poisoning are unsteadiness of gait, 
 incoherent talking, stupor, and coma. The features have 
 a vacant expression, or may be suffused and bloated. 
 The lips are livid, the pupils are unusually dilated, bloody 
 froth appears upon the lips, the breathing becomes difficult 
 and then stertorous. In treating such cases emetics should 
 be administered, or the stomach-pump used, cold affusions 
 
 1 For a detailed account of the methods of detecting alkaloids in sus- 
 pected matters, see Wharton and Stille, op. cit., vol. ii. p. 35-4. 
 
228 A MANUAL OP 
 
 employed, and ammonia and coffee given. On post-mortem 
 examination the mucous membrane of the alimentary 
 canal, the lungs and brain may be found congested, with 
 serous effusion under the arachnoid and in the ventricles. 
 
 Alcoholism, or chronic poisoning by alcohol, as already 
 mentioned, is the proximate cause of numerous diseases, 
 such as cirrhosis of the liver, fatty liver, epilepsy, gastritis, 
 disease of the kidneys. Alcoholism indirectly favors the 
 production of, and the mortality of, disease in general by 
 diminishing the resisting power of the system. The per- 
 ceptions finally become blunted, the moral and intellectual 
 faculties are perverted by its habitual use, until at last the 
 victim becomes a dipsomaniac. Alcohol can be obtained 
 from the stomach by distillation. The contents of the 
 stomach, if acid, having been neutralized by sodium car- 
 bonate, should be distilled. The distillate, having been 
 mixed with calcium chloride, must be then redistilled. The 
 second distillate should then be shaken up with dry sodium 
 carbonate, the supernatant fluid being drawn off for testing 
 purposes. 
 
 Poisoning by Ancesthetics. — The cerebral neurotics in- 
 clude the anaesthetics ether, chloroform, and chloral hydrate. 
 The symptoms produced by ether are very much the same 
 as those of alcohol. When inhaled, slow, prolonged, ster- 
 torous breathing results, the surface of the body feels cold, 
 the lips become blue, the face pale. The pulse is at first 
 accelerated, but is afterward slowed. The muscles become 
 relaxed. The eyes are fixed and glassy, the pupils dilated. 
 Anaesthesia becomes deep, coma following with entire loss 
 of sensation. Nausea and vomiting frequently occur. In 
 poisoning by liquid ether, the stomach-pump should be 
 employed, emetics being given afterward. When inhala- 
 tion has been carried too far, the patient should have plenty 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 229 
 
 of fresb air, cold affusions should be applied, and artificial 
 respiration and galvanism resorted to. Congestion of brain 
 and lungs, and the heart-cavities filled with liquid dark 
 blood, are usually found upon post-mortem examination. 
 The mode of extracting ether from the contents of the 
 stomach is the same as that made use of in the case of 
 alcohol. 
 
 The symptoms produced by chloroform when swallowed 
 are those of an irritant poison, but when inhaled the 
 symptoms resemble those caused by ether, but appear 
 much more rapidly. Death is caused by paralysis of the 
 respiration and circulation, the nerve-centres being prob- 
 ably directly affected, as death in some cases is almost in- 
 stantaneous. In treating cases of chloroform poisoning, if 
 the chloroform has been taken in a liquid form, an emetic 
 should be resorted to, or the stomach-pump used, and 
 stimulants administered. If the chloroform has, however, 
 been inhaled, with the first dangerous symptoms it should 
 be instantly discontinued and fresh air admitted, as a few 
 drops of chloroform may prove fatal in as many seconds. 
 Water should be dashed in the face, the tongue pulled out, 
 artificial respiration practised, and the galvanic current 
 applied. The post-mortem appearances presented in cases 
 of chloroform poisoning are those of death due to as- 
 phyxia. Chloroform can be extracted from the stomach by 
 distillation and tested by passing the vapor through flame, 
 by which it will be decomposed into carbon, hydrochloric 
 acid, and chlorine. The carbon will be recognized by its 
 black deposit, the acid by reddening litmus, and. the 
 chlorine by applying starch-paper dipped in a solution of 
 potassium iodide ; the latter being decomposed and the 
 iodine set free, the starch will become blue. 
 
 Chloral hydrate, so much used at the present day to 
 
230 A MANUAL OF 
 
 procure sleep, is on that account not iufrequently a cause 
 of death, over-doses being taken accidentally. In cases 
 of poisoning by it the face becomes flushed ; the pupils, 
 at first contracted, are then dilated ; the pulse is quick ; 
 profound sleep is induced, which passes rapidly into coma 
 through cessation of the circulation and respiration. The 
 action of chloral hydrate may be possibly due to its decom- 
 position in the system, probably in the blood, into an alka- 
 line formiate and chloroform. As thirty grains of chloral 
 hydrate have proved fatal, that amount can hardly be con- 
 sidered a safe dose to begin with. Nevertheless, as much 
 as an ounce has been taken at once with impunity. 
 
 Among the cerebral neurotics should be included carbon 
 monoxide and carbon dioxide, as the effects of both these 
 gases when inhaled are very similar to those produced by 
 narcotic poisons. Carbon monoxide is produced when 
 charcoal is burned, and frequently collects in pits, cellars, 
 wells, and mines. Carbon dioxide, as is well known, is one 
 of the principal products of respiration. The symptoms 
 of poisoning by both these gases are essentially the same — 
 giddiness, headache, drowsiness, insensibility, and coma 
 being the most prominent. 
 
 In treating cases of carbon monoxide poisoning vene- 
 section and transfusion of arterialized, defibrinated blood 
 should be tried. In cases of poisoning by carbon dioxide 
 the patient should be given plenty of fresh air, the cold 
 douche, galvanism, and stimulants applied, artificial respi- 
 ration practised, etc. It will be found much more difficult, 
 however, to revive a person affected by carbon monoxide 
 gas than by carbon dioxide, the poisonous effects of the 
 latter being transitory, whereas carbon monoxide in dis- 
 placing the oxygen of the blood and forming a somewhat 
 stable compound with the haemoglobin renders respiration 
 
MEDTCAL JURISPRUDENCE AND TOXICOLOGY. 231 
 
 very difficult. Suicides are frequently committed, more 
 especially in France, by inhaling charcoal vapor; and 
 death is often caused accidentally in America in the same 
 way, as in those cases where persons have gone to sleep in 
 a room with a charcoal fire burning without a flue. The 
 absorbing effect of carbon monoxide blood upon light 
 transmitted through it has already been referred to in 
 connection with the spectroscopic examination of blood. 
 
 Spinal Neurotic Poisons. — Poisoning by Strychnia. — 
 Strychnia, one of the most important of poisons on account 
 of being so frequently taken accidentally or suicidally, as 
 well as given with homicidal intent, exists, together with 
 brucia, in the seeds of the strvchnos mix vomica, a tree 
 found in India, The seeds owe their poisonous properties 
 to these two alkaloids, and as the symptoms of poisoning, 
 etc., by nux vomica are the same as by strychnia, we may 
 pass at once to the consideration of the latter — merely 
 mentioning that thirty grains of nux vomica, about the 
 weight of one seed, and three grains of the alcoholic ex- 
 tract have proved fatal. 1 Strychnia is not ouly used medici- 
 nally, but is readily obtainable otherwise, entering largely 
 into the composition of the so-called " vermin-killers," 
 Battley's vermin-killer containing as much as 23 per cent. 
 
 The first symptoms of strychnia poisoning, appearing 
 usually within from ten to twenty minutes after it is taken, 
 are a general uneasiness and restlessness, followed by a 
 feeling of suffocation. The muscles begin to twitch and 
 the head and limbs to jerk, and then violent tetanic con- 
 vulsions come on, involving the whole body. The legs 
 are stretched out stiffly and separated, the feet arched 
 and turned in, the arms are flexed and drawn across the 
 chest. The head and body are so bent back that opis- 
 1 Christison : op. cit., p. 201. 
 
232 A MANUAL OP 
 
 thotonos supervenes, the patient resting upon his head and 
 heels. The respiratory movements are arrested by the 
 muscular spasm, the face becomes livid, the pupils dilated. 
 The muscles of the mouth are so contracted as to give rise 
 to a broad grin, the risus sardonicus, and lockjaw is fre- 
 quently present, though one of the later symptoms. In- 
 tense thirst may be experienced. The paroxysm may last 
 from half a minute to several minutes; subsiding, it is 
 followed by relaxation, the patient being bathed in perspi- 
 ration and utterly prostrated. In a short time, sometimes 
 within a few minutes, the paroxysm returns, being 
 brought on by the slightest cause — a breath of wind, a 
 slight noise, an effort to move. It increases in frequency 
 and violence; death results usually in between five and 
 six hours from asphyxia or exhaustion, the mind remain- 
 ing clear almost to the last. As small a quantity as the 
 one-sixteenth of a grain of strychnia has proved fatal 
 in a child, and one-half of a grain in an adult. 1 It 
 should be mentioned that the action of strychnia, when 
 administered hypodermatically, is far more powerful than 
 when given by the mouth. In the treatment of strychnia 
 poisoning, emetics should be given at once, and the 
 stomach-pump used if the lockjaw permits of it. Lock- 
 jaw can sometimes be overcome by chloroform, the ad- 
 ministration of which is often attended in other respects 
 with good results. The thirst can be relieved by strong 
 tea better than by anything else. Calabar bean, on account 
 of being a spinal depressant, should be tried ; and bromide 
 of potassium in large doses, morphia, atropia, chloral 
 hydrate, nitrite of amyl may also prove efficacious as 
 antidotes. 
 
 On post-mortem examination the brain and spinal cord 
 1 Taylor : op. cit., p. 217. 
 
MEDICAL JTJEISPRtTDENCE AND TOXICOLOGY. 233 
 
 may be found very much congested, with effusion of blood. 
 Rigor mortis may be prolonged for several weeks after 
 death. In extracting strychnia from the stomach the 
 organic mixture should be first acidified with acetic acid, 
 and sufficiently diluted to make filtering easy. The fil- 
 trate, having been evaporated to the consistency of a syrup, 
 should be then heated with eight or ten times its bulk of 
 alcohol, and again filtered, the liquid being distilled off. 
 The filtrate should then be saturated with liquor potassse 
 and shaken up with its own bulk of ether. The acetate 
 of strychnia, previously formed, being now decomposed by 
 the potassa, the strychnia is precipitated and is taken up 
 by the ether. Any coloring-matter present may be re- 
 moved by sulphuric acid. In order to insure the perfect 
 purity of the strychnia the above process should be re- 
 peated two or three times. Strychnia may be recognized 
 by its bitter taste, by the tetanic convulsions that it pro- 
 duces when injected subcutaneously into a frog, and by the 
 play of colors it exhibits in the presence of nascent oxygen. 
 It is probably the bitterest substance known. Indeed, only 
 one grain gives a bitter taste to a gallon or even more 
 of water. In the absence, therefore, of such substances 
 as morphia, quinia, aloes, colocynth, quassia, characterized 
 also by having a bitter taste, a substance possessing this 
 quality and alleged to have caused death should certainly 
 be tested still further for strychnia. The delicacy of the 
 physiological test, that is, of causing convulsions in a frog 
 by the subcutaneous injection of strychnia, may be appre- 
 ciated from the fact that convulsions follow the injection 
 
 of only T"soUU* u P ar ^ °^ a g ram > 
 
 The color test is performed by adding a drop of pure 
 sulphuric acid to a small piece of strychnia on a white por- 
 celain surface, the strychnia, if perfectly pure, being dis- 
 
234 
 
 A MANUAL OF 
 
 solved by the acid without coloration. If a little bichro- 
 mate of potassium, or binoxide of manganese, be now 
 stirred into the mixture, a play of colors will be presented, 
 succeeding each other in the following order — blue, violet, 
 purple, pink, and finally red. It should be observed that 
 the value of the color test depends not so much upon any 
 particular color being developed, or upon there being a play 
 of colors, as upon the constant order in which the differ- 
 ent colors manifest themselves. The color test is even 
 more delicate than the physiological one, the TooooTo^h 
 of a grain of strychnia having been detected in this way. 
 It should be mentioned, however, that it has been objected 
 that there are certain substances, like morphia, which in- 
 terfere with the color test, and that there are other sub- 
 stances which exhibit very much the same play of colors 
 on the addition of sulphuric acid. In reply, it may be 
 said that those substances which interfere with the color 
 test can be gotten rid of by using chloroform instead of 
 ether in extracting the alkaloid from the stomach, and that 
 
 Fig. 49. 
 
 Fig. 50. 
 
 Various forms of crystals of strychnia. 
 
 Crystals of brucia. 
 
 the change of color manifested by strychnia differs so much 
 from that exhibited by other bodies on the addition of sul- 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 235 
 
 phuric acid that no real difficulty should be experienced 
 in distinguishing them (Fig. 49). 
 
 Brucia (Fig. 50), the remaining alkaloid of mix vom- 
 ica, is usually found associated with strychnia. As the 
 symptoms of brucia are the same as those of strychnia, 
 only less intense, and as the mode of extraction from the 
 stomach is the same in the case of both alkaloids, we need 
 not dwell upon its special properties. It may be men- 
 tioned, however, that it turns to a blood-red color in the 
 presence of nitric acid, the alkaloid being speedily dissolved. 
 
 Cerebrospinal Neurotic Poisons. — Poisoning by Bella- 
 donna. — Belladonna may be considered as the type of 
 a group of poisons the characteristic effects of which are 
 frequently flushed face, redness of the skin, heat and dry- 
 ness of the throat, dilatation of the pupil, illusion of the 
 senses, and active delirium. 
 Indeed, the latter symptom Fig. 51. 
 
 is so characteristic of these 
 poisons that the entire group 
 is often designated on that 
 account as " deliriauts." The 
 group includes stramonium, 
 hyoscyamus, different species 
 of solanum as well as bella- 
 donna, all representatives of 
 the natural order of Solanaceae, 
 and known therapeutically as 
 mydriatics. The symptoms 
 of poisoning by belladonna, 
 the Atropa belladonna (Fig. 
 51) or deadly nightshade, ap- 
 pearing usually within two hours of taking the substance, 
 are giddiness, drowsiness, intense thirst, dryness of the 
 
 Atropa belladonna : a, the berry. 
 
236 A MANUAL OF 
 
 mouth and throat, difficulty in swallowing, the saliva being 
 suppressed. Vomiting and purging are rare. The action 
 of the heart is increased, pulse rapid and strong. The face 
 is flushed, the eyes sparkle, with pupils invariably dilated. 
 The power of speech is lost, though there is a constant 
 movement of the lips and tongue, as if the patient was 
 trying to articulate. Vision is affected, if not lost, through 
 the loss of the power of accommodation. There is frequently 
 a desire to micturate, with inability to do so. The patient 
 is affected with all kinds of illusions and hallucinations, 
 and finally with delirium, which in some cases may be of 
 a pleasing character, in others so furious as to resemble 
 mania. Death, when it occurs, takes place usually within 
 twenty-four hours. A few berries of belladonna or a 
 drachm of the extract has proved fatal. 1 The symptoms 
 of poisoning by atropia, the active alkaloid of belladonna, 
 are the same as those of the plant itself — only manifesting 
 themselves more quickly and acting more powerfully. One 
 and a half grains of atropia have proved fatal. 2 
 
 In treating cases of poisoning by belladonna or atropia 
 the stomach should be evacuated by an emetic or by means 
 of the stomach-pump. Morphia should be administered 
 hypodermatically. As soon as the patient shows signs of 
 getting better, castor oil may be given and strong coffee. 
 The post-mortem appearances presented in cases of poison- 
 ing by atropia or belladonna are neither constant nor well 
 marked. The pupils are dilated. The brain may be con- 
 gested and the stomach inflamed. In cases of poisoning 
 from belladonna, the remains of the leaves and berries 
 should be carefully searched for in the stomach and intes- 
 tines. Atropia can be extracted from the stomach by 
 
 1 Woodman and Tidy: op. cit., p. 210. 
 
 2 Wharton and Stille : op. cit., p. 423. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 237 
 
 acidifying; the contents of the latter with acetic acid and 
 warm alcohol and filtering. The filtrate .should then be 
 treated with snbacetate of lead and sulphuretted hydrogen, 
 by which the sulphide of lead is precipitated. The clear 
 filtrate evaporated to dryness and acidified, and saturated 
 with potassa, can be then treated with alcohol, and the 
 extract tested. A solution of hydrobromie acid saturated 
 with free bromine gives a yellow precipitate which soon 
 becomes crystalline, and is insoluble in mineral acids, acetic 
 acid, or caustic alkalies. Atropia can also be tested by 
 applying a portion of the ultimate extract to the eye of a 
 man or of a rabbit, the smallest quantity producing dilata- 
 tion of the pupil. As the symptoms, treatment, etc. of 
 poisoning by stramonium or thornapple, Jamestown weed, 
 hyoseyamus or henbane, solanum dulcamara or bittersweet, 
 woody nightshade, are essen- 
 tially the same as those of Fig. 52. 
 belladonna, it will be un- 
 necessary to dwell especially 
 upon them. 
 
 Poisoning by Tobacco. — 
 Among the cerebro - spinal 
 neurotic poisons are tobacco, 
 lobelia (Fig. 52), conia, aco- 
 nite, Calabar bean, often con- 
 sidered together on account of 
 the property they possess in 
 common of depressing the 
 muscular system, although 
 they may differ from one an- 
 other in some respects. Tobacco, or the dried leaves of Xico- 
 tiana tabacum, owes its active and poisonous properties to a 
 
 Lobelia iuflata. 
 
238 A MANUAL OF 
 
 volatile liquid alkaloid, nicotina, 1 one of the most rapidly 
 fatal poisons known, existing in Havana tobacco to an ex- 
 tent of only two per cent., but in Kentucky and Virginia 
 tobaccos to as much as seven per cent. The symptoms of 
 poisoning by tobacco are giddiness, much depression and 
 faintness, trembling of the limbs, clammy sweats, frequent 
 vomiting, violent abdominal pains, with occasional purg- 
 ing. The pulse becomes first weak and then almost im- 
 perceptible ; breathing becomes difficult ; vision is affected ; 
 death taking place with convulsions and more or less 
 paralysis. In treating cases of poisoning by tobacco, the 
 stomach should be evacuated as soon as possible, either by 
 emetics or the stomach-pump. Pain may be relieved by 
 opium and the strength should be supported by stimulants. 
 The external application of tobacco leaves and of a decoc- 
 tion of tobacco to the skin, as well as half a drachm given 
 by enema, has proved fatal. Death has resulted from 
 tobacco within fifteen minutes and from nicotina in three 
 minutes. 
 
 On post-mortem examination the stomach, liver, lungs, 
 and brain may be found congested, but not invariably. 
 The remains of tobacco should be looked for with a lens. 
 The hairs found on the pieces are peculiar. In extracting 
 tobacco from the stomach essentially the same process may 
 be used as that described in obtaining belladonna. A con- 
 venient test for nicotina is corrosive sublimate, which 
 yields a white crystalline precipitate, soon changing to 
 yellow, and soluble in acetic and hydrochloric acids. As the 
 symptoms and post-mortem appearances caused by Indian 
 tobacco, lobelia inflata or its active alkaloid lobelina, are 
 very much the same as those due to the taking of ordinary 
 tobacco, it will be unnecessary to describe them. It may 
 1 Tardieu : op. cit., p. 778. 
 
MEDICAL JURISPRUDENCE AM) TOXICOLOGY. 239 
 
 bo mentioned, however, that one drachm of the powdered 
 leaves has proved fatal in about thirty-six hours. On 
 post-mortem examination the brain was found congested 
 and the mucous membrane of the stomach inflamed. 
 
 Poisoning by conia, the active alkaloid of the spotted 
 hemlock (Convum maculatum; Fig. 53), is generally the re- 
 
 Fig. 53. 
 
 Fig. 54. 
 
 Conium maculatum : a, the fruit ; 
 b, transverse section of the fruit. 
 
 Aconitum napellus (aconite) : 
 a, the root ; b, the leaf. 
 
 suit of accident, the fresh leaves being sometimes used in cook- 
 ing in mistake for parsley, which it slightly resembles. The 
 symptoms are dryness and constriction of the throat, mus- 
 cular prostration, pupils often dilated and vision affected, 
 paralysis, and frequently convulsions, delirium, and coma. 
 The post-mortem appearances presented are those of as- 
 
240 A MANUAL OF 
 
 phyxia, congestion of the brain, and inflammation of the 
 mucous membrane of the stomach. The treatment should 
 consist in the administration of emetics, diffusible stimu- 
 lants, and in practising artificial respiration. 
 
 Poisoning by Aconite. — The symptoms of poisoning by 
 aconite, obtained from monkshood or wolfbane (Aconitum 
 napettus; Fig. 54), are dryness of the throat, with tingling 
 and numbness of the lips and tongue, followed by nausea and 
 vomiting and abdominal pain. There are ringing in the ears 
 and diminishing, if not loss of, vision. The power of speech is 
 lost. Breathing becomes slow and laborious. Cold, clammy 
 sweats are common, accompanied with great prostration. 
 The numbness of the limbs increases until finally both ex- 
 tremities are paralyzed. Death occurs either from shock, 
 asphyxia, or syncope. Aconitia, the active alkaloid of 
 aconite, is probably the most powerful poison known. In 
 treating cases of poisoning by aconite or its active principle, 
 an emetic of sulphate of zinc should be administered at 
 once, or the stomach-pump used. Mustard plasters may 
 be applied to the pit of the stomach ; and ammonia, brandy, 
 strong tea, or coffee should be given. Digitalis should 
 be tried as an antidote. Twenty-five minims of Flemiug's 
 tincture and one-tenth of a grain of aconite have proved 
 fatal. 1 Death generally takes place within three or four 
 hours ; though it has occurred within twenty minutes, it 
 has been delayed nearly twenty hours. 
 
 On post-mortem examination there is usually found 
 general venous congestion, especially of the brain, liver, 
 and lungs, as well as inflammation of the mucous mem- 
 brane of the alimentary canal. The different parts of the 
 plant should be carefully looked for. The process of ex- 
 traction from the stomach is essentially the same as that 
 1 Taylor : op. cit., p. 226; Gny and Ferrier: op. cit., p. 621. 
 
MEDICAL JURISPRUDENCE AND TOXICOLOGY. 241 
 
 described for obtaining belladonna. The characteristic 
 symptoms produced when given to small animals, such as 
 weakness, staggering', difficult breathing, convulsive twitch- 
 ings, loss of sensibility, etc., constitute the most important 
 tests for aconitia. Iodide of potassium may also be used 
 as a test, giving with the alkaloid a reddish-brown amor- 
 phous precipitate. 
 
 Calabar bean, the seed of Physostir/ma vencnosum, owes 
 its poisonous properties to an alkaloid, physostigma, or 
 eseriue. The symptoms of poisoning are giddiness, fol- 
 lowed by paralysis of the voluntary muscles, convulsive 
 muscular twitch ings, and invariably contraction of the 
 pupil. Owing to the latter property, atropia should be 
 administered as an antidote. Six of the beans proved 
 fatal in the case of a boy who had eaten them. 1 
 
 The cerebro-spinal neurotic poisons include not only the 
 deliriant and depressant kind of poisons, but also such as 
 usually destroy life by causing heart failure, and hence 
 often called "asthenics." The most important of this kind 
 of poisons are hydrocyanic acid, digitalis, and cocculus 
 indicus. 
 
 Poisoning by Hydrocyanic Acid. — Hydrocyanic or prussic 
 acid is one of the most powerful and rapidly fatal poisons 
 known, its effects being manifested with lightning-like 
 rapidity. It is developed rather than pre-exists in the 
 kernels of the peach, apricot, plum, cherry, and in the 
 leaves and flowers of the peach and cherry-laurel through 
 the action of water upon amygdalin and emulsin, two 
 principles present in the plants. Pure prussic acid, being 
 rarely found anywhere except in the laboratory of the 
 chemist, has but little or no interest medico-legal ly. The 
 medicinal acid, or the solution of the pure anhydrous acid 
 
 1 Woodman and Tidy : op. eit. , p. 320. 
 
 1(3 
 
242 A MANUAL OF 
 
 in water, demands attention, however, on account of death 
 being so frequently caused by it. 
 
 The symptoms produced by prussic-acid poisoning are 
 giddiness, with immediate loss of muscular power, the 
 person staggering and falling to the ground. The breath- 
 ing becomes quick and gasping, the pulse imperceptible. 
 The eyes protrude and are glassy, the pupils being dilated 
 and insensible to light. The extremities are cold. The 
 face becomes livid or pale. The jaws are spasmodically 
 closed. There may be bloody frothing at the mouth, and 
 the odor of the poison may be noticed on the breath. 
 Death may take place preceded by coma, stertorous breath- 
 ing, or by convulsions. Unfortunately, the poisonous 
 effects of prussic acid manifest themselves so quickly that 
 the opportunity is but rarely afforded for treatment. The 
 latter, when practicable, consists in applying cold affu- 
 sions, practising artificial respiration, placing ammonia to 
 the nostrils. A mixture of a ferrous and ferric sulphate of 
 iron with caustic alkali should be administered with the 
 hope of forming the inert ferrocyanide of potassium. 
 Emetics and the stomach-pump should also be used. On 
 post-mortem examination the lungs, liver, spleen, and 
 kidneys will be found gorged with blood. The brain 
 may be found congested, and there may be effusion of 
 serum into the ventricles. The stomach and intestines 
 may also be found congested. The most important, con- 
 stant, and characteristic sign noticed, however, is the dis- 
 tinct odor of prussic acid exhaled when the body is opened 
 and often even before it is opened. Fifty minims of the 
 official acid, equivalent to about nine-tenths of a grain of 
 the anhydrous acid, have proved fatal. 1 Death may occur 
 either instantaneously or within ten or fifteen minutes after 
 1 Woodman and Tidy : op. cit., p. 457. 
 
MEDICAL JUBISPBUDENCE AND TOXICOLOGY. 243 
 
 Fig. 55. 
 
 swallowing the poison, being rarely protracted half an 
 hour. 
 
 The general method adopted in extracting prussic acid 
 from the stomach is to distil the contents of the latter at a 
 gentle heat, the vapor being collected in a receiver kept 
 cool by being placed in cold water, or to acidify the con- 
 tents of the stomach if alkaline, and place the mixture in 
 a vessel standing in a basin containing water at 60° F., 
 and then testing the rising vapor. The presence of prussic 
 acid can be recognized by the white cyanide of silver 
 formed through application of nitrate of silver, by the 
 white sulphocyanide of ammonium formed with sulphide 
 of ammonium, the latter turning red on the addition of 
 perchloride of iron, the formation of Prussian blue by add- 
 ing liquor potassse, a proto- 
 and per-salt of iron, and sul- 
 phuric acid. As the symp- 
 toms, etc. of poisoning by 
 the cyanides, oil of bitter 
 almonds, cherry-laurel water, 
 the kernels of the peach, apri- 
 cot, and cherry, essence of 
 mirbaue, are essentially the 
 same as those produced by 
 prussic acid proper, only less 
 intense, they need not be es- 
 pecially considered. 
 
 Poisoning by Digitalis. — 
 The symptoms of poisoning 
 by foxglove (Digitalis purpu- 
 rea; Fig. 55), or its active 
 alkaloid digitaline, are headache, giddiness, nausea, vomit- 
 ing, purging, abdominal pain, dimuess of vision with dilated 
 
 Digitalis purpurea leaf. 
 
244 A MANUAL OF 
 
 pupils, slow, irregular pulse. In treating cases of poisoning 
 by digitalis emetics should be given, and infusions containing 
 tannin, such as tea, coffee, oak bark, etc., as stimulants. On 
 post-mortem examination the brain may be found con- 
 gested, and the mucous membrane of the stomach inflamed. 
 Digitalis may be extracted from the stomach by the process 
 used in obtaining belladonna. The most reliable test for 
 digitaline is the effect it produces upon the action of the 
 frog's heart, causing stoppage and irregularity in the beats. 
 
 Poisoning by Cocculus Indicus. — The symptoms of poi- 
 soning by Cocculus indicus, or the berry of menispermum, or 
 Anamirta cocculus, are gastro-intestinal irritation, accom- 
 panied with lethargic stupor and powerlessness. The 
 poisonous properties are due to an alkaloid, picrotoxine. 
 Of six persons poisoned accidentally on one occasion by a 
 decoction of cocculus indicus, two died within half an 
 hour, the remaining four recovering after several hours. 
 The prominent symptoms in these cases were giddiness, 
 faintness, nausea, dimness of vision, intense thirst, and 
 abdominal pain. 1 
 
 In conclusion, it may be mentioned that the laburnum 
 (Qytisus laburnum), the yew (Taxus baccata), the privet 
 (Legistrum vulgare), the Guelder rose ( Viburnum opulus), 
 and the holly (Ilex aquifolium) possess acrid, irritant, nar- 
 cotic properties even when eaten in small quantities. 
 1 Wharton and Stille : op. eit., vol. ii. p. 499. 
 
INDEX. 
 
 A. 
 
 Abdomen, enlargement of, 108 
 
 wounds of, GO 
 Abortion, criminal, 116 
 
 feigned, 129 
 
 from natural causes, 128 
 
 means employed, 127 
 
 proofs of, 116, 124 
 Abortives, 128 
 Acetate of lead, 214 
 Acetic acid, 219 
 Aceto-arsenite of copper, 209 
 Acid, arsenic, 208, 209 
 
 arsenious, 200 
 
 carbolic, 219 
 
 hydrochloric, 193 
 
 hydrocyanic, 241 
 
 meconic, 224 
 
 nitric, 193 
 
 oxalic, 218 
 
 sulphuric, 193 
 
 tartaric, 219 
 Aconite, poisoning by, 240 
 Aconitia, 240 
 Aeon i turn napellus, 239 
 Adipocere, 33 
 vEthusa cynapium, 220 
 Affiliation, 144 
 After-birth, 121 
 Age deduced from teeth, 44 
 
 for legal responsibility, 148 
 
 Age of foetus, 121 
 
 of new-born child, 46 
 
 of skeleton, 47 
 Air, influence of, on putrefaction, 
 
 30 
 Alcohol, poisoning by, 227 
 Alkalies, poisoning by, 194 
 Amentia, 163 
 
 Ammonia, poisoning by, 194 
 Amorphous phosphorus, 197 
 Anaesthesia in rape, 103 
 Anaesthetics, poisoning by, 228 
 Analysis, chemical, 187 
 Animal food, noxious, 221 
 
 irritants, 221 
 Antagonism of poisons, 183 
 Antimony, poisoning by, 209 
 Apparent death, 25 
 Aqua fortis, 194 
 Areola of the breasts, 109 
 Arsenic, antiseptic power of, 203 
 
 poisoning by, 200 
 Arsenious oxide, 200 
 Arsenite of copper, 200, 209 
 Arsenites, 209 
 
 Arseniuretted hydrogen, 206 
 Artificial inflation of lungs, 132 
 Asphyxia, varieties of death by, 83 
 Asthenia, 36 
 Atropa belladonna, 235 
 Atropia, poisoning by, 235 
 Auscultation in pregnancy, 111 
 245 
 
246 
 
 INDEX. 
 
 B. 
 
 Baby-farming, 92 
 Ballottement in pregnancy, 110 
 Balls, apertures made by, 58 
 Barium, salts of, 196 
 Bean, Calabar, 241 
 Belladonna, poisoning by, 235 
 Bestiality, 106 
 Birth, concealment of, 137 
 
 premature, 114, 116, 140 
 
 proofs of a live, 131 
 
 protracted, 114, 139 
 Bismuth, poisoning by, 217 
 Bitter almonds, oil of, 243 
 Bittersweet, poisoning by, 237 
 Bladder, rupture of, 60 
 Blisters from burns and scalds, 82 
 Blood, animal and human, 72 
 Blood, coagulation of, 78 
 Blood-corpuscles, human, 66 
 
 measurement of, 66 
 Blood-crystals, 74 
 Blood-stains, examination of, 62, 75 
 Blows, 60 
 
 Body, putrefaction of, 29 
 Bones, age of, 47 
 
 human and animal, 42 
 identification of, 42 
 Born alive, meaning of, 130, 140 
 Brain, injuries of, 60 
 Breasts, change of, in pregnancy, 
 
 109 
 Bromine, poisoning by, 199 
 Brucia, crystals of, 234 
 
 poisoning by, 235 
 Brunswick green, 209 
 Bullets, deflection of, 58 
 Buoyancy of the body, 88 
 Burns and scalds, 81 
 Butter of antimony, 211 
 
 c. 
 
 Cadaveric alkaloids, 222 
 
 lividity, 29 
 
 rigidity, 27 
 
 spasm, 28 
 Cesarean section, 143 
 Calabar bean, 241 
 Caloricity, post-mortem, 27 
 Calvaria, 40 
 
 Cantharides, poisoning by, 222 
 Capacity, testamentary, 173 
 Carbolic acid, poisoning by, 219 
 Carbon dioxide, poisoning by, 230 
 
 monoxide, poisoning by, 230 
 Castor-oil beans, poisoning by, 221 
 Catamenia, suppression of, 108 
 Certificates of insanity, 172 
 Cervix uteri, 126 
 Cheese, poisoning by, 223 
 Chemical analysis, 187 
 Cherry-laurel water, 243 
 Chest, examination of, in cases of 
 infanticide, 132 
 
 wounds of, 60 
 Child-murder, 130-138 
 Ch loral hydrate, poisoning by, 229 
 Chloride of antimony, 211 
 Chloroform, poisoning by, 229 
 Cholera mistaken for poisoning, 185 
 Chorion, 117 
 
 villous processes of, 120 
 Chromium, poisoning by, 217 
 Cicatrices, indentification by, 151 
 Cicuta virosa, 221 
 Circulation, cessation of, 24 
 
 foetal, 134 
 Circumstantial evidence in cases of 
 
 poisoning, 189 
 Civil responsibility, 161, 171 
 Clothing, stabs in, 53 
 
INDEX. 
 
 247 
 
 Clothing, stains of, 02 
 
 I loagulation of the blood, 78 
 
 ( locculus indicus, 244 
 
 Colchieum, poisoning by, 221 
 
 Cold, death from, 93 
 
 Coldness of the body in death, 26 
 
 Colic, painter's, 215 
 
 Coma, death by, 35 
 
 Compensation of medical witnesses, 
 
 20 
 Concealment of birth, 137 
 
 of habits in life insurance, 156 
 
 of pregnancy, 107 
 Conception, date of, 113 
 Concussion of brain, 60 
 Conia, 239 
 
 Conium maculatum, 239 
 Contracts to cure, 157 
 Contused wounds, 55 
 Contusions on the living and the 
 
 dead, 55 
 Cooling of body after death, 26 
 Copper, poisoning by, 216 
 Cord, mark of, in hanging, 84 
 in strangulation, 84 
 
 umbilical, in foetus, 122 
 Coroner, office of, 23 
 Coroner's inquest, 21 
 
 physician, 19 
 Corpus luteum, 112 
 Corrosive sublimate, 211 
 Cotton, fibres of, 53 
 Courtesy, tenancy by, 143 
 Cowbane, poisoning by, 221 
 Cranium, fractures of, 60 
 Crimes, unnatural, 106 
 Criminal abortion, 116 
 
 responsibility, 161, 172, 175 
 Cross-examination, 49 
 Croton oil, poisoning by, 220 
 Crying, evidences from, 140 
 
 Cry psorch ides, 141 
 Cyanides, poisoning by, 242 
 
 ( lytisus laburnum, 244 
 
 I>. 
 
 Date of conception, 113 
 Dead body, examination of, 24 
 Death certificate, 21, 24 
 
 phenomena and signs of, 24 
 
 presumption of, 149 
 
 varieties of, 35 
 Decidua vera, reflexa, and serotina, 
 
 119, 120 
 Declarations, dying, 50 
 Deformities, identification by, 48, 
 
 151 
 Delivery, concealed, 137 
 
 premature, 140 
 
 signs of, 136 
 Delusions, 176 
 Dementia, 170 
 Development of foetus, 116-121 
 
 of generative organs, 146 
 De ventre inspiciendo, 107 
 Diaphragm, position of, 132 
 Digitaline, 243 
 Digitalis, poisoning by, 243 
 
 purpurea, 243 
 Dipsomania, 167 
 Discharge of lunatics, 173 
 Disease, influence of, in poisoning, 
 
 1S4 
 Diseased flesh. 221 
 Distance at which persons can be 
 
 seen, 151 
 Divorce, legal grounds for, 142 
 Docimasia circulations, 134 
 
 pulmonum, 132 
 Doubtful sex, 145, 147 
 Dress, examination of the. 53, 151 
 Dropwort, poisoning by, 221 
 
248 
 
 INDEX. 
 
 Drowning, death from, 87 
 
 resuscitation from, 89 
 
 signs of, 87 
 Drunkards, responsibility of, 167, 
 
 176 
 Ductus arteriosus, 134 
 
 venosus, 135 
 Dulcamara, poisoning by, 237 
 Dying declarations, 50 
 
 E. 
 Eccentricity not insanity, 173 
 Eczema from arsenic-poisoning, 201 
 Effusion of blood, 55 
 Elaterium, 220 
 Embryo, human, 116 
 
 changes undergone by, 121 
 development of, 116 
 Emerald green, poisoning by, 209 
 Emetic, tartar, poisoning by, 209 
 Emphysema of the lungs, 133 
 Epilepsy, feigned, 154 
 Epispadias, 141 
 Ergot, 128, 220 
 Erysipelas, 60 
 Eserine, 241 
 
 Essence of mirbane, 243 
 Ether, poisoning by, 228 
 Evidence, medical, 49 
 
 of poisoning, 186 
 Examination, cross-, 49 
 
 in chief, 49 
 
 of blood-stains, 62 
 
 of clothes, 53 
 
 of hairs, 53 
 
 of lunatics, 172 
 
 of weapons, 53 
 
 of wounds, 52 
 Experts, medical, 18 
 Exposure, death from, 137 
 Extra-uterine conception, 129 
 
 F. 
 
 Face, wounds of, 60 
 
 Family likeness, evidence from, 151 
 
 Farinaceous substances in stomach 
 
 of infant, 136 
 Fatality in wounds, 51 
 Features, evidence from, 151 
 Fees, medical, 19, 20 
 Feigned abortion, 129 
 
 bodily diseases, 153 
 
 deafness and dumbness, 154 
 
 insanity, 177 
 
 wounds, 154 
 Fish, diseased, 223 
 Flax, fibres of, 53 
 Flesh, diseased, 221 
 Foetal circulation, 134 
 
 sounds, 111 
 
 vessels, changes in, at birth, 134 
 Foeticide, 116 
 
 determination of, 125 
 
 means of producing, 127 
 Foetus, development of, 116 
 Food, poisonous, 221 
 Fool's parsley, poisoning by, 220 
 Foramen ovale, 134 
 Forensic medicine, 17 
 Fowler's solution, 200, 209 
 Foxglove, poisoning by, 243 
 Fractures, identity from, 48 
 
 in new-born children, 137 
 Frigidity of constitution, 143 
 Fungi, poisonous, 221 
 
 G. 
 
 Gases, noxious, poisoning by, 196 
 Gestation, normal period, 113 
 
 premature, 114 
 
 protracted, 113, 139 
 Gonorrhoea in rape, 100 
 
INDEX. 
 
 249 
 
 Grand jury, 48 
 
 Gratuitous practice, 161 
 
 Guaiacum test, 63 
 
 Guelder rose, poisoning by, 244 
 
 Gunpowder, wounds from, 58 
 
 Gunshot wounds, 57 
 
 H. 
 
 Habit, influence of, in poisoning, 
 
 184 
 Habits, concealment of, 156 
 Hrematin, 62 
 Hsemoglobin, 62 
 Hairs, identification of, 53 
 Hallucinations, 176 
 Hanging, death by, 85 
 
 signs of death by, 86 
 Head, wounds of, 60 
 Heart, wounds of, 60 
 Heat, cause of death by, 93 
 
 loss of, after death, 26 
 Hellebore, poisoning by, 221 
 Hemlock, poisoning by, 239 
 Hemorrhage of navel, 137 
 Henbane, poisoning by, 237 
 Heredity in insanity, 174 
 Hermaphrodites, 145 
 Hibernation, 25 
 Holly, poisoning by, 244 
 Homicidal mania, 168 
 
 wounds, 56 
 Human bones, 43 
 
 hairs, 52 
 Hydatids, uterine, 124 
 Hydrate of chloral, 229 
 Hydrochloric acid, 193 
 Hydrocyanic acid, 241 
 Hydrostatic test, 132 
 Hymen, evidence from, 99, 105 
 Hyoscyamus, poisoning by, 237 
 Hypnotism, relation of,to crime, 154 
 
 I. 
 
 Identification of the dead, 42 
 
 of the living, 150 
 Idiocy, 163 
 
 Idiosyncrasy in poisoning, 181 
 Illusions, 176 
 Imbecility, 163 
 Impotence, 141 
 
 Impregnation, unconscious, 103 
 Imputed wounds, 153 
 Incised wounds, 54 
 Indian tobacco, 238 
 Infant born dead, proofs of, 131 
 Infanticide, 130 
 
 means of committing, 137 
 
 proofs of live birth, 131 
 Infantile leucorrhcea, 100 
 Inflation of lungs, 132 
 Inheritance, 139 
 Inquests, coroners', 21 
 
 medical witnesses at, 48 
 Insanity, 162 
 
 feigned, 177 
 
 in relation to life insurance, 157 
 
 medico-legal relations, 162, 171 
 
 puerperal, 169 
 
 varieties of, 162 
 Insensibility of eyes to light after 
 
 death, 26 
 Inspection of the body, 38 
 Insurance, life, 155 
 Intellectual mania, 166 
 Intemperance in relation to life in- 
 surance, 155 
 Interments, premature, 24 
 Intestines, wounds of, 60 
 Intoxication distinguished from 
 
 concussion, 60 
 Iodine, poisoning by, 199 
 Irritant poisons, 191, 192 
 
250 
 
 INDEX. 
 
 J. 
 
 Jessamine, 221 
 Juniperus sabina, 221 
 Jury of matrons, 107 
 
 K. 
 
 Kiesteine in the urine, 110 
 Kleptomania, 166 
 
 L. 
 
 Labor, premature, 116 
 
 Laburnum, 244 
 
 Lacerated wounds, 54 
 
 Laudanum, 225 
 
 Lead, poisoning by, 214 
 
 Legal medicine, 17 
 
 Legitimacy, 139 
 
 Leucorrhcea, infantile, 100 
 
 License of counsel, 49 
 
 Life insurance, 155 
 
 Lightning, death from, 95 
 
 Likeness, parental, 144 
 
 Linen, microscopic appearance, 53 
 
 Live birth, 130 
 
 proofs of, 132 
 Liver, wounds of, 60 
 Lividity, cadaveric, 29 
 Lobelia inflata, 238 
 Lobelina, 237 
 Lochia, 137 
 Lucid intervals, 176 
 Lungs, emphysema of, 133 
 
 examination of, in new-born 
 children, 132 
 
 wounds of, 60 
 
 M. 
 
 Majority, 148 
 Malpractice, 157 
 Mania, 164 
 
 Mania, feigned, 179 
 
 homicidal, 168 
 
 intellectual, 166 
 
 moral, 166 
 
 puerperal, 169 
 
 suicidal, 168 
 Marks of blood, 39, 62 
 Marsh's test, 206 
 Maternity, early, 114 
 Matrons, jury of, 107 
 Measurement of blood-corpuscles, 
 
 66 
 Meconic acid, 224 
 Medical evidence, 49 
 
 experts, 18 
 
 jurisprudence, 17 
 
 malpractice, 157 
 
 profession and the coroner, rela- 
 tions of, 20 
 
 registration, 160 
 
 responsibility, 158 
 Medico-legal terms defined, 176 
 Melancholia, 165 
 Membrana pupillaris, 122 
 Menstrual blood, 79 
 Menstruation, 108 
 Mercuric chloride, 211 
 Mercury, poisoning by, 211 
 Micrometer, 66 
 
 Microscopic examination of blood- 
 stains, 64 
 in rape, 101 
 Milk in stomach of infant, 136 
 Mineral acids, poisoning by, 192 
 Miscarriage, 116 
 Moles, identification by, 151 
 
 uterine, 123 
 Monkshood, poisoning by, 240 
 Monomania, 168 
 Monsters, 143 
 Moral mania, 166 
 
INDEX. 
 
 25 1 
 
 Morphia, 224 
 
 Mortality of wounds, 58 
 Mother, examination of, 124, 13G 
 Motives for crime, 168, 189 
 Miico-purulent discharges, 100 
 Muriatic acid, 193 
 Mushrooms, poisoning by, 221 
 Mussels, poisoning by, 223 
 Mutilated bodies, identification of, 
 42 
 
 N. 
 Nrevi, identification by, 151 
 Neurotic poisons, 192, 223 
 Nicotina, 238 
 Nitre, death from, 196 
 Nitric acid, 194 
 Notes of autopsy, 38 
 Nux vomica, poisoning by, 231 
 Nymphomania, 165 
 
 O. 
 
 (Enanthe crocata, 221 
 Oil of bitter almonds, 243 
 
 of savin, 128, 221 
 
 of tansy, 128 
 Opium, poisoning by, 224 
 Organs of adults, weights of, 41 
 Orpiment, 200 
 
 Osmosis of poisons after death, 187 
 Ossification-test of age in new-born 
 
 child, 45, 115 
 Ovum, human, 140 
 Oxalic acid, 218 
 
 P. 
 
 Prederastia, 106 
 
 Painter's colic, 215 
 
 Pallor of body after death, 26 
 
 Palsy from lead, 215 
 
 Papaver somniferum, 224 
 
 Paper-hangings, arsenic in, 209 
 Paralysis, feigned, 154 
 Paralytic dementia, 170 
 Parental likeness, 144 
 Paresis of insane, 170 
 Paris green, 209 
 Paternity, 144 
 Personal identity, 42, 150 
 Phosphorus, poisoning by, 197 
 Placenta, 118, 121 
 Plea of pregnancy, 107 
 Poisoned flesh, 222 
 Poisonous food, 222 
 Poisons, absorption of, 182 
 
 definition, 181 
 
 elimination of, 182 
 
 evidences of, 184 
 
 examination for, 185 
 
 mode of action, 182 
 
 post-mortem imbibition of, 187 
 Policy, life-insurance, 155 
 Post-mortem examination, 38 
 Potassium oxalate, poisoning by, 
 218 
 
 salts, poisoning by, 194 
 Pregnancy, 107 
 
 concealed, 107 
 
 duration of, 113 
 
 feigned, 107 
 
 in the dead, 115 
 
 precocious, 114 
 
 signs of, 107 
 
 unconscious, 115 
 Premature burials, 24 
 
 labor, 116 
 Presumption of death, 149 
 Privet, poisoning by, 244 
 Procreative power, 142 
 Protracted gestation, 113, 139 
 Prussic acid, 242 
 Ptomaines, 222 
 
252 
 
 INDEX. 
 
 Puberty, 141 
 Puerperal mania, 169 
 Punctured wounds, 54 
 Purulent discharges, 99 
 Putrefaction, 29 
 
 conditions modifying, 26 
 
 order of, 32 
 Putrescent food, 222 
 Pyromania, 167 
 
 Q. 
 
 Quickening, 109 
 
 K. 
 
 Rape, anaesthesia in, 104 
 
 definition, 97 
 
 on adults, 97, 103 
 
 on children, 97 
 
 on the dead, 105 
 
 on the insane, 97 
 Red phosphorus, 197 
 Re-examination, 49 
 Reinsch's test, 208 
 Respiration, 131 
 
 a sign of life, 134 
 
 cessation of, 24 
 Responsibility, civil and criminal, 
 171 
 
 medical, 158 
 Rigidity, cadaveric, 27 
 Rigor mortis, 27 
 
 S. 
 Saccharine substance in stomach 
 
 of infant, 136 
 Salivation, mercurial, 212, 214 
 Salt of lemons, 218 
 
 of sorrel, 218 
 Saturnine poisoning, 215 
 Satyriasis, 165 
 Sausage, poisoning by, 222 
 
 Savin, oil of, 128 
 Scalds and burns, 81 
 Scalp, wounds of, 60 
 Scars, identification by, 151 
 Scheele's green, 200, 209 
 Schweinfurt's green, 209 
 Self-inflicted wounds, 55 
 Seminal stains, 101 
 Sex, determination of, 147 
 
 doubtful, 145, 147 
 Sexual malformation, 141 
 Shock, death from, 59 
 Shot, wounds made by, 57 
 Signs of deatl), 24 
 Silk, microscopic appearance, 54 
 Skeletons, age of, 44 
 
 date of interment, 48 
 
 identification from, 48 
 
 sex of, 44 
 
 stature of, 48 
 Skull, identification from, 43 
 Sleep, influence of, in poisoning, 
 
 184 
 Smothering, death by, 83 
 Soda and its salts, 194 
 Sodomy, 106 
 Softening of stomach in poisoning, 
 
 186 
 Solanum dulcamara, 237 
 Somnambulism, 168 
 Sorrel, salt of, 218 
 Sound, velocity of, 151 
 Specific gravity of lungs, 132 
 Spectral analysis, 75 
 Spermatozoa, 101 
 Spine, concussion of, GO 
 Starch, detection of, in stomach of 
 
 infant, 136 
 Starvation, death by, 92 
 Sterility, 142 
 Still-births, 131 
 
INDEX. 
 
 25.' 
 
 Stomach, mode of examination of 
 186 
 
 redness of, in poisoning, 186 
 
 ulceration of, 180 
 
 wounds of, 60 
 Stramonium, poisoning by, 237 
 Strangulation, death by, 84 
 
 signs of, 84 
 Strychnia, crystals of, 234 
 Strychnine, poisoning by, 231 
 Sublimate, corrosive, 211 
 Subnitrale of bismuth, 217 
 Subpoenas, 18, 23 
 Sudden death, 20 
 Suffocation, death by, 83 
 
 of new-born children, 83 
 Sugar, detection of, in stomach of 
 
 infant, 136 
 Suggillation, 29 
 Suicidal mania, 168 
 
 wounds, 55 
 Sulphide of arsenic, 200 
 Sulphuric acid, 193 
 Sunstroke, 93 
 Su perforation, 145 
 Surgical operations, death from, 60 
 Survivorship, 140, 149 
 Syncope, 35 
 
 T. 
 
 Tartar emetic, 209 
 Tartaric acid, 219 
 Tattoo marks, identification by, 151 
 Teeth a test for age, 44 
 Tenancy by courtesy, 143 
 Testamentary capacity, 173 
 Tetanus from wounds, 59 
 Time elapsing since death, 33 
 Tin, poisoning by, 21S 
 Tobacco, poisoning by, 237 
 Toxicology, 180 
 
 Trichina spiralis, 223 
 Trichinosis, 222 
 Trichomonas vaginalis, 101 
 
 U. 
 
 Ulceration and corrosion in poison- 
 ing, 186 
 Umbilical cord, condition of, in live 
 
 and dead-born children, 135 
 insertion of, 122 
 Unconscious pregnancy, 115 
 Unnatural crimes, 106 
 Uterine sounds, 111 
 Uterus, changes of, in pregnancy, 
 108, 110, 126 
 normal unimpregnated, 125 
 putrefaction of, 115 
 
 V. 
 
 Vagina, dilatation of, in rape of 
 children, 99 
 wounds of, 125 
 Vaginitis, 104 
 Vegetable irritants, 218 
 Ventre de inspiciendo, 107 
 Veratrum viride, poisoning by, 221 
 Verdigris, 216 
 Vertebra?, fractures of, 86 
 Viability of the child, 116, 140 
 Vienna green, 209 
 Virginity, signs of, 99, 105 
 Voice, identification by, 151 
 Vulval penetration, 97 
 
 W. 
 
 Wadding, wounds by, 58 
 Wall-papers, arsenical, 209 
 Water, influence of, on putrefaction. 
 
 29 
 Weapons, connection of, with 
 
 wounds, 52 
 
254 
 
 INDEX. 
 
 Wedlock, born in, 142, 143 
 Weight of new-born child, 122 
 White hellebore, 221 
 
 lead, poisoning by, 215 
 Wills, capacity for making, 173 
 Witnesses, ordinary and medical, 
 
 17, 18 
 Wounds, cause of death by, 58 
 
 definition of, 51 
 
 from gunpowder, 57 
 
 made before and after death, 
 55 
 
 Wounds on different parts of body, 
 60 
 on new-born children, 138 
 self-inflicted, 55 
 variety of, 55 
 
 Y. 
 
 Yellow arsenic, 200 
 Yew, poisoning by, 244 
 
 Z. 
 
 Zinc, poisoning by, 217 
 
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 17 
 
Nothnagel's Encyclopedia 
 
 OF 
 
 PRACTICAL MEDICINE. 
 
 Edited by ALFRED STENGEL, M.D., 
 
 Professor of Clinical Medicine in the University of Pennsylvania; Visiting 
 Physician to the Pennsylvania Hospital. 
 
 IT is universally acknowledged that the Germans lead the world in Internal Medicine ; 
 and of all the German works on this subject. Nothnagel's " Special Pathology and 
 Therapeutics " is conceded by scholars to be without question the best System of 
 Medicine in existence. So necessary is this book in the study of Internal Medicine 
 that it comes largely to this country in the original German. In view of these facts, 
 Messrs. W. B. Saunders & Company have arranged with the publishers to issue at once 
 an authorized edition of this great encyclopedia of medicine in English. 
 
 For the present a set of some ten or twelve volumes, representing the most practical 
 part of this encyclopedia, and selected with especial thought of the needs of the practical 
 physician, will be published. These volumes will contain the real essence of the entire 
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 nal. Later the special and more strictly scientific volumes will be offered from time to time. 
 
 The work will be translated by men possessing thorough knowledge of both English and 
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 editorial supervision of Dr. Alfred Stengel, who will select the subjects for the American 
 edition, and will choose the editors of the different volumes. 
 
 Unlike most encyclopedias, the publication of this work will not be extended over a 
 number of years, but five or six volumes will be issued during the coming year, and the 
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 receive the completed work while the earlier volumes are still fresh. 
 
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 Therefore, in purchasing this encyclopedia, physicians will be given the opportunity of 
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 tages which will be appreciated by those who do not care to subscribe for the entire work 
 at one time. 
 
 This American edition of Nothnagel's Encyclopedia will, without question, form the 
 greatest System of Medicine ever produced, and the publishers, fee} confident that i{ 
 will meet with general favor in the medical profession. 
 
 l8 
 
NOTHNAGEL'S ENCYCLOPEDIA 
 
 VOLUMES JUST ISSUED AND IN PRESS 
 
 VOLUME I 
 
 Editor, William Osier, M. D., 
 
 F. R. C.P. 
 
 Profei 
 
 of Medicine in Johns Hopkins 
 University 
 
 CONTENTS 
 Typhoid Fever. By J'k. H. Curschmann, 
 of Leipsic, Typhus Fever. By Dr. H. 
 Curschmann, of Leipsic. 
 
 Handsome octavo volume of about 600 pages. 
 Just Issued 
 
 VOLUME II 
 
 Editor, Sir J. W. Moore, B. A., M. D., 
 
 F.R.C.P.L, of Dublin 
 
 Professor of Practice of Medicine, Royal 
 College of Surgeons in Ireland 
 
 CONTENTS 
 
 Erysipelas and Erysipeloid. By Dr. H. 
 Lenhaktz, of Hamburg. Cholera Asi- 
 atica and Cholera Nostras By Dr. 
 K. von Lieuermeister, of Tubingen, 
 Whooping Cough and Hay Fever. By 
 Dr. G. Sticker, of Giessen. Varicella. 
 By Dr. Th. von Jurgensen, of Tubingen. 
 Variola (including Vaccination). By 
 Dr. H. Immermann, of Basle. 
 
 Handsome octavo volume of over 700 pages. 
 Just Issued 
 
 VOLUME VII 
 Editor, John H. Musser, M. D. 
 Professor oj Clinical Medicine, Univet 
 0/ Pennsylvania 
 
 CONTENTS 
 
 Diseases of the Bronchi. By Dr. I. A 
 Hoffmann, of Leipsic. Diseases of the 
 Heura. By Du. RoSENBACH, ■>! Berlin. 
 Pneumonia. By Du. E. AuFKBCHT, oi 
 
 Magdeburg. 
 
 VOLUME VIII 
 Editor, Charles G. Stockton, M. D. 
 
 Professor of Medicine, University of Buffalo 
 
 CONTENTS 
 Diseases of the Stomach. By Du. F. 
 RlEGEL, of Giessen. 
 
 VOLUME IX 
 Editor, Frederick A. Packard, M. D. 
 
 Physician to the Pennsylvania Hospital and 
 to the Children's Hospital, Philadelphia 
 
 CONTENTS 
 
 Diseases of the Liver. By Drs. H. 
 Quincke and G. Hoppe-Seyler, of Kiel. 
 
 volume in 
 
 Editor, William P. Northrop, M. D. 
 
 Professor of Pediatrics, University and 
 Bellevue Medical College 
 
 CONTENTS 
 
 Measles. By Dr. Th. von Jurgensen, of 
 Tubingen. Scarlet Fever. By the same 
 author. Rotheln. By the same author. 
 
 VOLUME X 
 Editor, Reginald H. Fitz, A. M., M.D. 
 
 Hersey Professor of the Theory and Prac- 
 tice of Physic, Harvard University 
 
 CONTENTS 
 
 Diseases of the Pancreas. By Dr. L. 
 Oser, of Vienna. Diseases of the Supra- 
 renals. By Dr. L. Neusser, of \ ienna. 
 
 VOLUME VI 
 Editor, Alfred Stengel, M, D. 
 
 Professor of Clinical Medicine, University 
 of Pennsylvania 
 
 CONTENTS 
 
 Anemia. By Dr. P. Ehrlich, of Frank- 
 fort-on-the-Main, and Dr. A. Lazarus, of 
 Charlottenbuig. Chlorosis. By Dr. K. 
 von Noorden, of Frankfort-on-the-Main. 
 Diseases of the Spleen a"nd Hemor- 
 rhagic Diathesis. By Dr. M. Litten, 
 of Berlin. 
 
 VOLUMES IV, V, and XI 
 Editors announced later 
 
 Vol. IV. — Influenza and Dengue. By Dr. 
 O. Leichtenstein, of Cologne. Malarial 
 Diseases. By Dr. J. Mannaberg, of 
 
 Vienna. 
 
 Vol.V. — Tuberculosis and Acute General 
 Miliary Tuberculosis. By Dr. G. Cor- 
 net, of Berlin. 
 
 Vol. XI. — Diseases of th? Intestines and 
 Peritoneum. By I>r. H. Nothnagel, 
 of Vienna. 
 
 19 
 
CLASSIFIED LIST 
 
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 MEDICAL PUBLICATIONS 
 
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 ANATOMY, EMBRYOLOGY, HIS- 
 TOLOGY. 
 
 Bohm, Davidoff, and Huber— A Text- 
 Book of Histology, 4 
 
 Clarkson— A Text-Book of Histology, . 5 
 
 Haynes— A Manual of Anatomy, ... 7 
 
 Heisler— A Text-Book of Embryology, . 7 
 
 Leroy — Essentials of Histology, .... 15 
 
 Nancrede — Essentials of Anatomy, . . . 15 
 Nancrede — Essentials of Anatomy and 
 
 Manual of Practical Dissection, .... 10 
 
 BACTERIOLOGY. 
 
 Ball— Essentials of Bacteriology, .... 15 
 Frothingham— Laboratory Guide, . . . 6 
 Gorham — Laboratory Course in Bacte- 
 riology, 22 
 
 Lehmann and Neumann— Atlas of 
 
 Bacteriology, *7 
 
 Levy and Klemperer's Clinical Bacte- 
 riology, 9 
 
 Mallory and Wright— Pathological 
 
 Technique, 9 
 
 McFarland— Pathogenic Bacteria, ... 9 
 
 CHARTS, DIET-LISTS, ETC. 
 
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 Thomas— Diet-Lists, 13 
 
 CHEMISTRY AND PHYSICS. 
 Brockway — Essentials of Medical 
 Physics, J 5 
 
 Wolff— Essentials of Medical Chemistry, 15 
 
 CHILDREN. 
 
 An American Text-Book of Diseases 
 
 of Children 1 
 
 Griffith— Care of the Baby 7 
 
 Griffith— Infant's Weight Chart, .... 7 
 Meigs — Feeding in Early Infancy, . . . 10 
 Powell — Essentials of Diseases of Chil- 
 dren, J 5 
 
 Starr— Diets for Infants and Children, . 12 
 
 DIAGNOSIS. 
 
 Cohen and Eshner— Essentials of Diag- 
 nosis, 1 5 
 
 Corwin — Physical Diagnosis, 5 
 
 Vierordt— Medical Diagnosis, 14 
 
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 Dictionary, 3 
 
 The American Pocket Medical Dic- 
 tionary, 
 
 EYE, EAR, NOSE, AND THROAT. 
 An American Text-Book of Diseases 
 
 of the Eye, Ear, Nose, and Throat, . . 1 
 De Schweinitz — Diseases of the Eye, . 6 
 Friedrich and Curtis— Rhinology, Lar- 
 yngology, and Otology, 6 
 
 Gleason — Essentials of the Ear, .... 15 
 Gleason — Essentials of Nose and Throat, 15 
 Gradle — Ear, Nose, and Throat, .... 22 
 Grunwald and Grayson — Atlas of Dis- 
 eases of the Larynx, 16 
 
 Haab and de Schweinitz— Atlas of Ex- 
 ternal Diseases of the Eye, 16 
 
 Jackson — Manual of Diseases of the Eye, 8 
 Jackson — Essentials Diseases of Eye, . 15 
 Kyle — Diseases of the Nose and Throat, 9 
 
 GENITO-URINARY. 
 
 An American Text-Book of Genito- 
 urinary and Skin Diseases, 2 
 
 Hyde and Montgomery— Syphilis and 
 the Venereal Diseases, 8 
 
 Martin — Essentials of Minor Surgery, 
 Bandaging, and Venereal Diseases, . . 15 
 
 Mracek and Bangs — Atlas of Syphilis 
 and the Venereal Diseases, 16 
 
 Saundby — Renal and Urinary Diseases, 11 
 
 Senn — Genito-Urinary Tuberculosis, . . 12 
 
 Vecki — Sexual Impotence, 14 
 
 GYNECOLOGY. 
 American Text-Book of Gynecology, . 
 Cragin — Essentials of Gynecology, . . . 
 Garrigues — Diseases of Women, . . . . 
 Long — Syllabus of Gynecology, . . . . 
 
 Penrose — Diseases of Women, 
 
 Pryor— Pelvic Inflammations, 
 
 Schaeffer and Norris— Atlas of Gyne- 
 cology, 
 
 17 
 
 Morton— Nurses' Dictionary, 10 
 
 HYGIENE. 
 
 Abbott — Hygiene of Transmissible Dis- 
 eases, 3 
 
 Bergey — Principles of Hygiene, .... 22 
 Pyle — Personal Hygiene, n 
 
 MATERIA MEDICA, PHARMA- 
 COLOGY, and THERAPEUTICS. 
 An American Text-Book of Applied 
 
 Therapeutics 1 
 
 Butler — Text-Book of Materia Medica, 
 
 Therapeutics, and Pharmacology, . . 4 
 Morris — Ess. of M. M. and Therapeutics, 15 
 Saunders' Pocket Medical Formulary, . 11 
 Sayre — Essentials of Pharmacy, .... 15 
 Sollmann — Text-Book of Pharmacology, 22 
 Stevens — Modern Therapeutics, .... 13 
 Stoney— Materia Medica for Nurses, . . 13 
 Thornton — Prescription-Writing, ... 13 
 
MEDIC A L P U/i /. ICA TIONS 
 
 MEDICAL JURISPRUDENCE AND 
 TOXICOLOGY. 
 
 Chapman — Medical Jurisprudence and 
 Toxicology 5 
 
 Golebiewski and Bailey— Atlas of Dis- 
 eases Caused by Accidents 17 
 
 Hofmann and Peterson— Atlas of Legal 
 Medicine, 16 
 
 NERVOUS AND MENTAL DIS- 
 EASES, ETC. 
 
 Brower — Manual of Insanity 22 
 
 Chapin — Compendium of Insanity, . . . 5 
 Church and Peterson — Nervous and 5 
 
 Mental Diseases, 5 
 
 Jakob and Fisher — Atlas of Nervous 
 
 System, 17 
 
 Shaw — Essentials of Nervous Diseases 
 
 and Insanity, 15 
 
 NURSING. 
 Davis — Obstetric and Gynecologic Nurs- 
 ing, 
 
 Griffith— The Care of the Baby, . . 
 Hart — Diet in Sickness and in Health, 
 Meigs — Feeding in Early Infancy, . 
 Morten — Nurses' Dictionary, . . . 
 Stoney — Materia Medica for Nurses, 
 Stoney — Practical Points in Nursing, 
 Stoney — Surgical Technic for Nurses, 
 Watson — Handbook for Nurses, . . . 
 
 J 7 
 
 OBSTETRICS. 
 
 An American Text-Book of Obstetrics, 
 Ashton — Essentials of Obstetrics, . 
 Boisliniere— Obstetric Accidents, 
 Dorland — Modern Obstetrics, , . 
 Hirst — Text-Book of Obstetrics, . 
 Norris — Syllabus of Obstetrics, . . 
 Schaeffer and Edgar — Atlas of Obstet 
 rical Diagnosis and Treatment, . . . 
 
 PATHOLOGY. 
 
 An American Text-Book of Pathology. 2 
 Durck and Hektoen— Atlas of Patho- 
 logic Histology 16 
 
 Kalteyer — Essentials of Pathology, . . 15 
 Mallory and Wright— Pathological 
 
 Technique, 9 
 
 Senn — Pathology, and Surgical Treat- 
 ment of Tumors, 12 
 
 Stengel — Text-Book of Pathology, ... 12 
 
 Warren— Surgical Pathology, 14 
 
 PHYSIOLOGY. 
 
 American Text-Book of Physiology, . 2 
 
 Budgett — Essentials of Physiology, . . 15 
 
 Raymond — Text-Book of Physiology, . 11 
 
 Stewart — Manual of Physiology, . . 13 
 
 PRACTICE OF MEDICINE. 
 
 An American Year-Book of Medicine 
 
 and Surgery 3 
 
 Anders — Practice of Medicine, 4 
 
 Eichhorst — Practice of Medicine, ... 6 
 
 Lockwood — Practice of Medicine, . . . 9 
 
 Morris — Ess. of Practice of Medicine, . 15 
 
 Salinger & Kalteyer — Mod. Medicine, ti 
 
 Stevens — Practice of Medicine 13 
 
 SKIN AND VENEREAL. 
 
 An American Text-Book of Genito- 
 urinary and Skin Diseases 2 
 
 Hyde and Montgomery —Syphilis and 
 the Venereal I liseases, 8 
 
 Martin— Essentials ol Minor Surgery, 
 Bandaging, and Venereal Diseases, . . 15 
 
 Mracek and Stelwagon— Atlas of Dis- 
 eases of the Skin, i>, 
 
 Stelwagon— Essentials of Diseases of 
 the Skin, 15 
 
 SURGERY. 
 
 An American Text-Book of Surgery, 2 
 An American Year-Book of Medicine 
 
 and Surgery, 3 
 
 Beck — Fractures, 4 
 
 Beck — Manual of Surgical Asepsis, ... 4 
 
 Da Costa — Manual of Surgery, 5 
 
 International Text-Book of Surgery, . 8 
 
 Keen— Operation Blank, 8 
 
 Keen — The Surgical Complications and 
 
 Sequels of Typhoid Fever 8 
 
 Macdonald — Surgical Diagnosis and 
 
 Treatment, 9 
 
 Martin — Essentials of Minor Surgery, 
 
 Bandaging, and Venereal Diseases, . . 15 
 
 Martin — Essentials of Surgery, 15 
 
 Moore — Orthopedic Surgery, 10 
 
 Nancrede — Principles of Surgery, . . . 10 
 
 Pye — Bandaging and Surgical Dressing, n 
 
 Scudder — Treatment of Fractures, ... 12 
 
 Senn — Genito-Urinary Tuberculosis, . . 12 
 
 Senn — Practical Surgery, 12 
 
 Senn — Syllabus of Surgery, 12 
 
 Senn — Pathology and Surgical Treat- 
 ment of Tumors ... 12 
 
 Warren — Surgical Pathology and Ther- 
 apeutics, 14 
 
 Zuckerkandl and Da Costa — Atlas of 
 
 Operative Surgery, 16 
 
 URINE AND URINARY DISEASES. 
 Ogden — Clinical Examination of the 
 
 Urine, 10 
 
 Saundby — Renal and Urinary Diseases, n 
 Wolf — Handbook of Urine Examination, 22 
 Wolff — Examination of Urine, 15 
 
 MISCELLANEOUS. 
 Abbott — Hygiene of Transmissible Dis- 
 eases, 3 
 
 Bastin — Laboratory Exercises in Bot- 
 any 4 
 
 Golebiewski and Bailey— Atlas of Dis- 
 eases Caused by Accidents, . . . . 17 
 Gould and Pyle — Anomalies and Curi- 
 osities of Medicine 7 
 
 Grafstrom — Massage, 7 
 
 Keating — Examination for Life Insur- 
 ance, S 
 
 Pyle— A Manual of Personal Hygiene, . 11 
 Saunders' Medical Hand-Atlases, . 16, 17 
 Saunders' Pocket Medical Formulary, . n 
 Saunders' Question-Compends, . . 14. 15 
 Stewart and Lawrence — Essentials of 
 
 Medical Electricity, 15 
 
 Thornton — Dose-Book and Manual of 
 
 Prescription-Writing 13 
 
 Van Valzah and Nisbet — Diseases of 
 the Stomach, 13 
 
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 Bergey's Principles of Hygiene. 
 
 The Principles of Hygiene : A Practical Manual for Students, 
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 A Practical Manual of Insanity. By Daniel R. Brower, M.D., 
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 Gorham's Bacteriology. 
 
 A Laboratory Course in Bacteriology. By F. P. Gorham, 
 M. A., Assistant Professor in Biology, Brown University. i2mo 
 volume of about 160 pages, fully illustrated. 
 
 Gradle on the Nose, Throat, and Ear. 
 
 Diseases of the Nose, Throat, and Ear. By Henry Gradle, 
 M. D., Professor of Ophthalmology and Otology, Northwestern 
 University Medical School, Chicago. Handsome octavo volume 
 of 800 pages, profusely illustrated. 
 
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 A Text-Book of Pharmacology. By Torald Sollmann, M. D., 
 Lecturer on Pharmacology, Western Reserve University, Cleve- 
 land, Ohio. Royal octavo volume of about 700 pages. 
 
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 By Charles G. L. Wolf, M. D., Instructor in Physiologic Chem- 
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 22 
 
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